Cerebral palsy - Definition, types, Etiolopathology, clinical features and Management

CEREBRAL PALSY AND
IT'S
PT MANAGEMENT
WELCOME IN THE PERFECT PHYSIO TUTORIAL YOUTUBE
CHANNEL
PRESENTED BY -
MR BHUNESHWAR

DEFINITION
Cerebral palsy (CP) is a group of disorders that affect a
person's ability to move and maintain balance and posture. CP
is the most common motor disability in childhood. Cerebral
means - Brain. Palsy means -weakness/Paralysis or problems
with using the muscles.
Cerebral Palsy (CP) is a group of permanent disorder of
the development of movement and posture, causing activity
limitation.

TYPES OF CEREBRAL PALSY
There are different types of CP that affect various parts of the
brain. Each type causes specific movement disorders. The types of
CP are:
1) Spastic cerebral palsy
Spastic CP is the most common type of CP, affecting
approximately 80 percent Trusted Source of people with CP. It
causes stiff muscles and exaggerated reflexes, making it difficult
to walk.

Many people with spastic CP have walking
abnormalities, such as crossing their knees or
making seizure like movements with their legs
while walking. Muscle weakness and paralysis
may also be present.
The symptoms can affect the entire body or just
one side of the body.

2) Dyskinetic cerebral palsy
People with Dyskinetic CP have trouble controlling
their body movements. The disorder causes
involuntary, abnormal movements in the arms, legs,
and hands.
In some cases, the face and tongue are also affected.
The movements can be slow and writhing or rapid
and jerky. They can make it difficult for the affected
person to walk, sit, swallow, or talk.

3) Hypotonic cerebral palsy
Hypotonic CP causes diminished muscle tone and overly
relaxed muscles. The arms and legs move very easily and
appear floppy, like a rag doll.
Babies with this type of CP have little control over their head
and may have trouble breathing. As they grow older, they may
struggle to sit up straight as a result of their weakened
muscles. They can also have difficulty speaking, poor reflexes,
and walking abnormalities.

4) Ataxic cerebral palsy
Ataxic CP is the least common type of CP. Ataxic CP is
characterized by voluntary muscle movements that
often appear disorganized, clumsy, or jerky.
People with this form of CP usually have problems with
balance and coordination. They may have difficulty
walking and performing fine motor functions, such as
grasping objects and writing.

5) Mixed cerebral palsy
Some people have a combination of symptoms
from the different types of CP. This is called mixed
CP.
In most cases of mixed CP, people experience a
mix of spastic and dyskinetic CP.

ETIOLOGY OF CP
Cerebral palsy is caused by an abnormality or disruption in
brain development, most often before a child is born. In
many cases, the cause isn't known. Factors that can lead to
problems with brain development include:-
Gene mutations that lead to abnormal development
Maternal infections that affect the developing fetus
Fetal stroke, a disruption of blood supply to the developing
brain

Bleeding into the brain in the womb or as a
newborn Infant infections that cause
inflammation in or around the brain
Traumatic head injury to an infant from a
motor vehicle accident or fall Lack of oxygen
to the brain related to difficult labor or
delivery, although birth-related asphyxia is
much less commonly a cause than historically
thought

RISK FACTORS FOR CP
Maternal health
 Certain infections or toxic exposures during pregnancy can
significantly increase cerebral palsy risk to the baby. Infections of
particular concern include:
 Cytomegalovirus. This common virus causes flu-like symptoms and
can lead to birth defects if a mother has her first active infection during
pregnancy.
 German measles (rubella). This viral infection can be prevented with
a vaccine.
 Herpes. This can be passed from mother to child during pregnancy,
affecting the womb and placenta. Inflammation triggered by infection
can damage the unborn baby's developing nervous system.

Syphilis. This is a sexually transmitted bacterial
infection.
Toxoplasmosis. This infection is caused by a
parasite found in contaminated food, soil and the
feces of infected cats.

Infant illness
 Illnesses in a newborn baby that can greatly increase the risk of cerebral
palsy include:
 Bacterial meningitis. This bacterial infection causes inflammation in the
membranes surrounding the brain and spinal cord.
 Viral encephalitis. This viral infection similarly causes inflammation in the
membranes surrounding the brain and spinal cord.
 Severe or untreated jaundice. Jaundice appears as a yellowing of the skin.
The condition occurs when certain byproducts of "used" blood cells aren't
filtered from the bloodstream.
 Bleeding into the brain. This condition is commonly caused by the baby
having a stroke in the womb.

Other factors of pregnancy and birth
While the potential contribution from each is
limited, additional pregnancy or birth factors
associated with increased cerebral palsy risk
include:
Breech presentation. Babies with cerebral palsy
are more likely to be in this feet-first position at the
beginning of labor rather than being headfirst.

