PEDIA FINALS
Neurological Disorder
Cerebral Palsy
- A group of non-progressive disorders of
upper motor neuron impairment that results
in motor dysfunction.
- A disorder characterized by impaired
movement & posture resulting from an
abnormality in the extrapyramidal or
pyramidal motor system.
- A damage to the cerebrum or cerebellum
resulting in abnormal muscle tone &
movement with mild-to-severe develop-
mental delays.
- Affected children may have speech or oral
difficulties, seizures, cognitive challenges, or
hyperactivity.
Cause:
1. Unknown but the disorder is associated with
low birth weight
2. Premature birth
3. Birth injury, head injury, severe dehydration
w/ venous thrombosis
4. Brain anoxia leading to cell destruction of
the motor tracts.
5. Nutritional deficiency, drugs, maternal
infection
6. Infection such as meningitis or encephalitis
7. Low birth weight infants or SGA
8. Born of occipito-posterior rather than
anterior births causing anoxia or brain
9. Damage after birth.
10. Shaken baby syndrome
Types:
- Traditionally subdivided into 2 main
categories based on the type of
neuromuscular involvement:
1. Pyramidal or spastic type- 40% affected
2. Extrapyramidal type:
a) ataxic- 10%
b) Dyskinetic or athetoid-30%
c) Mixed- 10%
 Pyramidal or spastic type- Excessive tone in the
voluntary muscles (loss of upper motor neurons).
- Has hypertrophic muscles, abnormal clonus,
exaggeration of deep tendon reflexes,
abnormal reflexes such as + babinski &
tonic reflex
- Held in ventral position- they arch their
backs & extend their arms & legs
abnormally.
- Failed to demonstrate a parachute reflex if
lowered suddenly, failing to hold out their
arms as if to break their fall.
- Assume scissors gait because tight adductor
thigh muscles cause their legs to cross when
held upright.
- tightening of the heel cord usually is so
severe that children walk on their toes,
unable to stretch their heel to touch the
ground.
- Affect both extremities on one
side( hemiplegia), all 4
extremities( quadriple- gia), or( diplegia or
paraplegia).
- Difficulty identifying objects placed in their
involved hand when their eyes are closed
( astereognosis).
 Dyskinetic or Athetoid type
- Involves abnormal involuntary movement.
- Athetoid means “wormlike”.
o Child is limp & flaccid. Later in place of
voluntary movement, he or she makes slow,
writhing motions. It may involve all 4
extremities, plus the face, neck, & tongue.
- With emotional stress, the involuntary
movements may become irregular & jerking
( choreoid) with disordered muscle tone
( dyskinetic).
 Ataxic Type
- Have awkward, wide-based gait.
- On neurologic examination, they are unable
to perform the finger-to-nose test or to
perform rapid, repetitive movements
(cerebellar function) or fine coordinated
motions.
 Mixed type
- Show symptoms of both spasticity &
athetoid movements. Spasticity & athetoid
movements may be present together
resulting to severe degree of physical
impairment.
Assessment of Cerebral Palsy
o Early warning signs of cerebral palsy
Warning Signs
Age: Neonate
 Weak or absent sucking or swallowing
difficulties
 Periods of apnea or bradycardia
 Encephalopathic cry(high-pitched)
 Extremely fussiness & irritability
 Poor tone
 Twitching of an arm or leg
 Not moving extremities normally
 Absent or weak primitive reflex responses
Age: 3 months
 Feeding difficulties, may be caused by
tongue thrust or poor swallowing
 Irritability or listlessness, or both
 Hypotonia, but may have head control in
prone position
 Strabismus, brisk tendon response
 Presence of primitive reflexes
Age: 6 months
 Delay in reaching developmental mile-
stones( motor, speech)
 Continued primitive reflexes
 Hands remain clenched, 1 hand becomes
dominant
 Hypertonia
 Arching or tendency to stand when held up
 Lack of interest in people or toys
 Unaware of or indifferent to stimuli in
environment
 Little if any spontaneous actions
Age : 9 months
 Persistent delay in motor milestones
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 Reach may be atypical as fingers are
extended & arms tremble w/ purposeful
movement
 Arms flexed
Age: 12 months
 Inability to sit alone
 Scissoring of lower extremities
 Toe walking while held, but unable to stand
alone
 Crawl, if present, may be abnormal as only
arms may be used
 Athetoid (irregular , twisting) movement
 Poor articulation or lack of speech
9.Provide safe, appropriate toys for age &
developmental level.
10. Position the child upright after meals.
11. Administer medications as prescribed
12. Surgical interventions are reserved for the
child who does not respond to more conservative
measures or for the child whose spasticity
causes progressive deformity.
13. Provide the child w/ technical aids such as
braces, walkers, customized wheelchairs &
computers or voice synthesizers.
14. Coordinate speech, physical, or occupational
therapy.

Assessment of Cerebral Palsy

o Diagnosis is based on history & physical
assessment.
- episode of possible anoxia during
prenatal life or birth
- sensory alterations such as
strabismus, refractive disorders,
visual perception problems, visual
field defect & speech
- Show attention deficit disorder
- Deafness caused by kernicterus Nursing diagnosis:
- Deficient knowledge related to
Physical findings that suggest CP understanding of complex disease condition
1. Delayed gross motor development Outcome Identification:
2. Abnormal head circumference - Parents will verbalize accurate information
3. Abnormal postures(opisthotonic) about the cause & progress of CP by next
4. Abnormal reflexes, persistence primitive visit.
reflexes Outcome Evaluation:
5. Abnormal muscle performance & tone - Parents state they understand that the
6. Extreme irritability & crying cause of the disease is unknown & that it is
7. Stiff & rigid arms or legs not progressive.
8. Feeding difficulties Nursing Diagnosis:
- Risk for self-care deficit related to impaired
Diagnostic Test mobility.
 Skull radiograph or sonogram- show Outcome Identification
cerebral asymmetry - Child will achieve maximum mobility
 CT or MRI scan negative, EEG abnormal possible during childhood.
Outcome evaluation:
- child feeds & dresses self & manages
Interventions: elimination independently.
1.The goal of management is early recognition &
intervention to maximize the child’s abilities.
2.A multidisciplinary team approach is implemented
to meet the many needs of the child.
3.Therapeutic management includes physical
therapy, occupational therapy, speech therapy,
education, & recreation
4.Assess the child’s developmental & intelligence
5.Encourage early intervention & participation in
school programs.
6.Prepare for using mobilizing devices to help
prevent or reduce deformities.
7.Encourage communication & interaction with the
child on his or her developmental level rather than
chronological age level.
8.Provide a safe environment by removing sharp
objects, using a protective helmet if child falls
frequently, & implementing seizure precautions if
any