Cerebral Palsy
Content
CEREBRAL PALSY
HISTORY
• Cerebral palsy Was known as little Disease • Spastic legs, lesser involvement of arm • Sigmund Freud(1897)- difficult birth
WHAT IS CEREBRAL PALSY
• Cerebral palsy is an umbrella-like term used to describe a group of chronic disorders impairing control movement that appear in early year of life(5-7 years) and generally do not worsen over time. • Faulty development or damage of brain that lead to disruption of movement and posture.
HOW MANY CHILDREN ARE AFFECTED
• 2 children born with CP out of everey 1000 live births.
RISK FACTORS IN CP
General- Gestational age < 32 weeks Birth weight > 2500gms Material History—Mental retardation Seizure disorder Hyperthyroidism Two or more fetal deaths During gestation- Twin gestation Fetal growth retardation third trimester bleeding Premature placentas separation Fetal factors- Abnormal fatal presentation Fetal bradycardia Neo natal seizure.
What are the early signs?
• Early signs of cerebral palsy usually appear before 3 years of age, and parents often suspect that their infant is not developing motor skills normally. • Infants with cerebral palsy are frequently slow to reach developmental milestones, such as learning to toll over, sit, crawl, smile, or walk. • This is sometimes called developmental delay. Some affected children have abnormal muscle tone. Decreased muscle tone is called hypotonia. • The baby may seem flaccid and relaxed, even flabby increased muscle tone is called hypertonia, and thereby may seem stiff or rigid. In some cases, the baby has an early period of hypotonia that progress to hypertonia after the first 2 to 3 months of life. Affected children may also have unusual posture or favor one of their body.
WHAT ARE DIFFERENT FORMS
• • • • Spastics Athetiod or dyskinetics Ataxics Mixed
SPASTIC CEREBRAL PALSY
• 70 to 80% of patients • Muscle are stiffed • Four typesdiplegia, quadriplgia, hemiplegia, double hemiplegia etcs • Scissors gait, knees touched eached others
ATHETIOD CEREBRAL PALSY
• Uncontrolled, slowed, writhing movements characterize this form of cerebral palsy . • Affect hands, feet, arms or legs , muscle of face and tongue • Disappear in sleep • 10 to 20 % of cerebral palsy
ATAXIC CEREBRAL PALSY
• Affect balance and depth of perception • Poor coordination, walk unsteadily • Difficulty in writing , buttoning , tremors and reaching for books increase tremor • 5 to 10 %
MIXED FORMS
• Common forms- spastics and athetoid movements
WHAT ARE ASSOCIATED MEDICAL DISORDERS
• Mental impairment • seizure • Growth • impaired vision or hearing • Abnormal sensation and perception
CAN CEREBRAL PALSY PREVENTED
• Head injury can prevented by safety belt , helmets. • Jaundice- - blue light • Rh incompatibility- serum treatment, blood transfusion if anti body develop
HOW IS THE CEREBRAL PALSY MANAGED?
• It cannot be cured • But treatment can often improve a child’s capabilities • Many patients can enjoy near-normal lives if their neurological problems are properly managed. • No standard therapy • It’s a team work • Management needs assessment of individual ‘s unique needs and impairments.
A TYPICAL TREATMENT TEAM INCLUDES
• A Physician: such as a pediatrician, a pediatric neurologist, or a pediatric physiatrist • An Orthopedist • A Physical therapist • An Occupational therapist • A Speech and Language pathologist • A Social Worker • A Psychologist • An Educator
WHAT SPECIFIC TREATMENTS ARE AVAILABLE?
• • • • • Physical therapy Behavioural therapy Drug therapy Surgery Mechanical aids
ASSESSMENT OF CHILDREN WITH CEREBRAL PALSY
• The following frameworks could be used:
– – – – – Diagnosis (which kind of CP) History Family’s concerns General impression Abilities
ASSESSMENT…
– – – – – Inabilities Basic tone Postural patterns Contractures and deformities Main underlying problems
• The quality of the child’s postural tone” • Severely spastic or moderately spastic • Athetoid, • Ataxic, • Flaccid, • Mixed (athetoid with spasticity).
