CEREBRAL PALSY: NURSING MANAGEMENT .pdf
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Cerebral palsy (CP) is a group of neurological disorders that affect movement and posture, caused by damage to the motor areas of the developing brain, most often before or during birth.
CEREBRAL PALSY: NURSING MANAGEMENT .pdf
- 1. Mr. Pradeep Abothu, M.Sc (N), PhD Scholar Associate Professor Dept. of Child Health Nursing ASRAM College of Nursing CEREBRAL PALSY
- 2. DEFINITION Cerebral palsy (CP) is a group of neurological disorders that affect movement and posture, caused by damage to the motor areas of the developing brain, most often before or during birth. Motor Areas of the Brain
- 3. INCIDENCE & ETIOLOGY Cerebral palsy affects approximately 1 to 3 per 1,000 live births. About 80% of cerebral palsy cases have an unknown Etiology. Known factors include: • Prenatal factors: Intrauterine infections (e.g., rubella, cytomegalovirus), maternal health issues (e.g., diabetes, thyroid problems), and exposure to toxins or drugs. • Perinatal factors: Birth asphyxia, low birth weight, premature birth, and trauma during delivery. • Postnatal factors: Shaken baby syndrome, Infections such as meningitis, head injuries, and stroke. • Genetic factors: Genetic mutations and hereditary conditions. Shaken baby syndrome
- 4. CLASSIFICATION Classification Based on Movement Disorder
- 5. 1. Based on Movement Disorder a. Spastic Cerebral Palsy: Spastic cerebral palsy is the most common type, accounting for 70-80% of cases. It occurs due to lesions in the cortical motor area or pyramidal tract of the brain. Subtypes include: • Monoplegia: Only one limb involved. • Triplegia: Three limbs involved. • Diplegia: All extremities affected, lower more than upper. • Quadriplegia: All four extremities involved, including legs, trunk, mouth, pharynx, and tongue. • Hemiplegia: Motor dysfunction on one side of the body, upper extremity more affected than lower.
- 6. b. Dyskinetic Cerebral Palsy: Dyskinetic cerebral palsy accounts for 10% of cases. It is caused by damage to the extrapyramidal tract and basal ganglia, resulting in involuntary movements and fluctuating muscle tone. Subtypes include: Athetosis CP: Slow, writhing movements. Dystonia CP: Abnormal postures and muscle contractions
- 7. c. Ataxic Cerebral Palsy: Ataxic Cerebral Palsy accounts for 10% of the cases. It involves damage to the cerebellum, resulting hypotonia and coordination problems d. Mixed Cerebral Palsy: Exhibit symptoms of both Spastic CP and Dyskinetic CP.
- 8. 2. Based on Functionality Based on the severity of the condition, CP can be classified as Mild CP: Minor motor impairments, able to walk independently. Moderate CP: Requires assistance or mobility aids for walking. Severe CP: Limited mobility; may rely on wheelchairs and require full assistance for daily activities.
- 9. CLINICAL MANIFESTATIONS Early Signs: Poor head control after 3 months Stiff or rigid limbs Floppy or limp posture Inability to sit unsupported by 8 months Clenched hands after 3 months Leg scissoring Seizures Sensory impairments (hearing, vision) Persistent tongue thrusting after 6 months Clenched fist Leg scissoring Poor head control
- 10. Spastic Cerebral Palsy: • Persistent neonatal reflexes. • Feeding difficulties. • Scissoring of lower limbs. • Opisthotonic posture. • Pseudobulbar palsy. • Restricted voluntary movements. • Positive ankle clonus. • Convulsions. • Multiple handicaps & behavioral problems. • Permanent contractures without muscle training. Opisthotonic posture Pseudobulbar palsy
- 11. Dyskinetic Cerebral Palsy: • Affected areas include arms, legs, neck, and trunk. • Athetosis (slow, writhing movements). • Choreiform movements (rapid, jerky movements). • Dystonia. • Tremor. • Rigidity. • Mental retardation. • Deafness. Ataxic Cerebral Palsy: • Hypotonia. • Hyporeflexia. • Ataxia appearing by age two. • Tremors.
- 12. DIAGNOSTIC EVALUATION • Medical History and Physical Examination: Assess factors like prematurity, birth complications, infections, and maternal health. Evaluate delays in reaching motor skills milestones (e.g., rolling over, sitting, walking) and Neurological examination. • MRI:To identify lesions or abnormalities. • CT Scan:To detect damage or developmental issues. • Ultrasound: Used in infants to identify abnormalities. • BloodTests:To check for underlying conditions or infections. • Hearing andVisionTests:To identify any sensory impairments. • Speech and Language Evaluations: To assess communication abilities and identify any speech or language delays.
- 14. Medical Management Treatment for a child with CP is lifelong and comprehensive; it involves the following approaches: Medical Management: • Muscle Relaxants are prescribed to reduce spasticity and muscle tightness, helping to improve mobility and comfort. • Anticholinergic Drugs are used to manage excessive drooling by reducing saliva production. • Anticonvulsants are administered to control seizures, which are common in children with cerebral palsy, enhancing overall stability and quality of life.
- 15. Therapeutic Management • Physical Therapy: Physical therapy for cerebral palsy focuses on strengthening, stretching, and mobility to prevent contractures and enhance coordination. It supports lifelong development and independence. • Occupational Therapy: Occupational therapy helps children gain independence in daily activities like dressing and feeding. Therapists assess abilities, recommend adaptive equipment, and develop fine motor skills for tasks such as writing.
- 16. • Speech and Language Therapy: This therapy addresses communication and swallowing issues, providing articulation exercises and AAC devices to aid in safe eating. • Recreational Therapy: Recreational therapy promotes social interaction and physical activity through play, enhancing physical skills, self-esteem, and social integration.
- 17. • Orthopedic Surgery: Orthopedic surgery involves procedures like tendon lengthening to alleviate spasticity, osteotomy to realign bones for better joint function, and hip surgery to correct displacement, enhancing mobility and preventing contractures. • Neurosurgery: Neurosurgery includes Selective Dorsal Rhizotomy, where specific nerve roots are cut to reduce spasticity and improve movement. This surgery aims to enhance overall function and may also involve resection of brain tissue to control seizures. Surgical Management
- 19. • Collaborate with physical therapists, occupational therapists, speech therapists, and dietitians for comprehensive care. • Engage family members in care planning and decision-making. • Use proper positioning techniques to promote comfort, prevent contractures, and enhance mobility. • Recommend and assist with the use of adaptive equipment (wheelchairs, walkers, splints) to promote independence. • Provide assistance with feeding, using adaptive utensils if necessary. • Monitor for signs of aspiration or choking.
- 20. • Encourage communication attempts and provide a supportive environment for expression. • Regularly assess for seizure activity and manage according to the care plan. • Educate family members on seizure recognition and management strategies. • Provide emotional support to the child and family, addressing concerns related to the diagnosis and treatment. • Connect families with support groups and resources for additional assistance. Possible Nursing diagnosis: • Impaired physical mobility related to decreased muscle strength and control. • Risk for impaired skin integrity related to decreased mobility and abnormal posture. • Feeding difficulties related to impaired muscle control and coordination. • Ineffective airway clearance related to muscle weakness and potential aspiration risk. • Social isolation related to communication difficulties and physical limitations.