CEREBRAL

PALSY
By: Ida Sherri L. Corvera
BSN III - NM
William John Little
(1810-1894)

In 1860s, known as
"Cerebral Paralysis or Littles Disease
After an English surgeon wrote the 1st medical descriptions
CEREBRAL PALSY (CP)
Cerebral- Latin Cerebrum;
Affected part of brain
Palsy " -Gr. para- beyond,
Lack of muscle control
CEREBRAL
PALSY

lysis loosening

A motor function disorder

caused by permanent, non-progressive brain lesion
present at birth or shortly thereafter. (Mosby, 2006)

Non-curable, life-long condition

Damage doesnt worsen
May be congenital or acquired
CEREBRAL PALSY
A Heterogenous Group
of Movement Disorders
CP Affects
Muscle
Strength

CAUSES
OF CEREBRAL PALSY
An insult or injury to the brain
CAUSES

Development Malformations
The brain fails to develop correctly.

Neurological damage
Can occur before, during or after delivery
Rh incompatibility, illness, severe lack of oxygen

* Unknown in many instances

CHIEF CAUSE
Severe deprivation of oxygen or
blood flow to the brain

TYPES
OF CEREBRAL PALSY
Accdg. to Neurologic Deficits
Based on the
- extent of the damage
- area of brain damage

Each type involves the way a person moves

3 MAIN TYPES
PYRAMIDAL
- originates from the motor areas of the cerebral cortex
2. EXTAPYRAMIDAL
- basal ganglia and cerebellum
3. MIXED
2. Accdg. to Type of Movement

4 MAIN TYPES
PYRAMIDAL
1. Spastic CP

EXTAPYRAMIDAL 2. Athethoid CP
3. Ataxic CP
MIXED
4. Spastic &
Types of Spastic CP
According to affected limbs:
* plegia or paresis - meaning paralyzed or weak:
Paraplegia
Diplegia
Hemiplegia
Quadriplegia
Monoplegia one limb (extremely rare)
Triplegia
three limbs (extremely rare)
DEGREE OF SEVERITY
1. Mild CP- 20% of cases

Athethoid CP

Moderate CP- 50%

- require self help for assisting their impaired ambulation capacity.

Severe CP- 30%;

-totally incapacited and bedridden and they always need care from others.
Signs and Symptoms
OF CEREBRAL PALSY
Early Signs
Early Signs

Abnormal or prolonged primitive reflexes

Moros reflex
Asymmetric tonic neck reflex
Placing reflex
Landau reflex

CHILD with CP
Behavioral Symptoms
Poor ability to concentrate,
unusual tenseness,
Irritability
ASSOCIATED PROBLEMS
OF CEREBRAL PALSY

Hearing and visual problems

Sensory integration problems
Failure-to-thrive, Feeding problems
Behavioral/emotional difficulties,
Communication disorders

Diagnosis
OF CEREBRAL PALSY
DIAGNOSIS
Physical evaluation, Interview
MRI, CT Scan EEG
Laboratory and radiologic work up
Assessment tools
i.e. Peabody Development Motor Skills, Denver Test II

ASSESSMENT

1. SUBJECTIVE
- INTERVIEW
a. History Taking
Include all that may predispose an infant to brain damage or CP
Risk factors
Psychosocial factors
Family adaptation
b. Childs Health History
Often admitted to hospitals for corrective surgeries and other complications.

Respiratory status
Motor function
Presence of fever
Feeding and weight loss
Any changes in physical state
Medical regimen

2. OBJECTIVE
- Physical Examination
CRITERIA
P osturing / Poor muscle control and strength
O ropharyngeal problems
S trabismus/ Squint
T one (hyper-, hypotonia)
E volutional maldevelopment
R eflexes (e.g. increaseddeep tendon)
*Abnormalities 4/6 strongly point to CP

Treatment
OF CEREBRAL PALSY
- No treatment to cure cerebral palsy.
- Brain damage cannot be corrected.

Crucial for children with CP:

Early Identification;
Multidisciplinary Care; and
Support

The earlier we start,

the more improvement can be made
-Health worker

I. Nonphysical Therapy
General management
- Proper nutrition and personal care

B. Pharmacologic
Botox, Intrathecal, Baclofen
- control muscle spasms and seizures,
-control drooling
Pamidronate -may help with osteoporosis.

Glycopyrrolate

C. Surgery
-To loosen joints,
-Relieve muscle tightness,
- Straightening of different twists or unusual curvatures of leg muscles
- Improve the ability to sit, stand, and walk.
Selective posterior rhizotomy
In some cases nerves need to be severed to decrease muscle tension of
inappropriate contractions.
D. Physical Aids
Orthosis, braces and splints
Positioning devices
Walkers, special scooters, wheelchairs
E. Special Education
F. Rehabilitation Services- Speech and occupational therapies
G. Family Services -Professional support
H. Other Treatment
-

Therapeutic electrical stimulation,

Acupuncture,
Hyperbaric therapy
Massage Therapy might help

'The ultimate long-term goal is realistic independence. To get there we have

to have some short-term goals.
Those being a working communication system, education to his potential,
computer skills and, above all, friends'.
- Parent of boy with CP

II. Physical Therapy

Sitting

- Vertical head control and

head and trunk.

control of

B. Standing and walking

- Establish an equal distribution of weight on each
foot, train to use steps or inclines

C. Prone Development
D. Supine Development
o Head control on supine and positions

NURSING RESPONSIBILITIES
NURSING RESPONSIBILITIES

Functioning as a member of the health team

Providing counseling and education for the parents and promote optimal
family functioning
C. Promoting physical and psychological health
D. Assisting with feeding management and toilet training
E. Assisting with rehabilitation therapies
(physical, occupational and speech)
F. Providing counseling for educational and vocational pursuits
G. Preventing child abuse
H. Providing care during hospitalization
Prevent physical injury

Prevent physical deformity

K. Promote a positive self-image