Cerebral Palsy:

Understanding
Of This Condition
Modern Definition of CP
A persistent,
but not unchanging disorder of
movement and posture
due to a non progressive disorder
of the
immature brain ( that is, under
two years of age).
 "Cerebral" refers to the brain

 "Palsy" to a disorder of movement or posture.

Cerebral Palsy is an injury to the brain (cerebral) causing the

muscles not to work in a normal way (palsy). 
Understanding CP
 It is not "curable" in the accepted sense, although
education and therapy can help persons with
cerebral palsy live to their best ability
 It is important to know that cerebral palsy is not a
disease or illness. 
 It isn't contagious and it doesn't get worse.
 The symptoms will change as the child grows. 
 Children who have cerebral palsy will have it all
their lives.
Causes:

 Failure of the brain to develop properly (developmental

brain malformation).

 Neurological damage to the child's developing brain.

Causes:
Developmental malformations:

Malformation causes are frequently unknown.

Possible:
 genetic disorders, chromosome abnormalities with
either too much or too little genetic material,
 Fail to develop the usual number of brain cells,
communication between brain cells impaired, or
brain cells may not migrate to the areas they are
supposed to.
 Faulty Blood supply to the brain.
Causes:
Neurological damage:
Result of an injury to their brain before,
during, or after birth.

 Lack of oxygen before, during or after birth.,

 Bleeding in the brain.

 Toxic injuries, or poisoning, from alcohol or

drugs used by the mother.
Causes:
Neurological damage:
 Head trauma resulting from a birth injury, fall, car
accident, or other cause.

 Severe jaundice, very low glucose levels, or other metabolic

disorders.

 Infections of the nervous system such as encephalitis or

meningitis.
Causes:

 Baby’s mother may have had an infection in early pregnancy,

e.g.
 German measles
 Shingles
 Influenza
 The placenta maybe insufficient,
The placenta may be below the baby’s head
in the uterus, where it can be easily damaged.
Causes:
Severity of the brain damage depends on the type and
timing of the injury.

In very premature babies, bleeding into the brain

(intraventricular haemorrhage) can cause extensive damage.
Causes:

The longer an unborn child goes without oxygen, the greater

the extent of brain tissue damage.
Understanding CP

 A commonly used term for a group of

conditions that have motor dysfunction as the
primary symptom.
 There are usually associated disabilities,

e.g. speech and feeding problems, epilepsy.

 Severity varies considerably from total
dependency and immobility, to independent
self- care and walking.
Defining CP

 Differential diagnosis requires understanding of how

children normally acquire mobility.
 Sometimes children with learning disabilities (MR) are
wrongly diagnosed as CP because they do not walk.
 Also CP children with severe disability are sometimes
wrongly termed MR.
Recognising the Difference : CP
or MR
 CP or MR

Need knowledge of the symptoms specific to CP.

Understand normal parameters of child development.

Types of CP

Parts of Body affected

and
Quality of child’s postural tone
Part of Body affected

 Total body affected =

Quadriplegia
 Lower limbs mostly affected=
Diplegia
 Upper and lower of one side of the body
affected=
Hemiplegia
Part of Body affected

 With diplegia there may also be altered tone in arms and

trunk, but they are much less affected.

 With hemiplegia the “unaffected” side and trunk are also

impaired.
Quality of Tone

 Hypertonic (Spasticity)
 Moderate
 Severe

 Athetoid
 Choreo
 Dystonic

 Ataxic
 Hypotonic (Flaccid or floppy)
 Mixed e.g. Athetoid with spasticity.
What is Tone?
Muscle Tone:
 Muscle tone is the amount of tension or resistance to
movement in a muscle.

 It is what enables us to keep our bodies in certain position

or posture.
Muscle Tone

 Changes in muscle tone enable us to

move.

 To bend your arm & brush your teeth,

you must shorten (increase the tone of)
the biceps muscles on the front of your
arm at the same time you are lengthening
(reducing the tone of) the triceps muscles
on the back of your arm.
Muscle Tone

To complete a movement

smoothly, the tone in all muscle
groups involved must be
balanced.
The brain must send messages to
each muscle group to actively
change its resistance.
Muscle Tone

 Thereis an always present

“readiness” of muscles to contract
and relax in anticipation of
movement.

 This can be called our Basic Tone.

Spasticity
Spasticity / Hypertonus

80% of all people with CP shows some spasticity.

Spasticity is abnormal increase in muscle tone.

It causes movement to be limited,
in stereotypical patterns,
or prevents any movement.
Spasticity is:

One type of increase in muscle tone at rest; characterized by increased

resistance to passive stretch, velocity dependent and asymmetric about
Spasticity

This is caused by damaged to the

movement areas and pathways of
the cortex .
Ataxia
 Ataxia

Ataxia is shaky and unsteady movement that result from the brain's failure
to regulate:
 the body's posture
 the strength of the movement
 direction of movements.
Ataxia is most often caused by damage in the cerebellum.    
Ataxia

Rare type of cerebral palsy affects balance and depth perception.

 Poor co-ordination
 Walk unsteadily, wide base
 Intention tremor
 Difficulty in judging distance
 Difficulty with quick movements
 Difficulty with precise movements
Ataxia

“Pure” Ataxia, (on its own), is

rarely diagnosed.

{Genetic disorder called “Dysequilibrium Disorder”

does show ataxia along with other disabilities; not
CP}
Following video clip shows some of the signs of Ataxia. This child shows
a mixed picture with low trunk tone and spasticity
is present.

Dysmeteria: is a tendency for limb movements to overshoot or undershoot

a target.
Ataxia
Ataxic

This is caused by damage to

the Cerebellum
Athetosis/ Dyskinetic
Athetoid
Two main types:

Choreo Athetosis.
Dystonic Athetosis.
Both have uncontrolled involuntary
movements throughout the body,
including the facial muscles.
Athetoid
 Movements may be
 Slow or fast
 Jerky
 Writhing
 Swiping
 Rotary or
 Un-patterned

 They may be present at rest but decrease in sleep

Choreo Athetoid
Athetoid

Movements are exaggerated with :

 attempts at voluntary movements,
 excitement,
 insecurity,
 or mental effort.
Dystonic Athetoid
Athetosis

This is caused by damage to the

basal ganglia.
 Understanding CP
 The problem originates in the brain
 It is mostly about movement
 Balance
 Co-ordination
 Staying still / being able to move
 Holding positions such as lying on tummy, sitting, standing etc.
 It can affect part or all of the body in varying degrees.
 The brain damage does not get worse,
 But the problems can progress with growth and time.
 Understanding CP
 There may be tightness or floppiness.
 There may be too much unwanted movement.
 There may be lack of balance and
co-ordination.
 Children may be clever, or have problems learning.
 There may be other problems of sight, hearing or
behaviour.
 There may be feeding and nutritional problems.
 Understanding CP
To understand a CP child we must know they are
different from adults with brain damage.
An adult hemiplegic, disabled from a stroke, has a brain
that has already, in childhood, made the neural
pathways in his brain to learn how to move.
As the CP child has had the damage before the brain has
established these pathways he can not do all the
practise of normal movements to create these
pathways.
 Understanding CP
 An example:
When you learn a new skill you must practise it before it is easy to do
without too much thinking ( become automatic).
This is because the practise lets the brain
make the neural connections it needs to know what to do when you want
do that activity again.
e.g. Learning to drive a car, or learning to typewrite.
Helping CP children?

 In the study and learning you do at AKI

you will need to think, all the time, about what you can do
to make it an easier and better life for the children and their
families
 All the theory you do will give you the tools and ideas to
make you better at doing that.

Inshallah
Questions?