CEREBRAL

PALSY
PEDIATRICS

Harsha
 • In 1860s, it was known as
William "Cerebral Paralysis” or
John Little “Little’s Disease”
(1810-
1894)
 CEREBRAL PALSY (CP)

• Cerebral“- Latin Cerebrum;

– Affected part of brain

• “Palsy " - 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.

• Non-curable, life-long condition

• Damage doesn’t worsen
• May be congenital or acquired
 CEREBRAL PALSY
A Heterogenous Group of Movement Disorders
 CP Affects
Muscle
Movements Strength

Balance
Coordination

Posture
 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 dev’t
 CAUSES
• Development Malformations
– The brain fails to develop correctly.

• Neurological damage
– Can occur before, during or after delivery
– 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
 TYPES
OF CEREBRAL PALSY
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
 4 MAIN TYPES
PYRAMIDAL 1. Spastic CP

EXTAPYRAMIDAL 2. Athethoid CP
3. Ataxic CP

MIXED 4. Spastic & Athethoid CP

 TYPES
SPASTIC -Stiffness

ATHETOID
--Uncontrolled
Fluctuating
Tone
Movements

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

• Paraplegia (lower extremity)

• Diplegia (symmetrical body parts)

• Hemiplegia (one side of the body)
• Quadriplegia (four limbs)

• Monoplegia –one limb (extremely rare)

• Triplegia –three limbs (extremely rare)

 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
 d.
e.
c.

f.
b.

g.
a. h.
 Early Signs
Infancy (0-3
Months)
• Stiff or floppy posture

• Excessive lethargy or irritability/

High pitched cry
• Poor head control

• Weak suck/ tongue thrust/ tonic bite/

feeding difficulties
 Early Signs

• Abnormal or prolonged primitive

reflexes

Moro’s reflex
Asymmetric tonic neck reflex
Placing reflex
Landau reflex
 CHILD with CP

c h l
ea ta
r en
to m es
ow lop n
Sl ve sto
de mile
 Behavioral Symptoms

• Poor ability to concentrate,

• Irritability
ASSOCIATED
PROBLEMS
OF CEREBRAL PALSY
• Hearing and visual
problems
• Sensory integration
problems
• Failure-to-thrive, Feeding
problems
• Behavioral/emotional
difficulties,
• Communication
disorders
• Bladder and bowel
control problems,
digestive problems
• Skeletal deformities,
dental problems
• Mental retardation and
learning disabilities in
some
• Seizures/ epilepsy
Diagnosis
OF CEREBRAL PALSY
 DIAGNOSIS
• Physical evaluation
• Interview
• MRI, CT Scan EEG
• Laboratory and radiologic work up
• Assessment tools
– i.e. body Development Motor Skills,
Denver Test II
ASSESSMENT
1. SUBJECTIVE
- INTERVIEW
 a. History Taking

– Include all that may predispose

an infant to brain damage or CP

• Risk factors
• Psychosocial factors
• Family adaptation
b. Child’s Health History
• Often admitted to hospitals for corrective
surgeries and other complications.
– Respiratory status
– Motor function
– Presence of fever
– Feeding and weight loss
– Any changes in physical state
– Medical regimen
2. OBJECTIVE
- Physical Examination
 CRITERIA
P osturing / Poor muscle control and strength
O ropharyngeal problems
SS trabismus/ Squint
TT one (hyper-, hypotonia)

EE volutional maldevelopment

RR eflexes (e.g. increaseddeep tendon)

*Abnormalities 4/6 strongly point to CP
Treatment
OF CEREBRAL PALSY
- No treatment to cure cerebral palsy.
- Brain damage cannot be corrected.

• Crucial for children with CP:

– Early Identification;
– Multidisciplinary Care; and
– Support
 I. Nonphysical Therapy

“The earlier we start,

the more improvement can be made”
-Health worker
A. General management
- Proper nutrition and personal care

B. Pharmacologic
Botox, Intrathecal, Baclofen
- control muscle spasms and seizures,
Glycopyrrolate -control drooling
Pamidronate -may help with osteoporosis.
C. Surgery
-To loosen joints,
-Relieve muscle tightness,
- Straightening of different twists or
unusual curvatures of leg muscles
- Improve the ability to sit, stand, and
walk.
Selective posterior rhizotomy
In some cases nerves need to be severed to decrease
muscle tension of inappropriate contractions.
D. Physical Aids
• Orthosis, braces and splints
• Positioning devices
• Walkers, special scooters, wheelchairs

E. Special Education

F. Rehabilitation Services- Speech and

occupational therapies

G. Family Services -Professional support

 H. Other Treatment

- Therapeutic electrical stimulation,

- Acupuncture,
- Hyperbaric therapy
- Massage Therapy might help
 
 II. Physical Therapy

'The ultimate long-term goal is realistic

independence. To get there we have to have some
short-term goals.
Those being a working communication system, education to his
potential, computer skills and, above all, friends'.
- Parent of boy with CP
A.Sitting
- Vertical head control and
control of head and trunk.

B. Standing and walking

- Establish an equal distribution of
weight on each foot, train to use steps
or inclines
C. Prone Development
D. Supine Development

o Head control on supine and positions

 NURSING
RESPONSIBILITIES
 NURSING RESPONSIBILITIES

A. Functioning as a member of the

health team
B. Providing counseling and education
for the parents and promote optimal
family functioning
C. Promoting physical and
psychological health
D. Assisting with feeding management
and toilet training
E. Assisting with rehabilitation therapies
(physical, occupational and speech)

F. Providing counseling for educational

and vocational pursuits

G. Preventing child abuse

H. Providing care during hospitalization

I. Prevent physical injury

J. Prevent physical deformity

K. Promote a positive self-image