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Cerebral

Palsy

Done by :
Hind Al-Suwais Nawal Al-Enizi

objectives
At

the end of theses presentation the student will be able to :

Define cerebral palsy . identify cause of CP. Identify types of cerebral palsy . Clarify possible sign of CP. Clarify diagnostic evaluation . Clarify therapeutic management of CP . Discuss nursing diagnosis of CP.

Cerebral Palsy
"Cerebral

palsy" is a general term for a group of

disorders that appear during the first few years of life and affect a child's ability to coordinate body movements. Cerebral palsy can cause muscles to be weak and floppy, or rigid and stiff.
Incidence:

1.5-3 per 1000 live births Most common permanent physical disability in childhood

Cause
Prenatal

Intrauterine hypoxia/asphyxia 80% unknown

Perinatal
Anoxia

( most common cause of brain damage )

Postnatal
Kernicterus Shaken

baby syndrome

Cont
Preterm

birth

ELBW/VLBW

( most important determinant of CP ) Periventricular Leuomalacia 12% (highest risk factor )

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Additional

factor Bacrerial meningitis Viral encephalitis Motor vehicle accidents Child abuse

Pathophysiology:
Gross

Malformations of the brain

Vascular
Atrophy

occlusion

Loss

of neurons

Degeneration

Types of CP
Spastic
Most

( preterm birth )

common (80%) Tense, contracted muscle Type of spastic

Hemiparesi Quadriparesis Diplegia

Monoplegia
Triplegia paraplegia

Athetoid

Cerebral Palsy

Uncontrolled

motion of limbs, hand and eyes. about 10-20%

Ataxic
weak

sense of Balance, poor coordination. This type of condition occurs in about 5-10 % of all cases.
Mixed
This

or dystonic

type means a combination of spastic, athetoid, or ataxic cerebral palsy.

A study of the Victorian CP Register shows similar distributions to those reported above. Around 86% of children with CP experienced a spastic motor type, which was relatively evenly distributed between spastic hemiplegia, diplegia and quadriplegia. The other groups were dyskinesia and mixed, which together accounted for 8% of cases, while the remaining motor types (ataxic, hypotonic) represented 5.6% of the (Howard et al, 2005).

Possible signs of CP
Physical

signs

Poor head control Stiff or rigid arms or legs Arching back Use only one side of the body Floppy or limp body posture Clenched hands.

Behavioral

signs

Feeding difficult Extreme irritability or crying Little interest in surrounding Excessive sleeping

clinical manifestation
delayed

gross motor development

The most common clinical manifestation in all types of CP (delay in all motor accomplishments; delay becomes more profound as the child grows)
Abnormal

motor performance

(e.g. early dominant hand preference, abnormal and asymmetrical crawl, poor sucking, feeding problems or persistent tongue thrust)

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Alterations

of muscle tone

(e.g. increased or decrease resistance to passive movements, child feels stiff when handling or dressing, difficulty in diapering or opisthotonos)
Reflex

abnormalities

(e.g. scissoring legs or persistent infantile posturing)

Abnormal

postures

(e.g. persistent primitive reflexes, such as tonic neck of hyperreflexia)

Testes and diagnoses

Early signs of cerebral palsy may be present from birth. But if signs and symptoms are mild, it may be difficult to make a definite diagnosis before the first year.
Neurologic

examination and history

Cranial ultrasound CT scan Magnetic resonance imaging (MRI)

Electroencephalogram

(EEG)

If the child has had seizures, your doctor may recommend an electroencephalogram (EEG) to check for epilepsy.

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Lab

result

blood may need to be checked to help rule out other conditions such as blood-clotting disorders that can cause strokes that may mimic cerebral palsy signs and symptoms.

The

persistence of primitive reflexes

Tonic neck reflex Crossed extensor reflex

Therapeutic management
Mobilizing

devices

Ankle-foot orthoses (AFO) Wheeled scooter boards Wheeled go-carts

Surgery

Orthopedic surgery

Neurosurgical procedures

Cont..
Medication

Dantrolene sodium Baclofen Diazepam (decrease spasticity and pain control)

Intrathecal Baclofen pump

Infuse Baclofen directly into the intrathecal space surrounding the spinal cord

Associated

problem

Speech-language therapy
Dental care Neurologic deficit

Thank you