Cerebral Palsy PDF

CEREBRAL PALSY Definition -CP is a nonspecific term applied to nonprogressive disorders (brain defect or lesion) present at birth or thereafter, characterized by impaired movement and posture and may be accompanied by perceptual problems, language deficits, and intellectual...

CEREBRAL PALSY Definition -CP is a nonspecific term applied to nonprogressive disorders (brain defect or lesion) present at birth or thereafter, characterized by impaired movement and posture and may be accompanied by perceptual problems, language deficits, and intellectual impairment. The etiology, clinical features, and course are variable and are characterized by abnormal muscle tone and coordination as the primary disturbances. A variety of prenatal, perinatal, and postnatal factors contribute to the etiology of CP. CP results more often from perinatal problems (especially birth asphyxia) and existing prenatal brain abnormalities. Aetiology Aetiology-Prenatal TORCHES group of infections (Toxoplasmosis, Rubella, Cytomegalovirus, Herpes, Syphilis) Exposure to drugs Congenital malformations Rh incompatibility-kernicterus Maternal health problems CT prenatal aetiology Drug Exposure-CP Alcohol Cocaine Heroin Marijuana CT Aetiology Aetiology- Perinatal Low apgar scores Problem deliveries Respiratory problems Neonatal hypotension CT Aetiology Aetiology-Postnatal Post meningitis Head trauma Cerebral vascular accidents Non-accidental trauma-child abuse  Pathophysiology: Prenatal cerebral hypoxia can be responsible for systemic degeneration of immature areas of the brain and can interfere with cell maturation The severity of the damage depends on the gestational age at the time of injury and the degree of injury sustained. Low birth weight and birth asphyxia are commonly identified risk factors for cerebral palsy. Malformation of the CNS play an important role in brain injury from perinatal trauma, and they predispose the infant to greater probability of sustained injury to the CNS. Asphyxia and Hypoxia oedema in the brain. Lack of oxygen and incorporation of amino acids during the synthesis of protein leads to acidosis. CO2 and lactic acid accumulate with acidosis, causing osmotic pressure changes. This condition contributes to generalized cerebral swelling and CNS damage.  Classification-CP Movement type Spasticity-associated with increased muscle tone, prolonged primitive reflexes, exaggerated deep tendon reflexes, clonus, rigidity of the extremities, scoliosis, contractures Dyskinesia-(Abnormal involuntary movement) extreme difficulty in fine motor coordination and purposeful movements i.e. Jerky, uncontrolled, and abrupt, resulting from injury to the basal ganglia or extrapyramidal tracts (Athetosis, Chorea, Tremor, Rigidity) Ataxia-Gait disturbances and instability. Infant may have hypotonia at birth and stiffness of the trunk muscles develops by late infancy. Mixed Classification-CP Topographical Monoplegia Hemiplegia Paraplegia Diplegia Triplegia Quadriplegia  Clinical Manifestations Delayed gross motor development Abnormal motor performance Alterations in muscle tone Abnormal postures Reflex abnormalities Associated disabilities o Subnormal learning and reasoning (mental retardation in about 2/3 of individuals) o Seizures o Impaired behavioural and interpersonal relationships o Sensory impairment (vision, hearing, etc.) Diagnostic Evaluation: The neurologic examination and history are primary modalities for diagnosis of CP. A thorough knowledge of normal variations of motor development is required for detecting abnormal progress. CT Diagnostic Evaluation: Birth History Weight Gestational age Any complications Was child in neonatal intensive care Was ventilator assistance needed If birth history normal consider-neurological consult CT Diagnostic Evaluation: Motor Milestones Head control-3-4 months Sitting –6 months Crawling –9 months Stand and Cruise- 10 months Walking- 12-18 months Adjust for prematurity CT Diagnostic Evaluation Physical Examination Assess motor tone with range of motion extremities Deep tendon reflexes Look for asymmetry Clonus-rapid dorsiflexion of ankle Fine motor activities i.e. assess for Balance, Sitting, Gait e.t.c. Much is learned by an examiner sitting and watching the child’s activity. Medical conditions Strabismus Difficulty swallowing Frequent choking Speech Vision Seizures Therapeutic Management Goals of therapy are early recognition and promotion of an optimum developmental course. Clinical picture may change with growth and development. The disorder is permanent, and therapy is chiefly symptomatic and preventive. Fundamental component to an effective treatment regimen includes ongoing assessment, evaluation, and revision of the child’s overall management plan Use of intrathecal Baclofen pumps and Botulinium toxin has shown some improvement in selected children with CP The management varies with age, type and severity of involvement, and associated disorders. The scope of care of child and family includes social and educational intervention and multidisciplinary team approach.