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cerebral palsy&mental retardation pediatrics pptx
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- 3. Cerebral palsy (CP) Cerebral palsy (CP) refers to a group of non-progressive, but often changing, motor impairment syndromes secondary to anomalies or lesions of the brain arising before or after birth. If the brain injury occurs after the age of 2 years, it is diagnosed as acquired brain injury rather than CP. It causes limitation of activity due to a static lesion affecting the developing brain. The prevalence of CP at age 8 in the United States is 1.5-4 per 1000; prevalence is much higher in premature and twin births.
- 4. Cerebral palsy (CP) Prematurity and low birthweight infants (leading to perinatal asphyxia), congenital malformations, and kernicterus are causes of CP noted at birth. Ten percent of children with CP have acquired CP, developing at later ages. Meningitis and head injury (accidental and nonaccidental) are the most common causes of acquired CP. Nearly 50% of children with CP have no identifiable risk factors.
- 5. Causes of CP Prenatal: cortical migration disorders or structural maldevelopment of the brain during gestation and cerebrovascular haemorrhage or ischaemia. Some of these problems are genetic. Other antenatal causes are genetic syndromes and congenital infection. Perinatal brain injury Postnatal
- 6. Causes of CP Prenatal. Perinatal brain injury : It may be due to hypoxic–ischemic injury before or during delivery. It may also result from arterial and venous stroke. Preterm infants are especially vulnerable to brain damage from periventricular leukomalacia secondary to ischemia and/or severe intraventricular hemorrhage and venous infarction. Postnatal .
- 7. Causes of CP Prenatal Perinatal brain injury Postnatal: Meningitis/encephalitis/encephalopathy Head trauma from accidental or non-accidental injury Symptomatic hypoglycemia Hydrocephalus Hyperbilirubinemia.
- 8. Cerebral palsy Mostchildren with CP, except in its mildest forms, are diagnosed in the first 18 months of life when they fail to attain motor milestones or show abnormalities such as asymmetric gross motor function, hypertonia, or hypotonia. CP can be characterized further by the affected parts of the body and descriptions of the predominant type of motor disorder. Co-morbidities in these children often include epilepsy, learning difficulties, behavioral challenges, and sensory impairments. Many of these children have an isolated motor defect.
- 9. Classification of CPby Type of Motor Disorder Spastic cerebral palsy Dyskinetic cerebral palsy Choreoathetotic cerebral palsy Ataxic cerebral palsy Atonic cerebral palsy Mixd cerebral palsy
- 10. Spastic cerebral palsy The most common form of cerebral palsy It accounts for 70-80% of cases. lt is due to damage of cerebral motor cortex or its connections. According to distribution of deficit, CP classified to: Quadriplegia (20%) -Most severe form of CP. It involves all the four extremities with generalized spasticity with mental retardation and seizures Diplegia (30%) - Spasticity and weakness predominantly involving the lower limbs with minimal or no involvement of upper limbs Hemiplegia (25%) - It involves either left or right side of the extremities. Upper limbs are more commonly affected at early stage than lower limbs Monoplegia Triplegia
- 11. Other types ofCP Dyskinetic CP: occurs in 10-15% of cases. It is dominated by abnormal patterns of movement and involuntary, uncontrolled, recurring movements. Ataxic CP: accounts for <5% of cases. This form results from cerebellar injury and features abnormal posture or movement and loss of orderly muscle coordination or both. Choreoathetotic CP: rare now that excessive hyperbilirubinemia is aggressively prevented and treated. This form is dominated by increased and stormy movements (hyperkinesia) and hypotonia. Mixed CP: accounts for 10-15% of cases.
- 13. Clinical features Delayin attaining motor developmental milestones. Abnormal muscle tone and reflexes. Persistent primitive reflexes like Moro’s, ATNR, Suck…. Poor coordination Abnormal movements and postures Delay in speech, visual difficulties, intellectual disability Seizures Bulbar & Pseudobulbar palsy leading on to frequent aspirations with feeding Microcephaly
- 14. Based on patient’sstatus about functional capacity: Class I - No practical limitation of activity Class II - Slight to moderate limitation of activity Class III - Moderate to gross limitation of activity Class IV - Inability to carry on any useful physical activity
- 15. Diagnosis Clinical diagnosis(historyand physical examination) MRI or CT of brain to localize the site of lesion or any congenital malformations Ophthalmic evaluation Hearing tests Speech and language evaluation Psychological educational evaluation EEG
- 16. Treatment CP cannotbe cured, but a host of interventions can improve functional abilities, participation in society, and quality of life. Physiotherapy. Spasticity management also may include oral medications (dantrolene, benzodiazepines, and baclofen), botulinum toxin injections, and implantation of intrathecal baclofen pumps. Orthopedic management. Management of seizures(antiepileptic drugs). Psychosocial support.
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- 19. Intellectual disability (lD) ID or mental retardation is defined as significantly subnormal intellectual functioning for a child’s developmental stage, existing concurrently with deficits in adaptive behaviors (self-care, home living, communication, and social interactions). ID is defined statistically as cognitive performance that is two standard deviations below the mean (roughly below the third percentile) of the general population as measured on standardized intelligence testing. The last known estimate of the prevalence of MR is that about 2% of the U.S. population is affected.
- 20. Causes Genetic disorders Chromosomal disorders Metabolic diseases Neurodegenerative diseases. Teratogenic influences(TORCH, drugs, radiation…………. Perinatal insults(asphyxia, hemorrhage, Prematurity…… Congenital & acquired hypothyroidism. Acquired childhood disease Environmental and Socioeconomic status. Unknown cause (25%)
- 21. Classification l.Q (intelligence quotient)= Mental age Chronological age x 100 Training Education Degree of ID lQ trainable educable Mild 50-70 trainable Non educable Moderate 35-50 - + trainable Non educable Severe 20-35 Non trainable Non educable Profound 0-20
- 22. Diagnosis The firststep in the diagnosis and management of a child with ID is to identify functional strengths and weaknesses for purposes of medical and rehabilitative therapies. A history and physical examination. Chromosomal analysis. Brain MRI. Metabolic screening. Thyroid function tests. Other tests according to suspected cause.
- 23. Treatment Multidisciplinary approach Health education, counseling and emotional support to family members. Occupational and physiotherapy Basic healthcare, immunization, growth monitoring. Management of associated conditions like seizures, impaired vision, speech, hearing, musculoskeletal disability, behavioral disorders etc. Minimal criticism and high appreciation, short term goals and structural learning results in less withdrawal, aggressive and hostile reactions.
- 24. Specific learning difficulties These have an impact on a specific area of the child or young person’s life/skills, and assessment is usually the remit of educational psychologists or other professionals. These include: dyslexia – difficulties with reading dyscalculia – difficulties in learning and comprehending numbers dysgraphia – difficulties with writing skills.