Dr harshuti shah

Child neurologist

Ahmedabad

Graduate in child neurology-Telaviv uni, Israel

Fellowship in epilepsy-Great Ormond street hospital for children,london

Fellowship in electrophysiology-Japan

Research in galactosemia- gold prize at world child neurology congress, Taiwan

New modality for Opsoclonus myoclonus syndrome, Child neurology congress, Australia

Common relative:Not much fruitful, unnecessary to spend

Child specialistMay or may not improve, needs lots of time to

improve

Fact by neurologist:Good part of brain may start taking the

function andwith therapy u can make functional child

Mental retardation with cerebral palsy

Common terminology to be used in the prescription paper

MISNOMER It is not always so.

Mental retardation may or may not be associated

BECAUSE

Definition: disordered motor function in early infancy which leads to abnormalities in muscle tone, muscle weakness and involuntary movements either alone or in combination.

Delayed Sitting

Walking

Intelligence and cognition are not included

Visual field defect-blindness,squinting

Deafness

Speech problems like, apraxia,dyspraxiadysarhtria

Mental retardation

Dyslexia-difficulty in learning

Behavioral disturbances-ADHD ,Autism

ARE NOT INCLUDED IN CP

They may or may not be associated

BUT

It is not included in CP

Mental stress to mother antenattaly

Fall of mother

Damage to developing brain

Usually ,

Hypoxic ischemic encephalopathy

Hypoglycemia

Hyperbilirubinemia

Intracerebral hemorrages

Maternal infections

Recently increased

Due to survival of low birth weight and premature babies

Awareness of parents

Early recognition

Not so,

CP means altered tone which may be hypotonic/hypertonic or even normal tone in few with delayed normal development

There may be involuntary movements associated with delayed development

TypesHypotonic

Spastic

Ataxic

Choreoathetotic

Mixed

ADHD AUTISM

Hyperactive

Short attention span

Good in cognition

Normal or near normal speech

destructive

Poor eye eye contact

Poor communication

Meaningless repeatation of words

Repetitive activity

Keeps things in place

Any Child is

Delayed in development

out of the normal range is labeled as cerebral palsy

Anything

which is

slow

is not

always

cerebral palsy

Sometimes it can happen

Single tab in very low dose changes the life

Dopa responsive dystoina

TRUE IN FEW BIOTINIDASE DEF.

His/her father/mother walked late

Spoke late

Was dull in studies

Wait & watch policy does not help

Child will improve with the advancement in age

Start the investigation and treatment as early as possible

Advantage of plasticity of developing brain

Synaptic connections are yet to develop till 1 ½ year of age

Give more and more stimuli for good part of brain to take over the function

Right from the NICU

What therapy?

We are massaging the child daily

Useful for absorption of Vit. D from the sunlight

Needs stretching and balancing exercises daily for recovery of lost muscle power

Done for weeks/months

Doing for 15 min.

We DO BETTER!!

MOTHER IS ALWAYS THE BEST THERAPIST FOR THEIR OWN CHILD BUT IT HAS TO BE FREQUENT /REPEATATIVE

ALLOW the good part of brain to take over the function of BAD /damaged part

So till the brain takes over the function

What occupational therapy?

ACCUPRESSURE IS EFFECTIVE

Good function of hand and oral muscles are to be taken care of.

Speech therapy

Special education

Regular

Precise

Why medicines?

For control of hurdles in improvement

i.e. epilepsy,spasticity,dystonia,contractures

ADHD,Autism

85% of CP do have epilepsy

Major seizures in severe cases and mild seizures in mild cases need to be controlled for faster normalization of brain activity and allowing the the brain to take over the function

Many are unrecognized

Always feeling that damage is progressive

Could be due to epilepsy

Increased tone which increase in height

NOT A CP

Spasticity and dystonia can be improved with medicines

NO IMPROVEMENT DESPITE OF MEDICINES

medicines are to relax the muscle for effective stretching it does not improve the muscle power directly

So expensive inj. Has been given repeatedly still there is no walking

THESE HAS THE SAME EFFECT AS MEDICINE but it acts precisely on particular muscle NO DIRECT EFFECT ON MUSCLE POWER

SHOULD NEVER BE DONE(Multiple example of spoiled cases)

It is essential

to relieve contracture

To keep the bones in neutral position

To prevent the deformity

Has to be in right person with proper decision

It is a God’s gift to special parents who can take care of special child

It is never the mother’s fault

It is a mishap

Everyone in the family should support morally and by all possible means

Change the mother

Divorce

Single parent

Non hereditary

Non familial

Non contagious

Useless to spend a lot

If it is CP

They always improve

Once improved they never regress

Degree of improvement depends upon

underlying brain damage

Defective Parents

Next normal child not possible

Lots of investigation

Purely a damage to the developing brain

Except routine extra precaution, nothing is necessary

Never

They are retarded OR dyslexic

Physically handicapped

Normal OR Extra normal intelligence

Can do better, normal or at least functional

By elective caesarian section

Good fetal monitoring is essential

Skillful gynecologist, careful fetal monitoring and knowledgeable neonatologist reduce the incidence of Cp

CP is a disease of developing brain.

It has to be identified as early as possible.

It has to be treated as early as possible to take the advantage of the plasticity of the brain

Maximum efforts are to be guided for making a functional child

All parents have a right to have one normal child and it has to be encouraged as much as possible

Photo of join hands