MRS

LESSON PLAN ON
CEREBRAL PALSY
SUBMITTED TO
Prof Dr Sheela Shenai N A SUBMITTED BY
PRINCIPAL
Mrs Ansu Maliyakal
M. O. S. C college of nursing
Assistant professor

M. O. S. C college of nursing
Sl Specific Content Teaching AV Evaluation
No Objective Learning Aids
Activity

LESSON PLAN ON CEREBRAL PALSY

Name of the Topic:Cerebral palsy

Subject: Child health nursing

Name of the group: Third year BSc nursing

Time : Two weeks

Previous knowledge: The students have had knowledge regarding cerebral palsy from newspapers , mass media and other internet
sources

Central objective: On completion of the topic the students will be able to gain knowledge and can apply in their future practice

Specific objective: On completion of the topic the students will be able to

• Define cerebral palsy

• Identify the two criteria for diagnosis
• Enlist the incidence of cerebral palsy
• Describe the specific features and related etiologic factors of cerebral palsy
• Explain the defining characteristics of cerebral palsy
• Explain the clinical features of cerebral palsy
• Explain the goals of management of cerebral palsy
• Explain the new treatment modalities of cerebral palsy
• Identify the prognosis of cerebral palsy
• Conclude the topic
1 Introduces the INTRODUCTION Introduces Pretest on
topic to the the topic cerebral Palsy
students The disease is termed as little disease as it was first described by John to the Post test on
Little. It is form of chronic motor disability which results from damage students cerebral palsy
to growing brain. It is non curable and non fatal.
It is also called as congenital static encephalopathy, congenital
spastic paralysis and CP

2 DEFINITION Online Power Pretest on

Interactive point cerebral Palsy
Define the Cerebral palsy refers to “injured CNS” and palsy refers to “lack of sessions slides Post test on
topic to the voluntary muscle strength or control” classroom cerebral palsy
students Quiz . Podcast
it is defined as Podcast
preparatio
“Group of permanent disorders of the development of movement and n
posture, causing activity limitation, that are attributed to nonprogressive
disturbances that occurred in the developing fetal or infant brain”

3 Identify the TWO CRITERIA FOR DIAGNOSIS Online Power Pretest on

two criteria for Interactive point cerebral Palsy
diagnosis • Original insult to brain results in fixed ,static lesion affecting sessions slides Post test on
motor performance classroom cerebral palsy
• Insult during early CNS development, typical at birth or shortly Quiz . Podcast
after Podcast
preparatio
n
 Power Pretest on
4. Enlist the INCIDENCE Online point cerebral Palsy
incidence of • 3.3 per 1000 live birth Interactive slides Post test on
cerebral palsy • 10 percentage have neurological deficit sessions cerebral palsy
• Premature babies are more prone classroom Podcast
• Premature with intra ventricular haemorrhage 50 % Quiz .
Podcast
• Perinatal preparatio
• LBW n
• Intra cerebral hemorrhage lead to ELBW
• Intra natal
• Postnatal
• bacterial meningitis,
• multiple births,
• viral encephalitis,
• motor vehicle crashes,
• Perinatal or neonatal brain lesion or brain
maldevelopment
• child abuse
• biochemical disorders may cause motor abnormalities

5 Describe the
specific SPECIFIC FEATURES AND RELATED ETIOLOGIC FACTORS Online Power Pretest on
features and Interactive point cerebral Palsy
related FEATURES RELATED FACTORS sessions slides Post test on
etiologic 1. Anoxia 1. Brain damage classroom cerebral palsy
factors of 2. Preterm birth a caused by Quiz . Podcast
cerebral palsy 2.Spastic Diplegia hypoxic infarction , hemorrhage Podcast
with periventricular leukomalacia in preparatio
3.Athetoid lateral ventricle n
(Extrapyramidal) 3. Due to birth asphyxia or
kernicterus and metabolic genetic
 disorders
4. Hemiplegic 4. focal cerebral infarction
(Hemiparetic) Cp (stroke) secondary to an intrauterine
or perinatal thromboembolism,
usually a result of maternal
5. Ataxic Cp thrombosis or hereditary clotting
disorder
5. Cerebral hypoplasia or neonatal
hypoglycemia
Generalized cortical and cerebral
atrophy often cause severe
quadriparesis with cognitive
impairment and microcephaly

DEFINING CHARACTERISTICS
Explain the Online Power Pretest on
6 defining Interactive point cerebral Palsy
characteristics • Motor abnormalities: sessions slides Post test on
of cerebral • Associated impairments: Seizures; hearing or vision impairment; classroom cerebral palsy
palsy attentional, behavioral, communicative, or cognitive deficits; oral Quiz . Podcast
motor and speech function Podcast
• Anatomic and radiologic findings: White matter lesions or brain preparatio
anomaly noted on computed tomography (CT) or magnetic n
resonance imaging (MRI)
• Causation and timing: Identification of a clearly identified cause
such as a postnatal event (e.g., meningitis, traumatic brain injury)

