Cerebral Palsy Pediatrics Lectures PDF

CEREBRAL PALSY  WHAT IS CEREBRAL PALSY? Cerebral palsy describes a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. Occur dur...

CEREBRAL PALSY  WHAT IS CEREBRAL PALSY? Cerebral palsy describes a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. Occur during pregnancy ,childhood, or after birth up to about age 5.  WHAT IS CEREBRAL PALSY? Cerebral palsy (CP) is a broad term used to describe a group of chronic "palsies" disorders that impair control of movement due to damage to the developing brain. The symptoms due to the brain damage often change over time , sometimes getting better and sometimes getting worse. CP is one of the most common causes of chronic childhood disability.  causes Pre-natal: Vascular events such as a middle cerebral artery infarct Maternal infections during the first and second trimesters such as rubella, cytomegalovirus, and toxoplasmosis Less common: metabolic disorders, maternal ingestion of toxins, and rare genetic syndromes  causes Perinatal: Problems During Labour and Delivery Obstructed labour Antepartum hemorrhagic Cord prolapse Other Neonatal Causes Hypoxic–ischemic encephalopathy Neonatal stroke, usually of the middle cerebral artery Severe hypoglycaemia Untreated jaundice Severe neonatal infection  causes Post-natal acquired CP Metabolic Encephalopathy Storage disorders Intermedullary metabolism disorders Metabolic disorders Miscellaneous disorders Toxicity such as alcohol  Infections Meningitis Septicemia Malaria (in developing countries) Injuries Cerebrovascular accident Following surgery for congenital malformations Near-drowning Trauma Motor vehicle accident Child abuse such as shaken baby syndrome  Risk Factors During Pregnancy Preeclampsia in term infants but not in preterm infants Multiple pregnancies associated with: Preterm delivery. Poor intrauterine growth. Birth defects. Intrapartum complications.  Risk Factors During Labor Likely Causes of Perinatal Asphyxia Prolapsed cord Massive intrapartum haemorrhage Prolonged or traumatic delivery due to cephalopelvic disproportion or abnormal presentation Large baby with shoulder dystocia Maternal shock from a variety of causes  Events Associated with Causal Factors Prolonged second-stage labor Emergency Cesarean section Premature separation of placenta Abnormal fetal position In Preterm, Can Include: Meconium-stained fluid Tight nuchal cord  Risk Factors for Preterm Infants Patent ductus arteriosus Hypotension Blood transfusion Prolonged ventilation Pneumothorax Sepsis Hyponatremia Total parenteral nutrition Seizures Parenchymal damage with appreciable ventricular dilatation  CLASSIFICATION PHYSIOLOGICAL CLASSIFICATION ANATOMICAL CLASSIFICATION  PHYSIOLOGICAL CLASSIFICATION Spastic CP. Ataxic CP. Athetoid CP. Mixed type CP. Hypotonic CP.  ANATOMICAL CLASSIFICATION Monoplegia.→ Only one limb is affected Hemiplegia. → Upper and lower limbs on one side of body Diplegia. → All limbs are affected ,the lower more than upper limbs Quadriplegia→ all the four limbs are affected.  SPASTIC Spastic cerebral palsy is by far the most common type, occurring in 80% of all cases. Child with this type of CP are hypertonic and have mobility impairment due to lesion in motor cortex. Clonus of the affected limbs may sometimes result.  SPASTIC  The spasticity can and usually does also lead to very early onset of muscle-stress symptoms like arthritis and tendinitis.  Sever spastic children experiences Hip dislocations often.  Often gets Epilepsy.  40% of cases will have MR.  ATAXIC Ataxia-type is caused by damage to the cerebellum. Occurring in at most 10% of all cases. Some of these children have hypotonia and tremors.  ATAXIC Motor skills such as writing, typing, or using scissors might be affected, as well as balance, especially while walking. It is common for these children to have difficulty with visual and/or auditory processing.  ATHETOID Athetoid cerebral palsy or dyskinetic cerebral palsy is mixed muscle tone – both hypertonia and hypotonia mixed with involuntary motions. People with Dyskinetic CP have trouble holding themselves in an upright, steady position for sitting or walking, and often show involuntary motions.  ATHETOID For some people with dyskinetic CP, it takes a lot of work and concentration to get their hand to a certain spot Because of their mixed tone and trouble keeping a position, they may not be able to hold onto objects, especially small ones requiring fine motor control. Supra nuclear palsy, feeding and speech disorders and may be deafness.  ATHETOID About 10% of individuals with CP are classified as dyskinetic CP but some have mixed forms with spasticity and dyskinesia. The damage occurs to the extrapyramidal motor system and/or pyramidal tract and to the basal ganglia. In newborn infants, high bilirubin levels in the blood, if left untreated, can lead to brain damage in the basal ganglia (kernicterus), which can lead to dyskinetic cerebral palsy.  MIXED CP Here the children will have a combination of spastic, ataxic or athetoid. MR is common for 60% of cases. Learning disability is common for these children.  HYPOTONIC CP Hypotonia in a child with CP can be permanent but is more often transient in the evolution of athetosis or spasticity and might not represent a specifc type of CP. For example, an infant who presents with generalized hypotonia through the trunk and extremities will often develop spasticity beginning distally and progressing proximally.  SIGNS AND SYMPTOMS Delayed Milestones. Lack or loss of Head control. Frequent Epilepsy. Drooling of saliva. Deformities in limbs due to tightness of muscles.  SIGNS AND SYMPTOMS Presence of Primitive reflexes. Spastic. Flaccid. Involuntary movements. Lack or loss of movements in limbs.  SIGNS AND SYMPTOMS Lack of social response. Hip dislocations. Inability to sit without support. Mental Retardation. Learning disability.  SIGNS AND SYMPTOMS Spinal deformities. Urinary & fecal incontinence. Dysarthria. Speech impairments. Difficulty in feeding.  DIAGNOSIS Clinical: - Delayed Development. - Primitive reflexes. - Tone abnormality. - Involuntary movements. CT/MRI: - Degeneration of brain cells. (atrophy)  TREATMENT Rehabilitation team: - Neurologist. - Orthopaedician. - Physiotherapist. - Occupational therapist. - Speech therapist. - Special educators. - Parents.  TREATMENT Medical Mx: - Anti convulsive drugs. - Anti spastic drugs.dantrolene sodium,baclofen, botox a injection - Proper supplements. Orthopedics: - Deformity correction. - Muscle length correction.  PHYSIOTHERAPY Passive/Active movements. Active assisted/ Active exercises. Passive stretching. Proper Positioning. Use of proper orthotics. - To prevent deformity. - Gait training. Use of proper assistive devices.  PHYSIOTHERAPY Rood's Approach: - To increase or decrease tone in the muscles. NDT Approach: - Use primitive reflexes to induce developmental milestones. Brunnstrom's Approach: - Train voluntary control. Sensory integration: - To train learning disability.