PRESENTED BY

SONA MARIYA JOSEPH

ROLL NO:44
STCON
 DEFINITION

CEREBRAL PALSY IS A CHRONIC NONPROGRESSIIVE MOTOR DYSFUNCTION

CAUSED BY DAMAGE TO THE MOTOR AREAS OF BRAIN

THE WORD CEREBRAL REFERS TO CEREBRUM WHICH IS THE AFFECTED AREA

OF BRAIN AND PALSY REFERS TO DISORDER OF MOVEMENT
 INCIDENCE AND ETIOLOGY

• IN 2007, THE INCIDENTS OF CEREBRAL PALSY WAS ESTIMATED TO BE 2.12-2.45 PER 1000 LIVE
BIRTHS
• CEREBRAL PALSY IS CAUSED BY DAMAGE TO THE MOTOR CONTROL CENTRES OF THE
DEVELOPING BRAIN WHICH CAN OCCURR DURING PREGNANCY CHILD BIRTH OR AFTER BIRTH
UP TO THE AGE OF 3 YEARS
• THIS RESULTS IN ACTIVITY LIMITATION WHICH IS OFTEN ACCOMPANIED BY DISTURBANCE OF
SENSATION DEPTH PERCEPTION AND OTHER SIGHT BASED PROBLEMS.
 FACTORS CONTRIBUTING TO CEREBRAL PALSY

MAINLY 4 FACTORS
• PRENATAL FACTORS
• BIRTH FACTORS
• PERINATAL FACTORS
• CHILDHOOD INFECTIONS
 PRENATAL FACTORS

• GENETIC OR CHROMOSOMAL ABNORMALITIES

• BRAIN MALFORMATIONS
• EXPOSURE TO TERATOGENS
• MULTIPLE FETUSES
• INTRAUTERINE INFECTIONS
• PLACENTAL PROBLEMS CAUSING INSUFFICIENT NUTRITION AND OXYGEN DELIVERY TO THE
FOETUS
 BIRTH FACTORS

• PRECLAMPSIA
• COMPLICATED LABOUR AND DELIVERY
• BIRTH INJURY CAUSED BY DIRECT HEADTRAUMA
• ASPHYXIA SECONDARY TO CODE PROLAPSE AND STRIANGULATION

PERINATAL FACTORS
• CNS DYSFUNCTION
• KERNICTERUS
 CHILDHOOD INFECTIONS

• HEAD TRAUMA
• MENINGITIS
• TOXIC INGESTION
• SHAKEN BABY SYNDROME
• INCIDENTS CAUSING HYPOXIA TO BRAIN ,LIKE NEAR DROWNING,CHOKING DUE TO FOREIGN
BODY ASPIRATION,AND POISONING.
 CLASSIFICATION /TYPES OF CEREBRAL PALSY

1.SPASTIC CEREBRAL PALSY

• SPASTIC HEMIPLEGIA
• SPASTIC DIPLEGIA
• SPASTIC TRIPLEGIA
• SPASTIC QUADRIPLEGIA
2.ATAXIC CEREBRAL PALSY
3.ATHENOID /DYSKINETIC CEREBRAL PALSY
3.MIXED TYPE
 1.SPASTIC CEREBRAL PALSY
• THIS IS THE MOST COMMON TYPE OF CEREBRAL PALSY OCCURRING IN 80% OF ALL
CASES.
• THESE PATIENTS HAVE HYPERTONIA AND IMPAIRMENT DUE TO UPPER MOTOR NEURON
LESION IN THE BRAIN AS WELL AS CORTICOSPINALTRACT OR MOTOR CORTEX.
SPASTIC HEMIPLEGIA
• IN THIS TYPE ONE SIDE OF THE BODY IS AFFECTED.
• INJURY TO THE LEFT SIDE OF THE BRAIN WILL CAUSES RIGHT SIDE BODY DEFICIT AND
VICE VERSA.
• THEY PATIENTS ARE MOST AMBULATORY OF ALL FORMS OF STATIC CEREBRAL PALSY.
• THE AFFECTED PERSONS HAVE EQUINUS ( LIMBING INSTABILITY )ON THE AFFECTED
SIDE AND PRESCRIBED ANGLE FOOT ORTHOSIS TO PREVENT THE EQUINUS
SPASTIC DIPLEGIA

• IN THIS TYPE LOWER EXTREMITIES ARE AFFECTED WITH LITTLE OR NO UPPERBODY SPASTICITY.

