CERBRAL PALSY

SPASTIC PARALYSIS / BRAIN DAMAGE

1. Definition

a. The brain disorder that irreparable but not progressive when begin shortly before, during or
after birth, and with disturbancec of voluntary muscle functiom , perception and often
associated with impairment of mental acuity

2. Incidence

a. 2 per 1000 live births

b. Usually in early childhood

3. Etiology

a. Congenital maldevelopment of the brain, especially of the cerebellum

b. Cereberal anoxia in perinatal period at prematurity

c. Birth injury, such as prlongonged labor, injury from forceps, precipitous delivery

d. Kernicterus by early treatment by exchange transfusions

e. Cerebral infections ( encephalitis) in early postnatal

4. Pathology

a. Brain disorders though irreparabel but not progresive

b. The location of the brain lesion are cerebral motor cortex, basal ganglia and cerebellum

5. Type & clinical Features

a. Spastic type (65%) at the pyramidal system lesion inthe cerebral motor cortex

i. Characteristic :

 Paralysis of patterns of voluntary movement

 Increased muscle tone (hypertonicity, spasticity, increased deep tendon reflex, clonus)

ii. Dificult to coordinate muscle action, when the child wants simple movements, many muscle
contract at the same time so the movement become restricted and difficult.

iii. The deep tendon reflexes become hyperactive and increased

iv. The lesion in the cerebral cortex, the spastic paralysismay involve at:
  Only one limb ( monoplegia)

 Upper and lower limb on one side( hemiplegia)

 Both lower limb ( diplegia,paraplegia)

 All four limbs ( tetraplegia)

v. The spastic type

 Stiff

 Clumsy

 Jerky

b. Athetoid type (20%) at extrapyramidal system lesion in the ganglia basalis

i. Characteristic :

 Involuntary

 Uncontrollable movements in muscle group of the face and all four limbs

ii. Athetotic muscle activity produce

 Twisting

 Writting

 Grimaces in the face

 Difficult to speech and eating

iii. The deep tendon reflexes and plantar cutaneous reflexes are normal

c. Ataxic type ( 5%) at cerebellar and brain stem lesion

i. Characteristic: disturbed coordination of muscle groups and relativr lack of equillibrum or

balance.

ii. To walk the child unsteady & frequently fall, to maintain balance using the arms

iii. The intteligence is usually unaffected

d. Tremor, rigidity, atonia type ( 10% of total)

6. Treatment

a. Pschological considerations
 i. For the parent

ii. And the child

b. Therapeutic drugs

i. No type of drug can affect the brain lesion it self and general

ii. The drugs have been used to help control the effect :

 Antikonvusal for the seizure or spastic

 Benzodiazepin for postoperative pain

 Trihexylphenidin for dystonia

 Analgesic for pain

c. Phsycal and occupational therapy

i. Daily passive stretching for spastic muscle

ii. Phsioteraphy

d. Speech therapy

e. Orthopaedic appliances

i. Removable splints to prevent deformity

ii. Braces for the lower limbs to stand and walk with help of crutches.

f. Surgical manipulation

i. Stretching of muscle contractures with general anesthesia

g. Surgical operation

i. The principles of orthopaedic treatment of neurological disorders and injuries :

 Prevention of musculoskelatal deformity

 Correction of existing musculoskletal deformity

 Improvement of muscle balance

 Improvement of function

 Improvement of appearance
  Rehabilitation

ii. For spastic type:

 Tendon lengthening

 Tendon transfer

 Arthrodesis

iii. For athetotic type: neurosurgical operation

iv. For ataxic type: no operation enable

h. Rehabilitation: phsyiotherapy

7. Goal :

a. An abiliyy to communicate with others

b. An ability to cope with the activities of daily living

c. Independent mobilitu