Cerebral Palsy Introduction PDF

CEREBRAL PALSY DEFINITION: Cerebral palsy (CP) is a neurodevelopmental condition beginning in early childhood and persisting through the lifespan Originally reported by Little in 1861 (called ‘cerebral paresis’)  According to American Academy for cerebral palsy and developmental medicine...

CEREBRAL PALSY DEFINITION: Cerebral palsy (CP) is a neurodevelopmental condition beginning in early childhood and persisting through the lifespan Originally reported by Little in 1861 (called ‘cerebral paresis’)  According to American Academy for cerebral palsy and developmental medicine (1977), cerebral palsy refers to a non-progressive CNS deficit. The lesion may be in a single or multiple locations of the brain, resulting in definite motor and possible sensory abnormalities. It occurs as a result of in-utero factors, events at the time of labor and delivery (congenital CP) or a variety of factors in the early developing years (acquired CP). DEFINITION….. Bax (1964)reported and annotated a definition of CP It stated that CP is ‘a disorder of movement and posture due to a defect or lesion of the immature brain.’ DEFINITION….. Mutch and colleagues modified the definition of CP in 1992 as follows: “An umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development”. DEFINITION….. Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, Causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of Sensation, perception, cognition, communication, and behaviours; By epilepsy, and by secondary musculoskeletal problem EXCLUSION Disorders of posture and movement which are (1) Of short duration (2) Due to progressive disease (3) Solely due to mental deficiency INCIDENCE AND PREVALENCE United Cerebral Palsy (UCP)- 550,000 and 764,000 Americans have a diagnosis of CP 9,750 new cases per year (UCP, 2003) The incidence of CP in developed countries has been reported to be 2 to 2.5 per 1,000 live births (Scherzer, 2001)  The prevalence has increased in industrialized countries Spastic diplegia has become more prevalent with a reduction in the athetoid type of CP (Scherzer, 2001) Incidence is slightly higher in premature neonates (anoxia plays the greatest role in contributing to CP) and in neonates who are small for their gestational age. CP is slightly more common in males than in female  Genetic causes of cerebral palsy account for only 2% of the cases diagnosed. Hughes and Newton (1992) have discussed familial spastic paraplegia, generalized athetosis, and ataxia Joubert syndrome, Marinesco-Sjogren syndrome, Gillespie syndrome, and Behr syndrome are all characterized by ataxia and are a few of the rare genetic disorders associated with CP Different course of the syndrome and named after it and not CP  Maternal disorders that result in “fetal deprivation of supply” including: Bleeding during pregnancy, Placental infarction, Toxemia/ pre-eclampsia Small size for gestational age, Diabetes in the mother, and Multiple pregnancies are also associated with a higher incidence of CP (Hagberg, Hagberg, & Olow, 1976).  Meningitis and encephalitis are the most common infectious causes of cerebral palsy Other medical conditions include: late-onset hydrocephalus, neoplastic intracranial lesions (brain tumors), intracranial hemorrhage due to an arteriovenous malformation or TYPES OF CEREBRAL PALSY Individuals with different types of CP presents with different challenges, and the treatment needs for these individuals will differ Cerebral palsy can be classified into five types. The terms used to classify the types of cerebral palsy relate to the associated muscle tone and movement characteristics of the individual. Muscle tone is “the ‘stiffness’ or tension with which a muscle resists being lengthened”. The common types of cerebral palsy are spastic, dyskinetic (athetoid), ataxic, hypotonic, and a mixed type (symptoms of more than one type of involvement are present)  ACQUIRED CEREBRAL PALSY Individuals who sustain damage to the brain in later childhood, before anatomical or physiological maturation of the brain is complete, are considered to have acquired cerebral palsy. For instance, when children sustain brain damage following brain infections or head injuries during the first 2 years of age, and the sequelae are similar to those of children with brain damage sustained in the prenatal, natal, and perinatal periods, they may be given a diagnosis of cerebral palsy (Scherzer, 2001)  Individuals with acquired cerebral palsy are a more heterogeneous group than those with congenital cerebral palsy with regard to etiology, topographical distribution of the neuromotor dysfunction, and associated conditions For this reason, the term cerebral palsy is not frequently used to describe them. These individuals are usually described by the name of their disorder, but their list of diagnoses would also include reference to their muscle tone and the distribution of that tone, for example, diffuse hypotonia, spastic quadriplegia.  