• THIS IS THE MOST COMMON FORM SEEN IN 70-80% CASES .

• THESE PATIENTS HAVE A“SCISSORS GAIT”

SPASTIC MONOPLEGIA

• ONE LIMB IS AFFECTED

SPASTIC TRIPLEGIA

• THREE LIMBS ARE AFFECTED

SPASTIC QUADRIPLEGIA

• ALL FOUR LIMBS ARE AFFECTED.

• THESE PATIENTS ARE UNABLE TO WALK

 2.ATAXIC CEREBRAL PALSY

• CAUSED BY DAMAGE TO CEREBELLUM

• OCCURS ABOUT 10% OF CASES

• HYPOTONIA AND TREMORS MAY BE PRESENT

• CONSISTS OF WIDE BASED GAIT

• MOTOR SKILLS SUCH AS A WRITING, TYPING, OR USING SCISSORS MIGHT BE AFFECTED

3. ATHENOID /DYSKINETIC CEREBRAL PALSY

• ATHENOID CEREBRAL PALSY INVOLVES MIXED MUSCLE TONE BOTH THE HYPOTONIA AND HYPERTONIA ARE PRESENT.

• PATIENTS HAVE TROUBLE HOLDING THEMSELVES IN UPRIGHT STEADY POSITION FOR SITTING OR WALKING.

• 10% PATIENTS HAVE THIS TYPE OF CEREBRAL PALSY.

 4.MIXED TYPE

• SYMPTOMS OF MORE THAN ONE FORM EXIST IN THESE PATIENTS

PATHOPHYSIOLGY
SIGNS AND SYMPTOMS
EARLY SIGNS
 C/F

• SPEECH AND LANGUAGE DISORDERS

• SKELETAL ABNORMALITIES AND ANGULAR DEFORMITY
• PAIN
• SCISSOR WALKING (WHERE THE KNEES COMES IN AND CROSS)
• IRREGULAR POSTURE
• JOINT AND BONE DEFORMITY AND CONTRACTURES
 DIAGNOSTIC EVALUATION

• HISTORY AND PHYSICAL EXAMINATION

• MRI
• CT SCAN
• EEG
• NEUROIMAGING STUDIES
• ASSESMENT TOOLS SUCH AS,
*PEABODY DEVELOPMENT MOTOR SKILLS
*DENVER TEST
PEABODY DEVELOPMENT MOTOR SKILLS
DENVER TEST
 TREATMENT

• 1. PHYSICAL THERAPY
• OCCUPATIONAL THERAPY
• SPEECH THERAPY
• BIO FEEDBACK
• MASSAGE THERAPY
• DRUG THERAPY
• SURGERY AND ORTHOSIS
 PHYSICAL THERAPY
• PHYSIOTHERAPY PROGRAMS ARE DESIGNED TO IMPROVE GAIT AND VOLUNTARY MOVEMENTS ,
TOGETHER WITH STRETCHING PROGRAMS TO LIMIT CONTRACTURES. LIFELONG PHYSIOTHERAPY IS
CRUCIAL TO MAINTAIN MUSCLE TONE BONE STRUCTURES AND PREVENT DISLOCATION OF THE JOINTS.