Low birth weight. Babies who weigh less than 5.5 pounds
(2.5 kilograms) are at higher risk of developing cerebral
palsy. This risk increases as birth weight drops.
Multiple babies. Cerebral palsy risk increases with the
number of babies sharing the uterus. If one or more of the
babies die, the survivors' risk of cerebral palsy increases.
Premature birth. Babies born fewer than 28 weeks into
the pregnancy are at higher risk of cerebral palsy. The
earlier a baby is born, the greater the cerebral palsy risk.

CLINICAL FEATURES OF CP CHILD
Variations in muscle tone, such as being either too stiff or too
floppy
 Stiff muscles and exaggerated reflexes (spasticity)
Stiff muscles with normal reflexes (rigidity)
Lack of balance and muscle coordination (ataxia)
Tremors or involuntary movements
 Slow, writhing movements

Delays in reaching motor skills milestones, such as
pushing up on arms, sitting up or crawling.
Favoring one side of the body, such as reaching with one
hand or dragging a leg while crawling.
Difficulty walking, such as walking on toes, a crouched
gait, a scissors-like gait with knees crossing, a wide gait
or an asymmetrical gait

 Excessive drooling or problems with swallowing
 Difficulty with sucking or eating
 Delays in speech development or difficulty speaking
 Learning difficulties
 Difficulty with fine motor skills, such as buttoning clothes or picking up
utensils
 Seizures

COMPLICATION
Contracture.
 Premature aging.
Heart and lung disease.
Osteoarthritis
 Osteopenia
Malnutrition.

DIAGNOSTIC EVALUATION OF CP CHILD
A physiotherapist will diagnose CP by taking a complete
medical history, performing a physical exam that includes a
detailed neurological exam, and evaluating the symptoms.
Additional testing can also be performed.
An electroencephalogram (EEG is used to evaluate the
electrical activity in the brain. It may be ordered when
someone is showing signs of epilepsy, which causes
seizures.

An MRI scan uses powerful magnets and radio
waves to produce detailed images of the brain. It
can identify any abnormalities or injuries in the
brain.
 A CT scan creates clear, cross-sectional images
of the brain. It can also reveal any brain damage.

A cranial ultrasound is a relatively quick and inexpensive
method of using high-frequency sound waves to get basic
images of the brain in young infants.
A sample of blood may be taken and tested to rule out
other possible conditions, such as bleeding disorders.

MANAGEMENT OF CP CHILD
Pharmacological treatment :-
Oral anticonvulsants and muscle relaxants are
commonly used as first-line treatments for CP. Your
doctor might prescribe:
diazepam (Valium)
baclofen
tizanidine

Physiotherapy management in cerebral
palsy
Goal of Physiotherapy treatment:-
To improve mobility.
To prevent deformities.
To educate the parents.
To teach daily living skills.
To provide community and social support

Physiotherapy treatment program
For Infants - Stimulating advanced Postural, Equilibrium ,
and balance to provide head and Trunk control .
For toddlers / preschooler - Stretching the spastic muscles
, strengthening the weak muscles and promoting the
mobility.
For Adolescents - Improving cardiovascular status.

Basic problem in the neuromotor
development in children with CP
Difficulty in flexing and extending the body
against gravity.
Problems in sitting .
Functional ambulation .

For functional ambulation a child needs
Motivation to move .
Enough muscles strength and control .
Able to shift his body weight ( Balance).
Awareness of body position and movement.
Sufficient visual and vestibular system.
No deformities interference with joint functions.

Physiotherapy techniques
1. For maintenance of soft tissue length :-
Active and passive ROM
Weight bearing exercises
appropriate Positioning .
EMS - For reduce the spasticity and increase the
stretching of spastic muscle as well as decrease tone and
increase Strength.

Used to reduce spasticity by reducing muscle
tone and stretch reflexes.
Cryotherapy-
Hydrotherapy -
Helps in stretching of Large muscle groups
and to help movement of trunk.

Resistance exercise for improving strength
for and endurance.
Proprioceptive neuromuscular Facilitations
(PNF techniques )

SURGICAL PROCEDURES FOR CP
Surgery may be needed for muscle tightness or correct bone
abnormalities caused by spasticity. These treatments include:
1) Orthopedic surgery. Children with severe contractures or deformities
might need surgery on bones or joints to place their arms, hips or legs
in their correct positions.
 Surgical procedures can also lengthen muscles and tendons that are
shortened by contractures. These corrections can lessen pain and
improve mobility. The procedures can also make it easier to use a
walker, braces or crutches.

2) Cutting nerve fibers (selective dorsal
rhizotomy).
In some severe cases, when other treatments
haven't helped, surgeons might cut the nerves
serving the spastic muscles in a procedure called
selective dorsal rhizotomy. This relaxes the muscle
and reduces pain, but can cause numbness.

PREVENTION
Make sure you're vaccinated.
Take care of yourself.
Seek early and continuous prenatal
care.
 Practice good child safety.
 Avoid alcohol, tobacco and illegal

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