Explain the CLINICAL FEATURES

7 clinical
features of Four types of cerebral palsy are Online Power Pretest on
cerebral palsy Interactive point cerebral Palsy
Spastic or pyramidal cerebral palsy sessions slides Post test on
classroom cerebral palsy
1. Persistent primitive reflexes, positive Babinski reflex, eventual Quiz . Podcast
development of contractures 70% to 80% Podcast
2. Diplegia preparatio
3. Tetraplegia: n
4. Triplegia:
5. Monoplegia:
6. Hemiplegia:
7. Hypertonicity with poor control of posture, balance, and
coordinated motion
8. Impairment of fine and gross motor skills

Dyskinetic (Nonspastic, Extrapyramidal

• Athetoid: Chorea
Dystonic: Slow, twisting movements of the trunk or extremities

Ataxic

Nonspastic, Extrapyramidal) Wide-based gait Rapid, repetitive

movements performed poorly

Mixed Type
• Combination of spastic CP and dyskinetic CP
when no specific motor pattern is dominant

• Delayed Gross Motor Development

1. A universal manifestation
2. Delay in all motor accomplishments
3. Increases as growth advances
4. Delays more obvious as growth advances Abnormal
 Motor Performance
5. Very early preferential unilateral hand preference
6. Abnormal and asymmetric crawl
7. Standing or walking on toes
8. Uncoordinated or involuntary movements
9. Poor sucking
10. Feeding difficulties
11. Persistent tongue thrust

Clinical Manifestations of Cerebral Palsy (at Time of Diagnosis)

1. Increased or decreased resistance to passive movements
2. Opisthotonic posturing (arching of back)
3. Feels stiff on handling or dressing
4. Difficulty in diapering
5. Rigid and unbending at the hip and knee joints when pulled to
sitting position (early sign)
6. Maintains hips higher than trunk in prone position with legs and
arms flexed or drawn under the body
7. Scissoring and extension of legs with feet plantar flexed in
supine position
8. Persistent infantile resting and sleeping position
9. Arms abducted at shoulders
10. Elbows flexed
11. Hands fisted
12. Persistence of primitive infantile reflexes
13. Obligatory tonic neck reflex at any age
14. Non persistence beyond 6 months old
15. Persistence or hyperactivity of the Moro, plantar, and palmar
grasp reflexes
16. Hyper reflexia, ankle clonus, and stretch reflexes elicited in
many muscle groups on fast, passive movements

Associated Disabilities
 • Altered learning and reasoning
• Seizures
• Impaired behavioral and interpersonal relationships
• Sensory impairment (vision, hearing)
• Failure to meet any developmental milestones, such as rolling
over, raising head, sitting up, crawling
• Persistent primitive reflexes, such as Moro, atonic neck
• Poor head control (head lag) and clenched fists after 3 months
old
• Stiff or rigid arms or legs; scissoring legs
• Pushing away or arching back; stiff posture
• Floppy or limp body posture, especially while sleeping
• Inability to sit up without support by 8 months old
• Using only one side of the body or only the arms to crawl

GOALS OF MANAGEMENT

8 Explain the Therapy has five broad goals: Online Power Pretest on
goals of • 1. To establish locomotion, communication, and self-help skills Interactive point cerebral Palsy
management • 2. To gain optimal appearance and integration of motor functions sessions slides Post test on
of cerebral • 3. To correct associated defects as early and effectively as classroom cerebral palsy
palsy possible Quiz . Podcast
• 4. To provide educational opportunities adapted to the child’s Podcast
needs and capabilities preparatio
• 5. To promote socialization experiences with other affected and n
unaffected children
.

Explain the MANAGEMENT Online Power Pretest on

9. management Interactive point cerebral Palsy
of cerebral Establish locomotion sessions slides Post test on
palsy • Ankle–foot orthoses (AFOs, braces) : classroom cerebral palsy
• prevent or reduce deformity, increase the energy Quiz . Podcast
efficiency of gait, and control alignment. Podcast
• Wheeled scooter boards preparatio
• allow children to propel themselves while on the n
abdomen, or total body is supported while the legs are
positioned with wedges to prevent scissoring.
• Wheeled go-carts

b. Surgical management : Orthopaedic surgery : correct contracture or

spastic deformities, to provide stability for an unstable joint, and to
provide balanced muscle power.
1. Tendon lengthening procedures, release of spastic muscles, and
correction of hip and adductor muscle spasticity or contracture to
improve locomotion.
2. Hip dislocation : hip surveillance
3. Spinal fusion :scoliosis.
4. Computerized motion analysis, radiographs,.
5. Selective dorsal rhizotomy may provide marked improvement in
some children with CP

c. Pain management
• Dantrolene sodium, baclofen [Lioresal], and diazepam orally
• Valium reduce spasticity
• side effects of these agents include hepatotoxicity,
(dantrolene), drowsiness, fatigue, and muscle weakness;
less commonly, central nervous system (CNS)
depression, hypotension, diaphoresis, and constipation
may be seen with baclofen.