OCCUPATIONAL THERAPY
• THIS HELPS ADULTS AND CHILDREN TO MAXIMIZE THEIR FUNCTIONING, ADAPT TO THEIR
LIMITATION, AND LIVE AS INDEPENDENTLY AS POSSIBLE.
• OCCUPATIONAL THERAPIST WORK CLOSELY WITH THE FAMILIES INORDER TO ADDRESS THEIR
CONCERNS AND PRIORITIES FOR THEIR CHILD.
• THE OCCUPATIONAL THERAPIST TYPICALLY FACILITIES IDENTIFICATION OF THE CHILDS ABILITIES,
AND DIFFICULTIES AND ENVIRONMENTAL CONDITIONS, SUCH AS PHYSICAL AND CULTURAL
INFLUENCES, THAT AFFECT HIS PARTICIPATION IN DAILY ACTIVITIES.
 SPEECH THERAPY

• IT HELPS THE MUSCLES OF THE MOUTH AND JAW, AND HELPS IN IMPROVING COMMUNICATION . SPEECH THERAPY
OFTEN STARTS BEFORE A CHILD BEGINS SCHOOL AND CONTINUES THROUGHOUT THE SCHOOL YEARS.

BIO FEEDBACK
• IT IS AN ALTERNATIVE THERAPY IN WHICH PEOPLE WITH CEREBRAL PALSY LEARN TO CONTROL THEIR
AFFECTED MUSCLES, SOME PEOPLE LEARN WAYS TO REDUCE MUSCLE TENSION WITH THIS TECHNIQUE.

MASSAGE THERAPY
• IT IS DESIGNED TO HELP RELAX THR MUSCLES, STRENGTHEN MUSCLES AND KEEP JOINTS FLEXIBLE.
 DRUG THERAPY

• DRUGS TO CONTROL SEIZURES,ELEVATE PAIN OR RELAX MUSCLE SPASM

• EG.(BENZODIAZIPINES, BACLOFEN OR INTRATHECAL PHENOL)
• HYPERCARBIC OXYGEN AND THE USE OF BOTOX(BOTULINM) TO RELAX CONTRACTING
MUSCLES.
 SURGERY AND ORTHOSIS

SURGERY INVOLVES ONE OR COMBINATION OF FOLLOWING.

• LOOSENING OF TIGHT MUSCLES AND RELEASING FIXED JOINTS MOST OFTEN PERFORMED ON HIP
KNEES,HAMSTRINGS AND ANGLES .
• STRAIGHTENING ABNORMAL TWIST OF LEG BONES THAT IS FEMUR AND TIBIA THIS IS A SECONDARY
COMPLICATION CAUSED BY SPASTIC MUSCLES GENERATING ABNORMAL FORCES ON THE BONES.
• CUTTING NERVES OF THE LIMBS MOST AFFECTED BY SPASMS. THIS PROCEDURE CALLED RHIZOTOMY,
REDUCES SPASMS AND ALLOWS MORE FLEXIBILITY AND CONTROL OF AFFECTED LIMB AND JOINTS.
• ORTHOTIC DEVICES SUCH AS ANKLE FOOT ORTHOSIS ARE OFTEN PRESCRIBED TO MINIMIZE GAIT
IRREGULARITIES AND INCREASE SPEED.
 NURSING MANAGEMENT

• A. THE INCREASE IN NEED FOR SECURITY AND PREVENT INJURY

•

• 1. AVOID CHILDREN FROM HARMFUL OBJECTS, FOR EXAMPLE CAN BE

•
• DROPPED. 2. WATCH THE CHILDREN DURING ACTIVITY.
•
• 3. GIVE THE KIDS A BREAK WHEN TIRED.
•
• 4. USE SAFETY EQUIPMENT WHEN NECESSARY.
 B. IMPROVE PHYSICAL MOBILITY

1. EXAMINE THE MOVEMENT OF THE JOINTS AND MUSCLE TONE.

2. 2. DO PHYSICAL THERAPY AND REPOSITIONING EVERY 2 HOURS.

3. 3. EVALUATION OF THE NEEDS OF SPECIAL EQUIPMENT FOR EATING,

4. WRITING AND READING AND ACTIVITIES. 4. TEACH THE USE OF A WALKER, HOW TO SIT, CRAWL IN
YOUNG CHILDREN, WALKING, AND OTHERS.

