CEREBRAL

PALSY
By: Norhafizah Ahmad
Paediatrician
HTJS

William
John
Little
(18101894)

In 1860s, known as
"Cerebral Paralysis or
Littles Disease
After an English surgeon
wrote the 1st medical
descriptions

William
John
Little
(18101894)

CEREBRAL PALSY (CP)

Cerebral- Latin Cerebrum;
Affected part of brain

Palsy " -Gr. para- beyond,

lysis loosening
Lack of muscle control

CEREBRAL
PALSY
A motor function disorder
caused by permanent, non-progressive brain lesion
present at birth or shortly thereafter. (Mosby, 2006)

Non-curable, life-long condition

Damage doesnt worsen
May be congenital or acquired

CEREBRAL PALSY
A Heterogenous Group
of Movement Disorders
An umbrella term
Not a single diagnosis

CEREBRAL PALSY
A Heterogenous Group
of Movement Disorders

ements

ation

CP Affects

Balance

Posture

In CP
Muscles are unaffected
Brain is unable to send
the appropriate
signals necessary to
instruct muscles when
to contract and relax

CAUSES
OF CEREBRAL PALSY

An insult or injury to the brain

Fixed, static lesion(s)
In single or multiple
areas of the motor
centers of the brain
Early in CNS devt

CAUSES
Development Malformations
The brain fails to develop correctly.

Neurological damage
Can occur before, during or after delivery
Rh incompatibility, illness, severe lack of oxygen

* Unknown in many instances

CHIEF CAUSE
Severe deprivation of oxygen or
blood flow to the brain
Hypoxic-ischemic
encephalopathy
or intrapartal
asphyxia

RISK FACTORS
Prenatal factors
Before birth
Maternal characteristics

Perinatal factors
at the time of birth to 1mo

Postnatal factors
In the first 5 mos of life

Prenatal factors
Hemorrhage/bleeding
Abruptio placenta

Infections
Rubella, cytomegalovirus,
toxoplasmosis,

Environmental factors
Maternal Characteristics

Maternal Characteristics
Age
Difficulty in conceiving or holding a
baby to term
Multiple births
History of fetal deaths/miscarriages
Cigarette smoking
Alcoholism and drug addiction
Social status; mother with MR
Mothers medical condition
>30 sticks per day

Perinatal Factors

High or low BP
Umbilical cord coil
Breech delivery
Over sedation of drugs
Trauma i.e. forceps or
vacuum delivery
Complications of birth

Postnatal Causes
Trauma, head
injury
Infections
Lack of oxygen
Stroke in the young
Tumor, cyst

CP Cases

*Several causes are preventable or treatable

Most Common Permanent

Disability of Childhood

TYPES
OF CEREBRAL PALSY

Classification of CP
According to:
1. Neurologic deficits
2. Type of movement involved
3. Area of affected limbs

1. Accdg. to Neurologic Deficits

Based on the
- extent of the damage
- area of brain damage
Each type involves the way
a person moves

3 MAIN TYPES
1. PYRAMIDAL
- originates from the motor
areas of the cerebral cortex

2. EXTAPYRAMIDAL
- basal ganglia and cerebellum

3. MIXED

2. Accdg. to Type of Movement

Photo from: Saunders, Elsvier.

4 MAIN TYPES
PYRAMIDAL

1. Spastic CP

EXTAPYRAMIDAL

2. Athethoid CP
3. Ataxic CP

MIXED

4. Spastic &
Athethoid CP

Spastic CP
Increased muscle tone,
tense and contracted muscles
Have stiff and jerky or
awkward movements.
limbs are usually
underdeveloped
increased deep tendon
reflexes
most common form
70-80% of all affected

Types of Spastic CP
According to affected limbs:
* plegia or paresis - meaning paralyzed or weak:

Paraplegia
Diplegia
Hemiplegia
Quadriplegia
Monoplegia one limb (extremely rare)
Triplegia
three limbs (extremely rare)

Diplegia/ Paraplegia
both legs w/ slight
involvement
elsewhere

both legs

Diplegia
May also have
Contractures of
hips and knees
and
talipes equinovarus
(clubfoot).

Hemiplegia
limbs on only one side

 Hemiplegia on right side

Hip and knee contractures
Talipes equinus (tip-toeing
- sole permanently flexed)
Asteriognosis may be present.
(inability to identify objects by
touch)

Quadriplegia

 Spastic
Quadriplegia
Characteristic scissors
positions of lower limbs
due to adductor spasms.

Athetoid/ Dyskinetic CP
Fluctuating tone
involves abnormal involuntary
movements
that disappear during sleep and
increase with stress.
Interferes with speaking, feeding,
reaching, grabbing, and any other
skills

20% of the CP cases,

Athetosis
Wormlike movements
Slow, uncontrolled motion, writhing
or twisting in character in the face,
extremities, and torso.
Dystonia - when held as a
prolonged posture

Dyskinesia
Dyskinetic movement
of mouth
Grimacing, drooling
and dysarthria.
Adductor spasm

Movements may become

choreoid
(rapid, irregular, jerky)
and

dystonic
(disordered muscle tone,
sustained muscle
contractions)
especially when stressed and
during the adolescent years.

Ataxic CP
Poor balance and lack of
coordination
Wide-based gait
Depth perception usually
affected.
Tendency to fall and stumble
Inability to walk straight line.
Least common 5-10% of cases

MIXED CP
A common combination is

spastic and athetoid

Spastic muscle tone and involuntary
movements.
25% of CP cases, fairly common

DEGREE OF SEVERITY
1. Mild CP- 20% of cases
2. Moderate CP- 50%
- require self help for assisting their

impaired ambulation capacity.

3. Severe CP- 30%;

-totally incapacited and bedridden

and they always need care from others.

Signs and
Symptoms
OF CEREBRAL PALSY

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CHILD with CP

Cerebral Palsy
Main problem:
Mentation and thought processes
are not always affected;
Trapped in their bodies with their disabilities
Ability to express their intelligence may be
limited by difficulties in communicating.

ASSOCIATED
PROBLEMS
OF CEREBRAL PALSY

 Hearing and visual

problems

Bladder and bowel

control problems,
digestive problems
Sensory integration
(gastroesophageal reflux)
problems
Failure-to-thrive, Feeding Skeletal deformities,
dental problems
problems
Mental retardation and
Behavioral/emotional
learning disabilities in
difficulties,
some
Communication
Seizures/ epilepsy
disorders

Oropharyngeal problems
Speech,
swallowing
breathing,
drooling,
feeding poorly

Dietary issues with Cerebral

Palsy
Feeding, Eating, Drinking and
Swallowing Difficulties (FEDS)
Lengthy Feeding Times
Oro-motor Difficulties
Self-Feeding
Sensory Difficulties
Gastroesophageal Reflux
Constipation

"Time and gravity

are enemies of very aging body,
especially mine." - Adult with CP

THANK YOU FOR PATIENTLY

LISTENING!!!