2013- 2014 cerebral palsy jan 2014 -

8/13/2019 2013- 2014 Cerebral Palsy Jan 2014 -

1/18

Dr. Sahar Hassanein

Prof. of Pediatrics

School of MedicineAin Shams University

Cerebralplasy


2/18

Objectives

To be able to identify and manage :

Abnormal Motor Development.

Cerebral palsy.


3/18

Abnormal Motor Development

Delayed Motor Development ?

Regression ?


4/18

What is Cerebral Palsy? Cerebral Palsy-Definition

Astaticnonprogressivemovementandposture

disorder asaresultofbraininjuryor

malformationthat

occurs

early

in

development

upto3yearsofage.

Itisnotanetiologicdiagnosisbutaclinical

syndrome(a

manifestation

of

static

encephalopathy)

thatrefersonlytoMotordysfunction.

Anyregression

or

deterioration

of

motor

or

intellectualskillslookforadegenerativedisease.


5/18

Whataresomeetiologicfactors? Prenatal?(list4):

Geneticfactors,toxins,placentalfactors,and

infection(TORCH).

Perinatal?(list2):

Prematurityand

its

sequelae,

asphyxia

Postnatal?(list3):

Infection(Meningitis),trauma,andasphyxia


6/18

1. Systemorpathophysiologic?

2. TopographicClassification orAnatomical

distribution?

3. Severitylevel

or

functional

classification?

Whatarethe3classificationsofCPandtheircharacteristics?

CerebralPalsy

Classification:


7/18

1. System or pathophysiologic?

There are 2 major types of CP, depending onlocation of lesions:

Pyramidal (Spastic). The pyramidal system carriesthe signal for muscle contraction. 77%

Extrapyramidal. The extrapyramidal systemprovides regulatory influences on that contraction.Non-spastic (extrapyramidal and mixed types) 23%

There is overlap of both symptoms and anatomiclesions.

CerebralPalsy

Classification:


8/18

2. Topographic Classification

Quadriplegia - all 4 extremities

Hemiplegia - one side of the body (arm) Diplegia - legs worse than arms

Paraplegia - legs only

Monoplegia - one extremity

CerebralPalsy

Classification:


9/18

3. By degree or severity

Mild impairment of only fine precision movement

Moderate gross and fine movement

- speech problems

Severe inability to perform ADL

CerebralPalsyClassification:


10/18

A. Pyramidal

Lesion is usually in the motor cortex, internalcapsule and/or cortical spinal tracts.

Clasped knife spasticity.

The spasticity can be worse when the person is

anxious or ill. The spasticity does not go away when the person

is asleep.


11/18

A. Pyramidal : Spastic CP (total) 77%

Quadriplegia (23%) - all 4 extremities

Hemiplegia (21%) - one side of the body (arm)

Diplegia (21%) -legs worse than arms

Paraplegia - legs only Monoplegia - one extremity

CerebralPalsy

Classification:


12/18

B. Extrapyramidal

Lesion is usually in the basal ganglia, Thalamus,

Subthalamic nucleus and/or cerebellum.

Ataxia Hypotonia Dystonia Rigidity

The tone may increase with volitional

movement, or when the person is anxious During sleep the person is actually hypotonic

CerebralPalsyTypes


13/18

B. Extrapyramidal: Divided into Dyskinetic and Ataxic types

1. Dyskinetic

Athetosis- slow writhing, wormlike

Chorea- quick, jerky movements Choreoathetosis- mixed

2. Ataxic CP

Results from damage to the cerebellum

Ataxia- tremor & drunken- like gait

CerebralPalsyTypes


14/18

How is the diagnosis made?

Clinical history and physical examination.

Laboratory and imaging tests are often needed to:

confirm suspected brain injury (e.g., porencephalic cyst),

to rule out a progressive or degenerative neurologicprocess (e.g., metachromatic leukodystrophy), or to

define etiology (e.g., chromosome analysis).

CerebralPalsyDiagnosis


15/18

Whataresomeassociateddisabilities? Mentalretardation,seizures,hearing.

Visual

impairments.

Attentiondeficits,learningdisabilities.

Dysphagia,malnutrition,poorgrowth.

Gastroesophageal

reflux,

constipation.

Jointcontracturesandscoliosis.

CerebralPalsyDiagnosis


16/18

Formulatethediagnosis

Postanoxic,spasticquadriplegiccerebral

palsywith

microcephaly,

MR,

squint,

pseudobulbarpalsyandGTCTTTwithAED.

ORequinesdeformity?

Marasmus


17/18

What is the treatment?

Treatment is supportive.

Directed toward maximizing functional abilities,

Managing concurrent medical problems,

Physical and occupational therapy, special education,psychology, audiology, and orthotics).

Cerebral Palsy Management


18/18

The EndFor any [email protected]

2013- 2014 cerebral palsy jan 2014 -

Documents