D. Neurosurgical management

a.Intrathecal baclofen for severe spasticity.

 • Involves the implantation of a pump to infuse baclofen directly
into the intrathecal space surrounding the spinal cord to provide
relief of spasticity.
• High doses has side effects, including drowsiness and
confusion, yet are often unable to provide adequate relief
of spasticity.
• Oral tizanidine given in conjunction with botulinum type

e. Seizure management

• Seizure
• Antiepileptic drugs (AEDs) such as
• carbamazepine (Tegretol); divalproex (valproate
sodium and valproic acid;
• Dystonia: levodopa ; trihexyphenidyl
• Hyperkinetic movement disorder, chorea or athetosis
• for increasing the use of upper extremities and
vocalizations; and reserpine
Dental hygiene
• Regular visits to the dentist and prophylaxis, including brushing,
fluoride, and flossing, should be started as soon as the teeth
erupt.
• Dental care is especially important for children given phenytoin
because they often develop gum
• hyperplasia.
• Decreased oral intake can lead to more tartar buildup

Technical aids

1. Airway clearance devices help mobilize secretions what was

done formerly by clap pulmonary therapy, or physiotherapy).
2. computerized toys and games: Eye/hand coordination canbe
 enhanced by. Toys may be operated by a head or hand switch.
3. Microcomputers combined with voice synthesizers aid children
with speech difficulties to “speak.”
4. Smart phones with speech applications are appropriate for
some children.

Other problems

• Constipation caused by neurologic deficits and lack of exercise,

• Poor bladder control and urinary retention,
• Osteopenia
• Chronic respiratory tract infections, problems with airway
clearance, and aspiration pneumonia
• Gastroesophageal Reflux, Abnormal Muscle Tone,
• Immobility, and altered positioning.
• Skin problems may result from pressure areas,
• Malalignment

Behaviour problems
• Attention deficit/hyperactivity disorder and other learning
problems require professional attention.
• Vision difficulties, such as strabismus, nystagmus, and optic
atrophy

Physical Therapy

Members are physical therapist; and other members of the health team,
including the nurse.
The most common approach
• stretching, passive, active, and resistive movements
applied to specific muscle groups or joints to maintain or
increase range of motion, strength, or endurance.
 Explain the New treatment modalities
new treatment Online Power Pretest on
11 modalities of Magnesium sulphate for prevention of cerebral palsy Interactive point cerebral Palsy
cerebral palsy • Magnesium sulphate reduces the risk of cerebral palsy among sessions slides Post test on
early preterm birth classroom cerebral palsy
Quiz . Podcast
Stem cell therapy Podcast
• It helps to prevent cell death in neuronal population and preparatio
abolishment of new blood vessels, cell multiplication n

Hyperbaric oxygen therapy

HBO is improving the oxygen availability to damaged brain cells with

potential for recovery , even in chronic injury

Identify the Prognosis

12 prognosis of • Achieve Ambulation between 2 and 7 years old –good prognosis Power Pretest on
cerebral palsy • Child having cognitive impairments, or higher percentage have Online point cerebral Palsy
mild cognitive and learning deficits. Interactive slides Post test on
• Severe spastic tetraplegic CP have normal intelligence. sessions cerebral palsy
• Growth is affected in children with spastic tetraplegia classroom Podcast
• About 30% remain in the home Quiz .
• 50% of individuals with spastic tetraplegia live in independent Podcast
setting preparatio
• Vocational rehabilitation and education is provided to increase n
good prognosis

13 Conclude the CONCLUSION

topic The topic on self directed learning on cerebral palsy
covered on meaning of cerebral palsy, its clinical features, defining
characteristics, diagnosis, goals of management and treatment
modalities both medical and surgical interventions , new treatment
modalities and prognosis.

References

1. Marlow D, Redding B, Kalia R. Marlow’s Textbook of Pediatric

Nursing, WB. Saunders Company/ South Asian edition Elsevier
2. Wong D L & Hockenberry M J. Wong’s Nursing care of Infants
and Children, Mosby
3. Premaletha T. Practical Pediatric Nursing, Paras Medical Publishers.
4. Assuma Beevi, Concise Textbook of Pediatric Nursing, Elsevier.
5. Ball Jane, Bindler Ruth Cowen Kay, et al. Principles of Pediatric
Nursing: Caring for Children Hardcover, Pearson Publishers