CEREBRAL PALSY

A Short Case

Presented by: Guntur Sulistyo

Introduction
◦ Cerebral = Brain
◦ Palsy = Muscles’ paralysis
◦ Cerebral Palsy is a non progressive disease of disturbance of movement which
is caused by developmental problems in brain

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Risk Factors

TORCH infection
Prenatal
●

●
Seizure

Asphyxia
Perinatal
●

●
Low Birth Weight

●
CNS Infection
Post Natal ●
Head Injury

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Types of Cerebral Palsy

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Types of Cerebral Palsy

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Database (May 19th 2021)
Identity
Name : Ms. D
 Sex : Female
 Age : 22 years old
 Address : Lampung Tengah
 Occupation :-
 Religion : Islam
 Marital status : Single
 Ethnic : Javanesse

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ANAMNESIS
 Chief Complaint: Punching her own head
 History of Present Illness:
 Patient’s mother said that her daughter has been punching her own head since
she was 10 years old. She has not been able to communicate with other
people. She had been ever able to stand, but never to walk.

 The patient had a febrile seizure when she was 2-5 years old. It was a tonic
seizure for 5-7 minutes 3 times in an hour.

 Her family had already surrendered, they only hoped she was medically
healthy although poor functionally.

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History of Past Illness:
Hypertension (-)
Stroke (-)
Diabetes Mellitus (-)
Trauma (-)
Malignancy (-)
Dyslipidemia (-)
Heart disease (-)

History of medication:
◦ Since 40 days old until 10 years she was cared by her
mother’s family in Kalimantan and underwent some 8
medications.
Review of System
◦ General state : not yet able to communicate
◦ Cardiopulmonary system : There was no palpitation and orthopnea.
Breathing problem was denied
◦ Gastrointestinal system : bowel problem were denied
◦ Urogenital system : bladder problem were denied
◦ Nervous system : there was no complaint of smelling, blurred vision,
mastication difficulty, facial weakness, dysarthria, dizziness, vertigo, deafness,
and turning head and neck
◦ Integumental system : there was no nodule nor pigmentation

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 Physical Examination
General Status

◦Compos mentis, dependent ambulation

◦BP : 110/70 mmHg, HR : 83x/m, RR : 18x/m, SaO2 : 99%
◦BW: 70 kg, Height: 140 cm, BMI: 35.7 kg/cm2 (obese grade II)
Head/Neck: Anemia -, Icterus - , Cyanosis -
Thorax :
Cor : S1–S2 single, murmur -, gallops -
Pulmo : vesicular/vesicular, Wh -/-, Rh -/-
Abdomen : soft, Liver / Spleen not palpable
Extremities : warm acral +/+, edema -/-, CRT >2 sec
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Musculoskeletal Status
NECK ROM MMT
Flexion F (0-450) 5
Extension F (0-450) 5
Lateral bending F/F (0-450) 5/5
Rotation F/F (0-600) 5/5

TRUNK ROM MMT

Flexion F (0-800) 5
Extension F (0-300) 5
Lateral bending F/F (0-350) 5
Rotation F/F (0-450) 5

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SHOULDER ROM MMT
Flexion F/F (0-1800) 5/5
Extension F/F (0-600) 5/5
Abduction F/F (0-1800) 5/5
Adduction F/F (0-450) 5/5
Internal rotation F/F (0-700) 5/5
External rotation F/F (0-900) 5/5

ELBOW ROM MMT

Flexion F/F (0-1500) 5/5

Extension F/F (1500-0) 5/5

Supination F/F (0-900) 5/5

Pronation F/F (0-900) 5/5

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WRIST ROM MMT
Flexion 0 - 20°/F (0-800) 5/5
Extension 0 - 20°/F (0-700) 5/5
Ulnar deviation 0 - 5°/F (0-300) 5/5
Radial deviation 0 - 5°/F (0-200) 5/5

