Cerebral Palsy

I. General
Group of disorders characterized by early onset of impaired movement and posture
Nonprogressive
Abnormal muscle tone, and coordination are primary disturbances
Most common permanent disability of childhood

II. Causes
Prenatal Brain abnormalities??
Perinatal problems, especially birth hypoxia???
Anorexia secondary to other causative factors

III. Classifications
Spastic
o Balance, posture, coordination
o More you try to control it gets worse
bilateral or symmetrical
motor, gross skill problems
Dyskinetic/Athetoid
o Abnormal movement is more like a worm movement when they walk that increases with age
because of stress
o Also have trouble with drooling, swallowing, & speech
Ataxic
o Wide base gait
o Very rapid and repetitive movements
Mixed type/Dystonic
o Combination of all

IV. Diagnosis
Neurological exam and history are primary modalities for diagnosis- are they doing what’s normal for their
age ( persistent with putting tongue out, not turning in bed, not smiling at 6 months, irritable
babies)
Observation of signs of any of the classifications- poor head control at 4 months, dfficulty feeding
(coughing, choking because of pharynx involvement)
EEG
Tomography
Screening for metabolic defects
Electrolytes

V. Management
Goal is for early recognition and promotion for optimum development within constraints of their brain
dysfunction
Requires a multidisciplinary approach
Treatment is very individualized
Establish locomotion, communication and self help
Gain optimum appearance and integration of motor functions- look as good as possible & most normal
To correct associated defects as effectively as possible
To provide individualized educational opportunities
To promote socialization experiences with affected and non affected persons
PT is one of the most frequently used conservative treatments
Exercises are individualized
Exercises include
 o Stretching
o Passive, active and resisted movements applied to specific muscle groups
Speech therapy
Support groups

VI. Therapeutic devices for CP

AFO’s
o Prevent deformities- increase energy efficiency of gait, control alignment
Other mobilization devices
o Scooters
o Go-carts
Technical aids- pointer in mouth, voice controllee
Therapeutic aids- color, finger paint
Ortho Surgical
Surgery is only for children who do not respond to PT
Used to promote function, not for cosmetic purposes
Tendon lengthening procedures
Release of spastic wrist flexor muscles
Correction of hip & adductor muscle spasticity or contracture to improve locomotion
Selective dorsal rhizotomy
A neurosurgical intervention in which dorsal column sensor rootlets that have abnormal
electrical stimulation are selectively cut
Results in flaccid muscles so child must be re-taught to sit, stand, walk
Requires much PT
Drugs
o Skeletal muscle relaxants
Diazepam (Valium)
Botulinum toxin (Botox)
Local nerve blocks
o Antianxiety
o Little effect on overall function
Combination neurosurgical and Pharmacological Management
Involves implantation of a pump to infuse baclofen directly into the intrathecal space surrounding
the spinal cord, this will prevent the side effects of oral administration.
Must go back every few months to fill pump

VII. Prognosis
Moderate disability
o Survival rate is about the same as for an unaffected child for the first 20 yo, declines after 20
because of other defects & infections
Severe disability
o 50% probability of surviving 20 years or more

VIII. Nursing Diagnosis

Risk for injury- falls, aspiration
Self care deficit
Impaired physical mobility
Fatigue
Body image
Impaired verbal communication
Altered Family Processes