HANDLING OF CHILDREN WITH

CEREBRAL PALSY

Vinay Kumar
MPT/CNDT
Physiotherapist
SVNIRTAR
 Group of disorders of the development of  
posture and movement, causing limitations in 
activities, attributed to  non-progressive 
disturbances in the developing fetal or infant 
brain. Often, the disorder is associated with 
sensory, behavioral, perception 
communicational and cognitive impairments
• We only talk about cerebral palsy if the brain damage
arises during one of the following periods:

• Prenatal period: Conception to the onset of labor

• Perinatal period: 28 weeks intrauterine to 7
days postnatal
• Postnatal period : First two (and some say five) years
of life

• After the age of 5 we speak of stroke or traumatic

brain injury.
• The prevalence varies between 1-5/1000
babies in different countries.

• The incidence is 2-2,5/1000 live births in

Western Countries.

• Some affected children do not survive.

 INDIA
• Incidence of cerebral palsy is about
• 2-4 per thousand live birth .
• Incidence of cerebral palsy in India has
remained constant over the last 20 years.
• India About 25 Lakh of person are suffering
with cerebral palsy.
• Incidence are 15 time higher in low birth wt
baby(<1.5 kg)
Etiology

 Improved medical care have decreased the 
incidence of CP among some children, 
medical advances have also resulted in the 
survival of children who previously would 
have died at a young age. 

 The type of cerebral palsy has also changed.
 In the 60’s around 20% of children with CP 
had athetoid/dyskinetic cerebral palsy. Today 
only 5 or 10% have this type and 80-90% have 
spastic CP.
 This decrease is mainly due to advances in 
the treatment of hyperbilirubinamia. 
 The increase of spastic cerebral palsy is 
because of higher survival rates for (very 
small premature) babies.
etiology

 Prenatal
 Prematurity (gestational age less than 36 
weeks)
 Low birth weight (less than 2500 g), which 
could be due to poor nutritional status of the 
mother
 Maternal epilepsy
Hyperthyroidism
Herpes simplex virus
 Infections (TORCH =toxoplasmosis, rubella, 
cytomegalovirus, Severe toxemia.

 Drug abuse                    
 Trauma
 Multiple pregnancies
 Placental insufficiency
 Perinatal
 Prolonged and difficult labor
 Vaginal bleeding at the time of admission for 
labor
 Bradycardia
 Hypoxia
 Postnatal (0-2 years)
 Central Nervous System infection 
(encephalitis, meningitis)
 Hypoxia                                   
 Seizures
 Neonatal hyperbilirubinemia
 Head trauma
 There is no way to predict which children’s 
brain will be damaged by one of these factors, 
or to what the extent of the damage will be. 
None of these factors always results in brain 
damage; and even when brain damage 
occurs, the damage does not always result in 
CP.
   E.g.: Some children may have an isolated 
hearing loss from their meningitis, others will 
have severe intellectual disability, and some 
will have CP (either alone, or with these other 
problems, too
Associated problem
types
Early identification

 Cerebral palsy can be identified at very early 
stage by an awareness of risk factors, regular 
developmental screening of all high risk 
babies, thorough neurological examination , 
delayed developmental milestone 
 History of:-
 •  Premature birth, Difficult delivery, Asphyxia, Septicemia , 
Jaundice
 •  Delayed motor mile stones like poor head control, 
inability to sit and stand
 •  Asymmetry in functional use of extremities.
 •  Difficulty in feeding and drooping of saliva
 •  Abnormally increase or decrease in tone.
 •  Involuntary movement.

 Associated problems like mental retardation & speech 
problem, hearing loss, squint and seizure
what parents may recognize

 The primary indicators parents will notice are 
developmental delay and impaired muscle tone.

 Developmental delay occurs when a child does 
not develop specific skills within the predicted 
time period. 

 If parents worry about the development of their 
child: take them seriously, because usually they 
are right!
Medical history

 Doctors  want to know about the child’s prenatal 
history, 
 as well as any complications during pregnancy, 
labor and delivery
  Eliminating other possibilities is a crucial factor 
in diagnosis of cerebral palsy. Both parents’ 
medical histories are important to this process. 
By reviewing medical history of parents, doctors 
can look for possible genetic,(down,spinal 
atrophy)progressive, or degenerative(Cerebral 
atrophy,wilson) nervous system disorders
 Common tests by neurologists or 
neuroradiologists, may include neuroimaging, 
such as  
 computed tomography scan (CT Scan), and 
magnetic resonance imaging scans (MRIs).
 Other specialists can be brought in to test 
hearing, vision, and perception, as well as 
cognitive, behavioral, and physical 
development
Diagnosis of CP

 Diagnosing cerebral palsy takes time, and is 
usually not made until the brain is fully 
developed when the child is two to five years old. 
Exceptions exist, usually in severe cases, when 
the child may be diagnosed soon after birth. 

 For example the average age of diagnosis for a 
child with spastic diplegia, a very common form 
of cerebral palsy, is 18 months.

 There is no definitive test that confirms or rules 
out cerebral palsy
Carrying the child
feeding
Feeding with bottle
Spoon and feeding
HELPING CONTROL MOUTH
FUNCTION
Spoon feeding
4 to 6 month
After 4 to 6 month
Chewing
Drinking
Self-feeding
Physiotherapy
Exercises
Occupational therapy
Orthotic Management
Sitting and standing frame
Botulinum toxininjection
Surgery
Mobility aids
Thank you