m gambino cerebral palsy
TRANSCRIPT
CEREBRAL PALSY AND ITS TREATMENTS
Mindy GambinoENG 333
OverviewBACKGROUNDTYPES, CAUSES AND SYMPTOMSTREATMENTS
CEREBRAL PALSY
Non curable, non progressive disorder
Affects the ability to moveAffects posture and balance
Types of Cerebral PalsySpasticAthetoidAtaxicMixed
SPASTIC CPTense, contracted musclesMost common
◦Affects 70-80% of all CP patientsStiff, awkward movementsDifficulty shifting positions
SPASTIC CP (Cont.)Three subtypes
1. Diplegia – affects one side2. Hemiplegic – affects both
arms/both legs3. Quadriplegia – affects all limbs
Spastic CP is caused by damage to the motor cortex
ATHETOIDUncontrolled motion in face,
arms, and trunkMovements may increase with
stress and dissipate during sleepInterferes with coordinated
movementsCaused by damage to the
cerebellum
ATAXIC CPPoor balance resulting in
stumbles and fallsCaused by damage to the
cerebellum10% of CP patients have this
form
MIXED CPSpastic, involuntary movementsCombinations of the previously
mentioned typesDamage to both the motor cortex
and cerebellum25% of CP patients have this
form
CAUSES OF CPDevelopmental malformationsNeurological damageBrain damage occurring before,
during or after birth
DEVELOPMENTAL MALFORMATIONSFailure of the brain to develop
correctlyLower than normal number of
brain cellsFetal brain cells not migrating to
correct areas
NEUROLOGICAL DAMAGE
Before , during or after birth
NEUROLOGICAL DAMAGEThree main causes before and
during birth◦ RH incompatibility
Blood conflict between the mother and fetus
◦ Illness of the mother Viral diseases Poor nutrition Diabetes Alcohol or drugs
NEUROLOGICAL DAMAGE (Cont.) Severe Lack of Oxygen
◦ Premature Separation of the placenta from the uterine wall
◦ Breach birth◦ Interference with circulation of the
umbilical cord
NEUROLOGICAL DAMAGE (Cont.)After Birth Causes of CP Accidental Injury Lead Poisoning Illness
◦ Meningitis◦ Encephalitis
SYMPTOMS OF CPUsually noticeable before age
threeTwo main
◦Physical ◦Behavioral
PHYSICAL SYMPTOMS OF CPDifficulty suckingPoor muscle controlPoor coordinationMuscle spasms and seizuresDevelopmental delays in:
◦Crawling◦Sitting◦Walking
BEHAVIORAL SYMPTOMS OF CP
Unusual tensenessIrritabilityLack of concentrationEmotional ProblemsSometimes Down Syndrome
TREATMENT FOR CPOrthopedic SurgeryOrthoticsDrug TherapiesPhysical and Occupational
Therapy
ORTHOPEDIC SURGERYCorrects muscle and bone
deformities caused by spasmsCan be done at any age, usually
from age four
ORTHOPEDIC SURGERY (Cont.)
BenefitsSignificant improvement in
walkingImproved range of motionDecreased deformity
ORTHOPEDIC SURGERY (Cont.)
DrawbacksTime consuming25% chance of infectionChild may temporarily regressCostly - $20,000 or more
ORTHOTICSKnown as bracesReduces plasticityStretches tight muscles and
holds them to prevent contracture
May improve walking
DRUG THERAPIES
Botox injectionsInthrethecal baclofen
BOTOX INJECTIONSInjected into the spastic muscleQuick procedure – 5 minutesUsed on a few muscle groups at a
timeLasts up to three monthsUsed for spastic diplegia or
spastic quadraplegia
INTHRATHECAL BACLOFENPump implanted in the abdomen
to distribute doseDelivered into the spinal fluidRefilled every three monthsDecreases spasms and blocks
abnormal nerve signals
INTHRATHECAL BACLOFENIncreased muscle controlDosage can be adjusted 5-10% risk of infectionRisk of spinal fluid leaksHigh cost - $20-$25,000
SELECTIVE DORSAL RHIZOTOMYNeurosurgical treatmentNerves from brain to leg muscles
are exposed in the spinal cord30-50% of the top of each nerve
is cut offPermanent decrease in spasmsFor children between four and
eight
SELECTIVE DORSAL RHIZOTOMY (Cont.)RisksCould decrease feeling in legsExtensive hospital say4-6 weeks of inpatient
rehabilitationExpensive
SPEECH THERAPYNon invasiveSpecial devices such as a
computer with a voice synthesizer
OCCUPATIONAL THERAPYDevelops skills such as:
◦Feeding◦Brushing teeth◦Dressing
Improves day to day livingBoosts self-esteem
PHYSICAL THERAPYUsed in conjunction with other
treatmentsPrevents muscle weakening
(atrophy)Helps prevent muscle
contractureImproves motor development