cerebral palsy

Cerebral Palsy Cerebral Palsy a group of disabilities caused by injury or insult to the brain either before or during birth, or in early infancy. Cerebral refers to the cerebrum, which is the affected area of the brain, and palsy refers to disorder of movement. Cerebral Palsy is caused by damage to the motor control centers of the developing brain and can occur during pregnancy (about 75 percent), during childbirth (about 5 percent) or after birth (about 15 percent) up to about age three. It is a non-progressive disorder TYPES OF CEREBRAL PALSY 1. MUSCLE STIFFNESS OR 'SPASTICITY' The child who is 'spastic' has muscle stiffness, or 'muscle tension'. This causes part of his body to be rigid, or stiff. MUSCLE STIFFNESS OR 'SPASTICITY' MUSCLE STIFFNESS OR 'SPASTICITY' TYPES OF CEREBRAL PALSY 2. UNCONTROLLED MOVEMENTS OR 'ATHETOSIS' These are slow, wriggly, or sudden quick movements of the child's feet, arms, hands, or face muscles. TYPES OF CEREBRAL PALSY 3. POOR BALANCE OR 'ATAXIA' The child who has 'ataxia', or poor balance, has difficulty beginning to sit and stand. TYPES OF CEREBRAL PALSY 4. Mixed • Combination of any type • Results in severe degree of physical impairment Parts of the body affected DEPENDING ON WHICH LIMBS ARE INVOLVED, THERE ARE 3 TYPICAL PATTERNS: Causes before birth: Infections Differences between the blood of mother and child (Rh incompatibility). Problems of the mother, such as diabetes or toxemia of pregnancy. Inherited No cause can be found in about 30% of the children. Causes around the time of birth: Lack of oxygen (air) at birth. Birth injuries from difficult births. Prematurity. Causes after birth: Very high fever Brain infections (meningitis, encephalitis). Head injuries. Lack of oxygen from drowning, gas poisoning, or other causes. Poisoning Bleeding or blood clots in the brain, often from unknown cause. Brain tumors. • How to recognize cerebral palsy • EARLY SIGNS: • At birth a baby with cerebral palsy is often limp and floppy, or may even seem normal. Slow development Difficulties in taking care of the child Feeding Problem Communication difficulties 4 major forms • Spastic (50-60%) a. diplegia b. hemiplegia c. quadriplegia • Athetoid / Athetoid (25-30%) • Ataxic (5%) • Mixed type (5%) Athetoid/Dyskinetic • • • • • • • • “Wormlike” Involuntary and uncontrolled Accentuated by emotional stress Choreoid movement Drooling of saliva Speech difficulty Intellectual impairment may be present Unable to perform finger-to-nose test Ataxic • Disturbed sense of balance and depth of perception causing falls and stumbles incoordination. • Wide-based gait, high stepping, stumbling, lurching • Poor performance of rapid repetitive movements. • Unable to perform finger-to-nose test or other fine coordinated movement • + nystagmus. Mixed • Combination of any type • Results in severe degree of physical impairment • Spastic: + athetoid (most common) • ataxic + athetoid 41.00% • • • • • • • • • • • Spastic Hypertonic muscles Abnormal clonus Persistent primitive reflexes Failure to demo parachute reflex Delay of normal posture control Exaggerated DTR Arms pressed against the body with forearm bent at right angle and hand flexed against forearm Mild cases: fingers overextend and wrists rotates on reaching Spastic Gait Walk on toes May or may not be cognitively challenged TYPICAL SPASTIC POSITIONS WHEN LYING ON THE BACK : Topographic Classification • • • • • Hemiplegia (35-45%)- arm Diplegia (10-20%) -leg Paraplegia(10-20%) Triplegia (15-20%) Quadriplegia (15-20%) Hemiplegia • Arm: more involved than leg - shorter with smaller muscle circumference - + astereognosis • Leg: in older one heel of shoes more worn out - difficult to abduct the involve hip - difficult to extend knees - difficult to dorsiflex foot Paraplegia • Paralysis of the lower half of the body including lower trunk and both legs • Delayed sitting, standing, walking • Scissor’s gait • A lower leg may be splayed outward and feet flexed Quadriplegia • Non-ambulatory • Arms: abnormal, awkward hand movement • Drooling of saliva • Pseudobulbar paralysis • May not be cognitively challenge By degree or severity • Mild – impairment of only fine precision movement • Moderate – gross and fine movement - speech problems • Severe – inability to perform ADL Etiology • Prenatal >TORCH +syphyllis > spastic hemiplegia and athetosis • Perinatal > asphyxia due to obstetric complication: breech presentation, placenta previa, CPD > Kernicterus= basal ganglia= athetoid form • Postnatal > 2ndary to meningitis, head trauma, encephalitis, cerebral embolism or thrombosis > anoxia, asphyxia > severe DHN Clinical Findings • Delayed gross motor development • Smaller than normal head circumference • Abnormal postures (Opisthotonic) • Persistence of some primitive reflexes • Small for his/her ages • Stiff and rigid arms or legs Mgt • Goal: Early recognition and intervention to maximize child’s abilities • Assess the child’s developmental level and intelligence • Encourage early intervention and participation in school programs • Prepare for using mobilizing devices to help prevent or reduce deformities • Encourage communication and interaction with the child on a functional level, not chronological age level • Provide safe environment and toys • Position upright after meals • Administer medications as prescribed • Surgical intervention