Professional Documents
Culture Documents
Walking 5 meters
(eg, in bedroom or other
room)
Walking 50 meters
(eg, at school, in the
classroom and playground)
Walking 5oo meters
( eg, in the shopping mall or
street)
GMFC
5 level system
Severity of motor involvement based on
age, motor ability and use of assistive
technology
Natural history
Child below normal size
Poor motor and cognitive skills
Deformities of joints and bones
Associated complications; epilepsy,
visual impairment, musculoskeletal
deformities, growth delay, sleep
disturbance and reduced life expectancy
Epilepsy
Higher incidences in quadriplegia than
dyskinesia and spastic diplegia esp,
preterm infants
Epilepsy is linked with an increased risk
of sensory & cognitive impairment
Seizures lead to developmental
regression
Sensory impairment
Visual impairment (7% to 9%)
Visual impairment leads to uncontrolled
trunk and head
Lack of proprioceptive & tactile system
Diminished anticipatory control
Nutritional factors and ability to walk
are significant factors in decreased
bone mineral density
Difficulty in swallowing and chewing
Reflux result in aspiration and
consequent chest infection
Sleep disturbance due to:
Sleep hypoxemia
Upper airway obstruction
Decreased melatonin level
Nocturnal seizures
Reflux and positional discomfort
Causes of hypoxemia
Brainstem dysfunction
Upper airway obstruction (hypertrophy
of tonsils & adenoids
Musculoskeletal deformities in
different types of cerebral palsy
Imbalances in muscle group
Deformities of joints and bones
Osteopororosis in children unable to
walk
Hemiplegia
Smaller limbs in affected side
Leg shortening
Equinus of the foot and ankle
Flexion of the elbow, wrist and fingers
Adducted thumb
Diplegia
Contractures of the hip flexors & adductors
& hamstrings & calf & internal rotation of
the hip and femoral anteversion
Hyperextension of the knee to compensate
for tight tendo-achilles
Kyphosis as a sequel to tight hamstrings
Hyperlordosis as a compensatory balance
mechanism
Quadriplegia
Dislocation of hips
Pelvic obliquity
Spinal curvature
Limitation in sitting, standing and
walking and hygiene and personal care
Windswept deformity
Joint pain
Gross Motor Function
Classification System
Level I
Walks without restriction: limitations
to more advanced gross motor skills
Level II
Walks without assistive devices;
limitations in walking outdoors and in
community
Level III:
Walks with
assistive
devices ;
limitations in
walking
outdoors and in
community
Level IV:
Self-mobility with
limitations;
children are
transported or
use powered
mobility outdoors
and in community
Level V
Self –mobility is severely limited , even
with the use of assistive technology
Effects of C.P in life periods
Birth to 3 years
conservative and non invasive treatment
Preschool
increasing complications
School age
social participation
Effects of C.P in life periods
Maturation
sexual maturation
social acceptance
emphasize on function
Adulthood
Senior adult
Medications
Antiemetrics to control gastric reflux
Baclofen orally or intrathecally
Dantrolen sodium
Weakness,
Tizanidine liver
dysfunction
Neurolytic blocks
BTX-A
Anticonvulsants
Surgical and orthopedic
management
Release of tendon, muscle or
connective tissue for lengthening
Bony surgery
Multilevel surgery at the hip, knee and
ankle
Selective Dorsal rhizotomy
Devide the posterior nerve rootlets in
the lumbosacral region to reduce lower
limb spasticity
Management assistance
Holding, Baby carrying
Positioning
Daily care
Orthosis
Adaptive equipments
Management
Assessment of Tone, Motor behavior
pattern, posture, sensory status specially
vision (cataract, congenital glaucoma,
strabismus, visual acuity, blindness,
nistagmus, hemianopia
Monoplegia 100%
Hemiplegia 100%
Ataxia
85-90%
Diplegia 0-70%
Predictor Ambulation
By motor function Potential
Sit independently by 2 years 100%