FEATURES OF SEVERE SPASTICITY:
• • • • • • • • • • Exaggerated co-contraction, Tone unchanging with changing conditions Tone increased proximally more than distally Very little or no movement Movement only in middle range Difficulty in initiating movement Difficulty in adjusting to being moved or handled No balance or protective reactions Poor righting reactions Associated reactions causing increased spasticity not seen as movements.
FEATURES OF MODERATE SPASTICITY:
• Changeable hypertonus rising from relatively normal at rest to high or very high with stimulation, effort, speech or emotion (particularly fear).
• Poor balance and protective responses.
• Spasticity more distal than proximal.
FEATURES OF MODERATE SPASTICITY:
• Associated reactions, seen as movemtns, likely to increase spasticity as child uses effort to function. • Child likely to move and function using stereotyped abnormal patterns, • Total patterns of flexion or extension which are likely to be compensatory, i.e., flexion in lower limbs with extension in upper and vice versa.
FEATURES OF ATHETOSIS
• Constant fluctuations in tone between abnormally high and abnormally low. • Involuntary movements. • Lack of adequate co contraction leading to difficulty in sustaining postural control against gravity and poor proximal fixation, • Inadequate balance and protective responses, • Marked asymmetry • Lack of grading of movement, • Child dislikes being held still.
FEATURES OF ATAXIA:
• Postural tone is fairly low to normal. The child cann move and hold some postures against gravity. • Co contraction is poor, causing difficulty in holding steady postures. • Proximal fixation is not effective for carrying out selective movements. • There may be an intention tremor and jerky quality of movement, especially with effort and against gravity. • Inadequate balance reactions and slow or delayed protective responses. • Poor grading of movement.
FEATURES OF FLACCIDITY OR HYPOTONUS (LOW TONE).
• • • • Child takes up all available support, Poor head and trunk control Child does not move much Joints are hypermobile (wide range of movement) • Child does not respond even to strong stimulation • Associated problems such as poor vision, hearing, speech and difficulty in feeding.
Thank You
HISTORY
• Cerebral palsy Was known as little Disease • Spastic legs, lesser involvement of arm • Sigmund Freud(1897)- difficult birth
WHAT IS CEREBRAL PALSY
• Cerebral palsy is an umbrella-like term used to describe a group of chronic disorders impairing control movement that appear in early year of life(5-7 years) and generally do not worsen over time. • Faulty development or damage of brain that lead to disruption of movement and posture.
HOW MANY CHILDREN ARE AFFECTED
• 2 children born with CP out of everey 1000 live births.
RISK FACTORS IN CP
General- Gestational age < 32 weeks Birth weight > 2500gms Material History—Mental retardation Seizure disorder Hyperthyroidism Two or more fetal deaths During gestation- Twin gestation Fetal growth retardation third trimester bleeding Premature placentas separation Fetal factors- Abnormal fatal presentation Fetal bradycardia Neo natal seizure.
What are the early signs?
• Early signs of cerebral palsy usually appear before 3 years of age, and parents often suspect that their infant is not developing motor skills normally. • Infants with cerebral palsy are frequently slow to reach developmental milestones, such as learning to toll over, sit, crawl, smile, or walk. • This is sometimes called developmental delay. Some affected children have abnormal muscle tone. Decreased muscle tone is called hypotonia. • The baby may seem flaccid and relaxed, even flabby increased muscle tone is called hypertonia, and thereby may seem stiff or rigid. In some cases, the baby has an early period of hypotonia that progress to hypertonia after the first 2 to 3 months of life. Affected children may also have unusual posture or favor one of their body.