THUMB ROM MMT

Flexion
MCP F/F (0-900) 5/5
IP F/F (0-800) 5/5
Extension
MCP F/F (0-500) 5/5
IP F/F (0-200) 5/5
Abduction F/F (0-700) 5/5
Adduction F/F (700-0) 5/5
Opposition F/F 5/5
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FINGERS ROM MMT
Flexion
MCP F/F (0-900) 5/5
PIP F/F (0-1000) 5/5
DIP F/F (0-900) 5/5
Extension F/F (0-300) 5/5
Abduction F/F (0-200) 5/5
Adduction F/F (200-0) 5/5
Opposition F/F 5/5

HIP ROM MMT

Flexion F/F (0-1200) 5/5
Extension F/F (0-300) 5/5
Abduction F/F (0-450) 5/5
Adduction F/F (0-300) 5/5
Internal rotation F/F (0-450) 5/5
External rotation F/F (0-350) 5/5
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KNEE ROM MMT
Flexion F/F (0-1350) 5/5
Extension F/F (1350-0) 5/5

ANKLE ROM MMT

Dorsoflexion Spastic 3/5

Plantarflexion Spastic 3/5

Inversion Spastic 3/5

Eversion Spastic 3/5

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BIG TOE ROM MMT
Flexion
MTP Spastic 3/5
IP Spastic 3/5
Extension Spastic 3/5

TOES ROM MMT

Flexion
MTP Spastic 3/5
IP Spastic 3/5
Extension Spastic 3/5

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Neurological Status
Spasticity based on Modified Ashworth Scale:

Elbow 0

Wrist 0

Knee 3

Ankle 4

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POSTER Criteria
◦ Posture : Scissoring
◦ Oral Drolling : +
◦ Strabismus : +
◦ Tonus : +
◦ Evolution : Spinal
◦ Physiological Reflex : +
◦ Pathological Reflex : Babinsky +

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Barthel Index
Feeding = 5
Grooming = 0
Bathing = 0
Dressing = 5
Bowels =5
Bladder = 5
Toilet use = 5
Transfer = 5
Mobility = 10
Stairs =5
Total  45
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Problem list
◦ Body Function :
B.152 Emotional function
B.201 Visual function
B.710 Mobility of joint function
B.530 Weight maintenance function (Obese gr II)
◦ Body Structure :
◦ S.760 Structure of lower extremity

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- Activity Limitation :
d.230 Carrying out daily routine : cannot do houseworks like washing and cooking
d.450 Walking
d.455 Moving around
d.530 Toileting
d540 Dressing

- Participation restriction
d.640 Doing Houseworks

- Environmental Factors
E 580 : Health services systems and policies

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Clinical Diagnosis

◦ Cerebral Palsy + Mental Retardation + Obese Grade II.

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 ICF Diagnosis

Health Condition
Cerebral Palsy + Mental Retardation+ Obese Grade II

Body Functions and Structures:

Activities:
B.152 Emotional Function
Participation:
B715 Mobility of joint function d.230 Carrying out daily routine
B540 General metabolic functions d.450 Walking d.640 Doing Houseworks
B530 Weight maintenance function
d.530 Toileting
S.760 Structure of lower extremity d.540 Dressing

Personal Factors:
External Factors: Age
E 580 : Health services systems and policies Female

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Planning
◦ Surgical : -
◦ Medical :
◦ Rehabilitation Medicine
PDx :
PTx :

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 Summary
Ms. D. 22 yo. with chief complaint: punching her own head since 10 years ago. Her
developments were restricted since she was a newborn. Her older siblings had the same
condition. She had ever been able to stand but never been able to walk yet. She can not
communicate with other people

The patient had a febrile seizure when she was 2-5 years old. It was a tonic seizure,
lasted for 5-7 minutes, 3 times in an hour. The history of falling are denied.

From physical examination, we found obesity grade II and spastic on both ankles

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We diagnosed the patient with Cerebral Palsy +Mental Retardation +
Obese Grade II

We planned for

Our therapy consist of

We informed the patient about her disease, to continue exercise

programmes at home,

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THANK YOU

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