Cerebral Palsy

- Motor impairment syndrome secondary to non progressive lesion in developing brain [anomalies/ lesion of brain before/
after birth]

Risk Factors Antenatal (80%) & Birth (10%) Postnatal (10%)

 Congenital malformation  Meningitis
 Congenital infection: rubella, CMV, herpes  Head trauma, intraventricular
 Maternal seizure hemorrhage
 Treatment w thyroid hormone, estrogen, progesterone  Symptomatic hypoglycaemia
 Pregnancy complication polyhydramnios, eclampsia,  Hydrocephalus
maternal fever, abnormal fetal presentation  Cerebral ischemia: Stroke, near
 Prematurity – vulnerable to brain damage from drowning
periventricular leucomalacia (PVL) secondary to  Hyperbilirubinemia/ kernicterus
ischemia, severe intraventricular hemorrhage
 Low birth weight, fetal growth retardation (<1500g)
 Hypoxic ischemic encephalopathy (birth asphyxia)
Comorbidity w  Epilepsy
 Learning difficulty
 Behavioural changes
 Sensory impairment
 Visual impairment, squint
 Hearing loss
 Speech and language difficulties
Types Spastic (90%) – cerebral cortex Dyskinetic (6%) – basal ganglia Ataxic (4%) – cerebellum

 Damage to upper motor
neurone (pyramidal,
corticospinal tract)
 Hypotonia  spaticity w
UMN signs
 Hypotonia – head, trunk
 Hemiplegia: unilateral
involvement [meningitis]
 Diplegia: legs > arms [hypoxic
ischemia encephalopathy,
HIE]
 Quadriplegia: HIE
 Chorea – irregular, sudden,  Trunk & limb hypotonia
brief non repetitive  Poor balance
movement  Delayed motor development
 Athethosis – slow writing  Incoordinate movement,
movement occurring more intention tremor
distally: fanning of fingers  Wide based gait
 Dystonia – simultaneous
contraction of agonist &
antagonist muscle of trunk &
proximal muscle – twisting
appearance
C/F <6m
 X support their head, over-extend their back & neck when being held
 Feel stiff/ hypertonic, floppy/ hypotonic
 Have cortical thumbs/ thumbs persistently bent towards the center of the palm

>6m
 x roll over in either direction
 develop right/ left handedness earlier than normal [reach out with one hand while keeping the other
one in fist]
 have struggle to bring their hands together
>10m
 unable to crawl on all 4 limbs
 unable to stand on their own, even with support
Young children
 Abnormal limb, trunk posture & tone w delayed motor milestone
 Feeding difficulty, oromotor incoordination, slow feeding, gagging, vomiting
 Abnormal mouth & tongue pattenrs: retracting & thrusting the tongue, frequent grimacing
 Joint & bone deformity & contracture (permanent fixed, tight muscles, joints)
 Abnormal gait once walking is achieved: scissoring gait
 Poor coordination, difficulty speaking
 Persistence primitive reflexes: moro reflex, rooting reflex, palmar reflex

Investigations  Cytogenetic : chromosome karyotype

 Metabolic: thyroid function test, LFT, BUSE, amino acid
 Congenital infection screen
 Imaging: cranial u/s, CT, MRI, skeletal survey
 EEG, nerve conduction study
 Nerve & muscle biopsy
 Others: hearing, vision, cognitive assessment

Management  Occupational therapist, physiotherapist, speech therapist

 Developmental psychologist
 Paediatrician, orthopaedic surgeon, ophthalmologist, audiologist