WHAT ARE DIFFERENT FORMS
• • • • Spastics Athetiod or dyskinetics Ataxics Mixed
SPASTIC CEREBRAL PALSY
• 70 to 80% of patients • Muscle are stiffed • Four typesdiplegia, quadriplgia, hemiplegia, double hemiplegia etcs • Scissors gait, knees touched eached others
ATHETIOD CEREBRAL PALSY
• Uncontrolled, slowed, writhing movements characterize this form of cerebral palsy . • Affect hands, feet, arms or legs , muscle of face and tongue • Disappear in sleep • 10 to 20 % of cerebral palsy
ATAXIC CEREBRAL PALSY
• Affect balance and depth of perception • Poor coordination, walk unsteadily • Difficulty in writing , buttoning , tremors and reaching for books increase tremor • 5 to 10 %
MIXED FORMS
• Common forms- spastics and athetoid movements
WHAT ARE ASSOCIATED MEDICAL DISORDERS
• Mental impairment • seizure • Growth • impaired vision or hearing • Abnormal sensation and perception
CAN CEREBRAL PALSY PREVENTED
• Head injury can prevented by safety belt , helmets. • Jaundice- - blue light • Rh incompatibility- serum treatment, blood transfusion if anti body develop
HOW IS THE CEREBRAL PALSY MANAGED?
• It cannot be cured • But treatment can often improve a child’s capabilities • Many patients can enjoy near-normal lives if their neurological problems are properly managed. • No standard therapy • It’s a team work • Management needs assessment of individual ‘s unique needs and impairments.
A TYPICAL TREATMENT TEAM INCLUDES
• A Physician: such as a pediatrician, a pediatric neurologist, or a pediatric physiatrist • An Orthopedist • A Physical therapist • An Occupational therapist • A Speech and Language pathologist • A Social Worker • A Psychologist • An Educator
WHAT SPECIFIC TREATMENTS ARE AVAILABLE?
• • • • • Physical therapy Behavioural therapy Drug therapy Surgery Mechanical aids
ASSESSMENT OF CHILDREN WITH CEREBRAL PALSY
• The following frameworks could be used:
– – – – – Diagnosis (which kind of CP) History Family’s concerns General impression Abilities
ASSESSMENT…
– – – – – Inabilities Basic tone Postural patterns Contractures and deformities Main underlying problems
• The quality of the child’s postural tone” • Severely spastic or moderately spastic • Athetoid, • Ataxic, • Flaccid, • Mixed (athetoid with spasticity).
FEATURES OF SEVERE SPASTICITY:
• • • • • • • • • • Exaggerated co-contraction, Tone unchanging with changing conditions Tone increased proximally more than distally Very little or no movement Movement only in middle range Difficulty in initiating movement Difficulty in adjusting to being moved or handled No balance or protective reactions Poor righting reactions Associated reactions causing increased spasticity not seen as movements.
FEATURES OF MODERATE SPASTICITY:
• Changeable hypertonus rising from relatively normal at rest to high or very high with stimulation, effort, speech or emotion (particularly fear).
• Poor balance and protective responses.
• Spasticity more distal than proximal.
FEATURES OF MODERATE SPASTICITY:
• Associated reactions, seen as movemtns, likely to increase spasticity as child uses effort to function. • Child likely to move and function using stereotyped abnormal patterns, • Total patterns of flexion or extension which are likely to be compensatory, i.e., flexion in lower limbs with extension in upper and vice versa.
FEATURES OF ATHETOSIS
• Constant fluctuations in tone between abnormally high and abnormally low. • Involuntary movements. • Lack of adequate co contraction leading to difficulty in sustaining postural control against gravity and poor proximal fixation, • Inadequate balance and protective responses, • Marked asymmetry • Lack of grading of movement, • Child dislikes being held still.
FEATURES OF ATAXIA:
• Postural tone is fairly low to normal. The child cann move and hold some postures against gravity. • Co contraction is poor, causing difficulty in holding steady postures. • Proximal fixation is not effective for carrying out selective movements. • There may be an intention tremor and jerky quality of movement, especially with effort and against gravity. • Inadequate balance reactions and slow or delayed protective responses. • Poor grading of movement.
FEATURES OF FLACCIDITY OR HYPOTONUS (LOW TONE).
• • • • Child takes up all available support, Poor head and trunk control Child does not move much Joints are hypermobile (wide range of movement) • Child does not respond even to strong stimulation • Associated problems such as poor vision, hearing, speech and difficulty in feeding.
Thank You
