CEREBRAL PALSY - { It is a condition marked by impaired mm coordition caused by damage to the brain before or at birth CLASSIFICATION - spastic - Spastic

hemiplegeia A child with spastic hemiplegeia will typically have spasticity (muscle stiffness) on one side of the body - usually just a hand and arm, but may also involve a leg. The side that is affected may not develop properly. The child may have speech problems. In the majority of cases intelligence is not affected. Some children will have seizures. - Spastic diplegia The lower limbs are affected, and there is no or little upper body spasticity. The child's leg and hip muscles are tight. Legs cross at the knees, making walking more difficult. The crossing of the legs when the child is upright is often referred to as scissoring. - Spastic quadriplegia The child's legs, arms, and body are affected. This is the severest from of spastic cerebral palsy. Children with this kind of cerebral palsy are more likely to have mental retardation. Walking and talking will be difficult. Some children have seizures. - athethoid (dyskinetic) - This is the second most common type of cerebral palsy. Intelligence will nearly always be normal, but the whole body will be affected by muscle problems. Muscle tone is weak or tight - causing random and uncontrolled body movements. The child will have problems walking, sitting, maintaining posture, and speaking clearly (tongue and vocal cords are hard to control). Some children drool if they have problems controlling facial muscles. - ataxic - The child's balance and depth perception are affected. Depth perception refers to a person's ability to judge where objects are in relation to where he/she is. It is the least diagnosed type of cerebral palsy. The child will find it difficult to tie his/her shoelaces, button up shirts, cut with scissors, and other fine motor skills. Because of balance difficulties, the child may walk with the feet far apart. There may be intention tremors - a shaking that starts with a voluntary movement, such as reaching out for a toy, the closer he/she gets to the toy the worse the tremors become. Most children with ataxic cerebral palsy are of normal intelligence and have good communication skills. Some may have erratic speech. - hypotonic - Muscle problems will appear much earlier. The baby's head is floppy, and he/she cannot control the head when sitting up. Some parents have described their child's movements as similar to that of a rag doll. The baby gives only a moderate amount of resistance when an adult tries to move their limbs. The baby may rest with his/her elbows and knees loosely extended, compared to other infants whose elbows/knees will be flexed. Some babies may have breathing difficulties. - Injury to the cerebellum can result in this type of cerebral palsy. - mixed

CAUSES

- bleeding in the brain - brain infections (encephalitis, meningitis, herpex simplex infections) - head injury - infections in the mother during pregnancy (rubella) - severe jaundice RISK FACTORS - multiple births - infection - seizure - premature birth - hypoxia S/S - lack of mm coordination (ataxia) - slow, writhing movements (athetosis) - stiff mm and exaggerated reflexes (spasticity) - difficulty with sucking or eating - delays in developmental milestones - tremors or involuntary movements - difficulty walking - difficulty with precise motions such as picking up a crayon or spoon - abnormal gait - legs make scissor movement - walk on the toes - seizures DIAGNOSIS - MRI - CT scan - cranial ultrasound - EEG (electroencephalogram) - vision test - hearing screen - blood test TREATMENT - walking aids - glasses - anticonvulsant for seizures - botulinum toxin to help with sapsticity and drooling - mm relaxant (baclofen) to reduce tremors and spasticity

TIC DOULOUREUX (TRIGEMINAL NEURALGIA) - nerve disorder that causes a stabbing or electric-shock-like pain in parts of the face CAUSES - trauma - infection

- multiple sclerosis - tumors - bony abnormalities - compression of trigeminal nerve by a blood vessel S/S - sudden, severe, stabbing, sharp, shooting, electric-shock like pain on one side of face - usu felt in lower half of the face - pain is intermittent that last from a few seconds - minutes - NO loss of taste, hearing, or sensation STIMULUS THAT TRIGGERS TIC DOULOUREUX - talking - eating - brushing teeth - cool air on the face - shaving - chewing - drinking - lightly touching the face DIAGNOSTIC - blood test - MRI of the head - trigeminal reflex testing MEDICATIONS - anti-seizure drugs (carbamazepine, phenytoin) - mm relaxants (baclofen, clonazepam) - tricyclic antidepressants (carbamazepine, amitriptyline) SURGERY - cutting or destroying part of trigeminal nerve - electrostimulation - percutaneous balloon microcompression - removal of tumor (if tumor is cause) - stereotactic radiosurgery (Gamma knife) - microvascular decompression of MVD ERIK ERIKSONS PSYCHOSOCIAL STAGES STAGE INFANCY (birth - 18 mos) BASIC CONFLICT trust vs mistrust IMPORTANT EVENTS feeding OUTCOME Children develop a sense of trust when caregivers provide reliabilty, care, and affection. A lack of this will lead to mistrust.

EARLY CHILDHOOD (2-3 yrs)

autonomy vs shame and doubt

toilet training

Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt. Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority. Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self. Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation. Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world.

PRESCHOOL (3-5 yrs)

initiative vs guilt

exploration

SCHOOL AGE (6-11 yrs)

industry vs inferiority

school

ADOLESCENCE (12-18 yrs)

identity vs role confusion

social relationships

YOUNG ADULTHOOD (1940 yrs)

intimacy vs isolation

relationships

MIDDLE ADULTHOOD

generativity vs stagnation

work and parenthood

MATURITY (65-death)

ego integrity vs despair

reflection on life

Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair.