CEREBRAL PALSY

Prepared by: Mohammed Ahmed Rajab

Introduction

◦ Historically known as static encephalopathy

◦ A group of motor impairment syndromes resulting

from disorders of early brain development.

◦ Often associated with epilepsy and abnormalities of

speech, vision and intellect.

◦ However, many children and adult with CP function

at a high educational and vocational level without

sign of cognitive dysfunction

Epidemiology

◦ CP is the most common and costly form of chronic

motor disability

◦ Prevalence: 2/1000

◦ Prevalence of CP is increased in low birth weight

infants (<1000g)

◦ CP incidence higher in premature and twin birth

Aetiology

•Infection- German measles

- Shingles

•Diabetes

•Toxemia of

pregnancy

•Rh incompatibility

•Asphyxia

•Birth injury

•Prematurity

Caused by developmental, genetic,

metabolic, ischemic, infections

Antenatal

factors (80%)

Intrapartum

(10%)

Postpartum

(10%)

◦ Very high fever

◦ Brain infection

◦ Head injury

◦ Lack of oxygen

◦ Poisoning

◦ Intracranial

hemorrhage or

blood clot

Risk Factors◦ Before Pregnancy:

- History of fetal wastage

- Long menstrual cycle

- Maternal thyroid disorder

- Family history of mental retardation

◦ During Labor and Delivery:

- Premature separation of placenta

◦ During Early Postnatal Period:

- Newborn hypoxic ischemic or bilirubin (kernicterus) encephalopathy

◦ During Pregnancy:

- Low socioeconomic status

- Tx of mother with thyroid hormone, estrogen or progesterone

- Maternal seizure disorder

- Polyhydramnios

- Eclampsia

- Bleeding in 3rd trimester

- Twin gestation

- Congenital malformation

- Fetal growth retardation

- Abnormal fetal presentation

Physiologic

identify forms of motor impairment

Spastic CP

Dyskinetic CP

Ataxic CP

Mixed CP

Distribution

identify location of musculoskeletal involvement

Spastic diplegia

Spastic quadriplegia

Spastic hemiplegia

Classification

Spastic CP◦ The most common form of CP (70-

80%)

◦ Due to injury to upper motor neurons

of pyrimidal tract

◦ Often exhibit truncal hypotonia in 1st

year of life

•Characterized by at least 2 of following:

-Abnormal movement pattern

-Increased tone

-Pathologic reflexes (Babinski, hyper-reflexia)

Dyskinetic CP◦ 10-15%

◦ Result of injury to basal ganglia (associated with kernicterus)

◦ Characterized by variable tonal abnormalities & involuntary

movement (athetosis, chorea)

◦ Fewer seizures & >normal cognitive function

Ataxic CP◦ <5% of CP cases – rare

◦ Results from cerebellar injury

◦ Abnormalities of voluntary movement and balance

◦ Wide-based, unsteady gait, abnormal muscle tone

Mixed CP◦ 10-15% of all cases

◦ > 1 type of motor pattern is present

& when 1 pattern does not clearly

dominate another

◦ Associated with > complications:

sensory deficits, seizures, cognitive-

perceptual impairments

Dystonic CP

◦ Uncommon

◦ Characterized by reduced activity and stiff movement

(hypokinesia) and hypotonia

Choreoathetotic CP

◦ Rare

◦ Caused by excess hyperbilirubinemia

◦ Dominated by increased and stormy movement (hyperkinesia)

and hypotonia

Clinical Manifestations

◦ Spectrum of developmental abnormalities

◦ Mental retardation

◦ Epilepsy

◦ Motor handicap

•Visual, hearing, speech, cognitive &

behavioral abnormalities

Diagnosis◦ History and PE should preclude

progressive disorder of CNS,

degenerative disease, metabolic

disorders, spinal cord tumor,

muscular dystrophy

◦ MRI scan of brain or spinal cord

◦ Test of hearing and visual function

◦ Genetic evaluation

Management◦ CP cannot be cured

◦ Family support – educate parents

◦ Adjunctive therapy:

- Physiotherapy

- Occupational therapy

- Speech therapy

◦ Surgery

◦ Psychologist or psychiatrist

Nursing Manegment

◦ Early Intervention

◦ • The earlier disabled children are given

rehabilitation and education, the better they are

able to realize their full potential later in life.

◦ - Early intervention can have a really positive

impact on a child’s life.

◦ Physiotherapy

◦ - Physiotherapy is extremely beneficial and the

children love the interaction

◦ Feeding

◦ • Three finger jaw control helps in swallowing

◦ • Speech therapy helps in better swallowing

◦ - Care and dignity when feeding a disabled child

improve trust and ensure a healthy, happy child.

◦ Children with learning disabilities

◦ - Encourage appropriate use of the curriculum and

teacher’s guide for mentally disabled children.

◦ - A teacher using teaching materials she has made

herself and adapted to the individual needs of this

child.

◦ Children with hearing and visual impairments

◦ - Special technical skills and training are to be

provided to help deaf or blind children.

◦ - Teaching self help skills through play for blind

children.

◦Drugs:

- Oral Dantrolene sodium, benzodiazepines, baclofen

– treat spasticity

- Botulinum toxin

- Levodopa

Thank you!!