Introduction

Cerebral palsy is a disorder of movement and posture that appears during infancy
or early childhood. It is caused by non- progressive damage to the brain before,
during or shortly after birth.
 CP is not a single diseases but a name given to a wide variety of static
neuromotor
 The damage to the brain may occur during the prenatal, perinatal or
postnatal period.
 Any non- progressive CNS injury occurring during the first 2 year of life is
considered to be CP.
 CP was first described by the English physician Sir Francis William Little in
1861 and was known as Little’s disease for a long time.
Epidemiology :-
 Impairment syndromes occurring secondary to a lesion in a developing
brain. CP is the most common cause of childhood disability in Western
Societies. The incidence is 2-2.5/1000 live birth.
 Some affected children do not survive and the prevalence varies between
1-5/1000 babies in different countries.
 This is explained by increased survival of premature and very low birth
weight infant and by a rise in the number of multiple birth.
Pathophysiology :-
Etilogy cause of CP involve prenatal, perinatal and postnatal.
 Prenatal Maternal- ( 70-80% of CP cases are acquired
prenatally)diabetes/hyperthyroidism, exposure to radiation/toxins,
Malnutrition, Cognitive impairment/seizure, Infection, Incompetent
cervix, genetic abnormalities, previous child with development
disabilities, premature birth, medication use, severe proteinuria
gestational, Chromosomes abnormalities, Genetic Syndrome, Rh
incompatibility infections, Congenital malformations.
  Perinatal- (about 6% with perinatal complication), Intraventricular
haemorrhage, CNS infection, Low birth weight, Number of days on
mechanical ventilation.
 Postnatal- (about 10-20% postnatally acquired) – brain injury, hypoxia,
stroke, meningitis/ encephalitis, seizure.
Time of brain injury
Prenatal Conception to the onset of labour.
Perinatal 28 weeks intrauterine to 7 days postnatal.
Postnatal first few years of life.

Literature Review
1) Karen W. Krigger, etal.2006 “Cerebral palsy: an overview”, says that the
orthoses are commonly use in conjuction with physical therapy, to prevant
deformities or improve activities in children also explained about the
assessment instrument used in CP or facilitaye more normal motor
development.
2) Nadi Berker, etal. Textbook of cerebral palsy, explained about the active
and passive ROM exercises, stretching and strengthening exercises
continue for life time in CP.
3) Mintazekerem G. Rehabilitation of children with CP from a physiotherapist
perspective; advised weight bearings exercises ( tilt table, standing frame),
muscle strengthening, functional exercises including passive stretching ( to
relieve soft tissue tightness).
4) Julieanee P Sees, etal.2013, Journal of children’sOrthopaedics, “Overview of
foot deformity management in children with cerebral palsy”. In CP the most
common deformity is Equino varus which present in large majority of
children with CP at the beginning of standing and walking.
The Equinovarus is easily managed with daytime planter Flexion controlling
Orthotics (AFO).

Full assessment of patient

Name- XYZ
AGE – 4.5 Y/ Girl child
Occupation of father –Worker.
Address – Raigarh
Chief complaint –child is not able to hold her neck properly, not able to sit, stand
and walk.
Birth & Medical history:-
Pre natal history – mother’s weight was (40kg) at the time of pregnancy, caused
by malnutrition and anaemia. Didn’t followed any nutritional diet during
pregnancy.
Peri natal history - Normal delivery took place in 9 month of gestation period at
government hospital.
 Birth weight – 1.75 kg
 Delayed birth cry ( after 15 mints of delivery)
 H/o was kept in NICU for 8 days and was under treatment (No medical
documents are available).
Family history :-
 Consenguinus marriage
 The age of father & mother during delivery was 22 & 20 year.
Socioeconomic History :-
 Poor class family
 Lack of nutrition diet
Environmental history :-
 A very small house
 Locality is Raigarh, Chhattisgarh
 Taste of water is salty and more polluted after monsoon season
 Source of water is hand pump.
 Iron content is less in food
Development history:-
 Mild neck control at the age of 4 year(hold for 10-15 second)
 Rolling was achieved 3 months ago
 Quadruped, independent sitting and standing not yet achieved.
History on observation :-
 Child came in department with mother
 Child is cooperative

On examination :-
Higher mental function (HMF)
 Speech – affected (can’t say a single word).
 Hearing – Respond to sound
 Pupillary reflex is normal.
 Social smile is present

Motor examination :-
Tone – B/L UL – hypertonic (MAS 2)
B/L LL – hypertonic (MAS2)
Reflexes – BJ TJ KJ AJ
L 3+ 3+ 3+ 3+
R 3+ 3+ 3+ 3+

T/C/D – Tightness of B/L hip adductors and TA,

Deformity –B/L equinovarus deformity
Posture – elbow is in flexion , the hip is in adduction, and the foot is in
equinovarus.
Functional Abilities – able to do rolling on each side
Able to sit on a chair with support for 1-2 hours
Able to do bridging
Mild grip strength is present, able to hold cylindrical object
Babinski sign is –present.

Short Term Goal:-

 o To improve neck control
o Sitting, Rolling & Crawling to be facilitated
o Improve trunk stability
o Decrease in muscle tone of hypertonic muscle

Long term Goal:-

o Improve ADL’s,
o Prevent further deformity, contracture, muscle tightness and
another complication of CP.
o Make patient functionally active and live a meaningful life.
o Improve capabilities,
o Sustain health in terms of locomotion, cognitive development,
social interaction and independence.

Treatment protocol:-

Neuro Developmental Therapy –

1. Standing in standing frame with AFO with hand activities .

2.Supine and prone on gym ball
3.Passive stretching should be done.
4.Extension of neck to facilitate neck control.
5. Function stretching of hip adductors aand elbow flexors.
6. ROM exercise of UL & LL (Gental and rhythmic).
7. Practice to rolling.
8. Pull to sit, supine and prone on wedge.
9. Customised CP wheel chair for sitting at home is advised
10. AFO is advised
References :-

1. Karen W. Krigger, etal.2006 “Cerebral Palsy : an overview”.

2. Nadir Berker, Textbook of Cerebral Palsy.
3. Mintaze Kerem G et al. Rehabilitation of children with cerebral palsy from a
physiotherapist perspective. Acta orthop Traumatol Turc. 2009;34(2).
4. Julieanee P Sees, etal, 2013, Journal of Children’s Orthopedics, “Overview
of foot deformity management in Children with Cerebral Palsy.