SPASTIC CEREBRAL PALSY Stiffness of muscles in the involved extremities Stiffness throughout the trunk Their movements are slow because of the stiffness, and If their attempt to increase the speed of their movement, the stiffness increases. The direction of their movement tends to be accurate. If, for an example, they are reaching for an object, they reach directly, but slowly, toward that object. The range of movement of individuals with spasticity is frequently reduced, and They may develop contractures and deformities over time.  DYSKINETIC CEREBRAL PALSY Involuntary movements and variable muscle tone Movements are described as slow and writhing Reversal of movement is seen, as when an individual intends to reach for an object placed in front of him or her, and the arm and hand move away from the desired object before he or she is able to redirect the movement toward it Direction of movement is often imprecise, and individuals with dyskinesia will frequently under- or overreach an object  Timing is inconsistent, and latency of initiation of movement is sometimes seen Velocity of movement is generally slow, but this is also inconsistent with rapid movements observed Individuals with tension athetosis or rigidity show consistently increased tone, and resistance is seen throughout the range of movement in both agonist and antagonist muscles and is not velocity dependent Individuals with dyskinesia are also at risk for joint dislocation HYPOTONIC CEREBRAL PALSY Hypotonia or flaccidity is usually seen in very young children This is often a transitional stage, which progresses to either spasticity or dyskinesia Children with severe hypotonia show little voluntary movement They are weak and have little movement against gravity Their range of movement is excessive, and they have postural instability Their development of motor milestones can be severely delayed  ATAXIC CEREBRAL PALSY Hypotonia, Spasticity, or dyskinesia. Imprecise timing of movement, Disturbed balance, and Increased incoordination with attempts to increase speed of movement are characteristic. CLASSIFICATION BASED ON TOPOGRAPHICAL DISTRIBUTION Paresis & plegia Monoplegia Diplegia/paresis Hemiplegia Paraplegia Quadriplegia Pentaplegia CHARACTERISTICS OF THE TYPES OF CEREBRAL PALSY (HOWLE, 2002) Spastic Cerebral Palsy Selective motor control & stiff muscles Abnormal and limited movement synergies Muscle tone increased with velocity-dependent resistance to passive movement Excessive co-activation of muscular activity Limited range of motion Slow muscle activation and postural responses Dyskinetic Cerebral Palsy Movements appear uncontrolled and involuntary Includes athetosis, rigidity and tremor Resistance seen through range of movement in rigidity Movements are abnormal in timing, direction, and spatial characteristics Reversal of movement and/or latency of movement Impaired postural stability Hypotonic Cerebral Palsy Diminished resting muscle tension Decreased ability to generate voluntary muscle Force Excessive joint flexibility Postural instability Often transient with evolution to spasticity or athetosis Ataxic Cerebral Palsy Impaired postural control Disordered balance Imprecise control in timing of coordinated movement Frequently associated with hypotonia Decreased force during active movement Tremor may be present ABNORMAL ORAL MOVEMENT PATTERNS AND POSTURE Lip retraction Increased muscle tone the lips pulled back into a smile posture and the cheeks are tight. The upper lip is elevated and gum ridge/ teeth are visible Interferes with normal feeding UMN disorder- hypertonic reaction Jaw thrust & lack of jaw grading Forceful downward extension of jaw Arrhythmic in nature may appear fixed in a position Movement of jaw – all or none Tonic bite Stimulation of the teeth or gum ridges elicits a strong rapid and forceful bite Release – difficult Tongue retraction Tongue is tight and held back in the oral cavity Range of movement is restricted Sometimes held against the roof of the mouth Removal of spoon/feeding utensil- difficult Tongue thrust Retention of extrusion reflex Tongue may appear thick Transport of food into oral cavity Nasal regurgitation Backward flow of liquid or semi digested food through nasal cavity Abnormal velar function