CEREBRAL PALSY

DEFINITION

Cerebral palsy is a comprehensive diagnostic term

used to designate a group of non progressive
disorders resulting from malfunction of the motor
centers and pathways of the brain.
 ETIOLOGY
•Cytomegalo virus
•Toxoplasmosis
PRENATAL •Prenatal cerebral hemorrhage associated
with toxemia of pregnancy
•Placental dysfunction, Maternal anoxia,
anemia, abruption placenta.
•Erythroblastosis fetalis
•Radiation Miscellaneous-toxins, drugs.

•Anoxia due to anesthesia, prolonged

NATAL FACTORS labor, placenta previa,
•Respiratory obstruction.
•Cerebral hemorrhage.

•Anoxia
•Cerebro vascular accident
POSTAL NATAL •Head trauma
•Infections like meningitis, encephalitis,
brain abscess
 TYPES
1. SPASTIC TYPE:
•Defect in the cortical motor area or pyramidal tract causes
abnormally strong tonus of certain muscle groups.
This is characterized by
Increased stretch reflexes
Increased muscle tone.
There is an uneven distribution and a lack or delay of normal
postural control.
There may be deformity of the joints due to spastic muscle action.
The general activity may be clumpsy.
The children may have hemplegia, Quadriplegia, diploplegia or
paraplegia.
2. DYSKINETIC TYPE:

Lesions of the extra pyramidal tract and basal ganglia.

This is characterized by involuntary, un coordinated and

uncontrollable movements of muscle groups that disappear during
sleep.

There may be slow, worm like movement, drooling due to

involvement of oral muscles and the tongue and there may be
difficulty in speaking.

There may be visual or eye defects and deafness. Deformities may

develop due to continious uncontrollable movements.

3. A TAXIA:

Disturbances of balance results in cerebellar involvement.

There is failure of muscle co-ordination resulting in irregular

 CLASSIFICATION BY DEGREE OF SEVERITY
Only fine precision movement is impaired.

Gross and fine motor movements and speech

MILD
impaired.

Able to perform usual activities of daily living.

Inability to perform adequately the usual activities of

SEVERE living (walking, using hands, communicating verbally)
 TOPOGRAPHICAL CLASSIFICATION
HEMIPLEGIA: (35%-40%) Findings limited to one side of the body

Arm usually involved more than leg.

DIPLEGIA: (10%-20%) Similar parts of both sides of body involved

Legs usually involved more than arms.

PARAPLEGIA: (10%-20%) Only legs involved.

QUADRIPLEGIA:(15%-20%) All four extremities involved upper and lower

extremities affected equally

MONOPLAGIA: (rare) Only one extremity involved

TRIPLEGIA: (rare) Three extremities involved.

 CLINICAL MANIFESTATIONS
 Early signs may include one or more of the
following:
Asymmetrical movements.
Listlessness or irritability.
Difficulty in feeding or swallowing .
Persistent gagging or choking when fed.
 poor sucking
After 6 months of age, persistent tongue thrusting.
Excessive, high-pitched, or feeble cry.
Long thin infants who are slow to gain weight.
CONT.,
Late signs may include one or more of the following:
 Failure to follow normal pattern of motor development.
Poor head control after 3 months of age.
Use only one side of the body or only the arms to crawl.
Cannot sit without support by 8 months.
 Delayed gross motor development is a universal
manifestations of cerebral palsy
 Failure to smile by 3 months.
 Clenched fists after 3 months.
 Persistence of infantile reflexes.
 Stiff rigid arms or legs.
 Pushing away or arching back.
 Abnormal postures(Floppy or limp body posture).
 Delayed or defective speech.
 Evidence of mental retardation.
PATHOPHYSIOLOGY
CONT.,
 ASSOCIATED DISABILITIES & PROBLEMS
 Disturbed mental development
 Seizures.
 Growth retardation
 Sensory impairment
 Visual impairment
 Hearing impairment.
 Speech impairment.
 Gait diturbance.
 DIAGNOSTIC EVALUATION
1. Thorough evaluation of prenatal, perinatal and postnatal
factors; APGAR scores.
2. Neurologic examination and history are the primary
modalities for the diagnosis of CP.
3. Computed tomography(CT)Scan or magnetic resonance
imaging (MRI) and blood testing to rule out presence of
toxins, infections process, neoplasm's.
4. Electro myography.
5. Electro encephalography.

INVESTIGATION FOR SPECIFIC DEFECTS:

1. Psychological testing to determine cognitive functioning.
2. Hearing ability test.
3. Vision test.
4. Psychologic assessment; including family adaptation
 THERAPEUTIC MANAGEMENT
 Each child is evaluated and managed on an individual
basis. The plan of therapy may involve a variety of
settings; facilities and specially trained persons,
including the parents.

1. ANKLE-FOOT ORTHOSES (AFOs, braces): are worn by

many of these children and are used to help prevent
or reduce deformity, increase the energy efficiency of
gait and control alignment .
Other mobilization devices include wheeled scooter
boards that allow children to propel themselves while
on the abdomen & wheeled go-carts that provide
sitting balance and serve as “wheel chair” experience
for young children.
CONT.,
2.ORTHOPEDIC SURGERY:
May be required to correct contracture or
spastic deformities, to provide stability for an
uncontrollable joint and to provide balanced
muscle power.
• This includes tendon-lengthening procedures
(especially heel cord lengthening), release of
spastic wrist flexor muscles and correction of hip
and adductor muscle spasticity or contracture to
improve locomotion.
• A neurosurgical intervention, selective dorsal
rhizotomy, is used selectively in some children
with CP.
CONT.,
3.Pharmacologic agents given orally (dantrolene
sodium, Baclofen, and diazepam) have had
variable effectiveness in improving muscle co-
ordination in children with CP.
Anti anxiety agents have been used to relieve
excessive motion and tension.
Botulinium toxin(Botox) has become an important
drug in the treatment of spasticity.
Botox is injected into the targeted muscle, where
it acts to inhibit the release of acetylcholine into a
specific muscle group, thereby reducing spasticity.
CONT..,
4. ANTIEPILEPTIC DRUGS (AED’S): Such as
carbamazapine (Tegretol) and valproic acid are
prescribed routinely for children who have
seizures.
5. Care of visual and auditory deficits requires the
attention of appropriate specialists and speech
therapy involves the services of a speech
therapist.
6. Regular visits to the dentist and prophylaxis,
including brushing, fluoride and flossing, should be
instituted as soon as the teeth erupt.
 NURSING MANAGEMENT
The responsibilities of the nurse include
• Functioning as a member of the health team.
• Providing counseling and education for the parents.
• Promoting physical and psychosocial health.
• Assisting with feeding management and toilet
training.
• Assisting with physical therapy.
• Assisting with speech therapy.
• Preventing child abuse.
• Counseling for educational and vocational pursuits
and
• Providing care during hospitalization.