5. TEACH HOW TO REACH FOR OBJECTS, HOW TO MOVE THE LIMBS,

6. APPROPRIATE ROM. 6. PROVIDE A REST PERIOD.

 C.IMPROVE COMMUNICATION

EXAMINE THE RESPONSE TO COMMUNICATION.

2. USE THE CARDS/PICTURES/WHITEBOARDS TO FACILITATE COMMUNICATION.

3. INVOLVE THE FAMILY IN TRAINING A CHILD TO COMMUNICATE.

4. REFER TO A SPEECH THERAPIST.

5. TEACH AND ASSESS NON-VERBAL MEANING.

6. TRAINED IN THE USE OF THE LIPS, MOUTH AND TONGUE.

 D.IMPROVE THE NUTRITIONAL STATUS NEEDS

• 1.EXAMINE THE DIET OF CHILDREN.

•
• 2. WEIGH WEIGHT EVERY DAY.
•
• 3. PROVIDE ADEQUATE NUTRITION AND FOOD PREFERENCES, LOTS OF PROTEIN, MINERALS AND VITAMINS.
•
• 4. GIVE EXTRA FOODS THAT CONTAIN LOTS OF CALORIES.
•
• 5. HELP YOUR CHILD MEET THEIR DAILY NEEDS WITH THE ABILITY
 E.PREVENT THE OCCURRENCE OF ASPIRATION

• 1. DO IMMEDIATELY WHEN THERE IS SUCTION SECRETIONS.

• 2. PROVIDE AN UPRIGHT POSITION OR SEMI-SITTING WHILE EATING AND DRINKING.
• 3. EXAMINE THE PATTERN OF BREATHING

F.INCREASE THE NEED FOR INTELLECTUAL

1. REVIEW THE CHILD’S LEVEL OF UNDERSTANDING.

2. TEACH IN UNDERSTANDING CONVERSATIONS WITH VERBAL OR NONVERBAL.

3. TEACH WRITING USING WHITEBOARDS OR OTHER DEVICES THAT CAN BE USED ACCORDING TO THE ABILITY OF
PARENTS AND CHILDREN.

4. TEACHING READING AND WRITING ACCORDING TO HIS NEEDS

 G. MEET THE DAILY NEEDS

• 1. EXAMINE THE LEVEL OF CHILDREN’S ABILITY TO MEET DAILY NEEDS.

• 2. ASSIST IN MEETING THE NEEDS; EATING AND DRINKING, ELIMINATION, PERSONAL HYGIENE,
DRESS, PLAY ACTIVITIES.
• 3. INVOLVE FAMILIES AND FOR CHILDREN WHO ARE COOPERATIVE IN MEETING THEIR DAILY
NEEDS.
 H.ENHANCE THE KNOWLEDGE AND ROLE OF
PARENTS IN MEETINGS THE CHILD CARE NEEDS
• 1. EXAMINE THE LEVEL OF PARENTAL KNOWLEDGE.
• 2. TEACH PARENTS TO EXPRESS THEIR FEELINGS ABOUT THE CHILD’S CONDITION.
• 3. TEACH PARENTS IN MEETING CHILD CARE NEEDS.
• 4. TEACH ABOUT THE CONDITIONS EXPERIENCED BY CHILDREN AND ARE RELATED TO PHYSICAL
THERAPY AND EXERCISE NEEDS.
• 5. EMPHASIZE THAT PARENTS AND FAMILIES HAVE AN IMPORTANT ROLE IN HELPING MEET THE
NEEDS.
• 6. EXPLAIN THE IMPORTANCE OF PLAY AND SOCIALIZATION NEEDS OF OTHERS.
 I. PREVENT IMPAIRED SKIN INTEGRITY

• 1. EXAMINE THE AREA THAT IS ATTACHED ANCILLARY EQUIPMENT.

• 2. USE A SKIN LOTION TO PREVENT DRY SKIN.
• 3. DO THE MASSAGE IN A DEPRESSED AREA.
• 4. PROVIDE A COMFORTABLE POSITION AND PROVIDE SUPPORT WITH PILLOWS.
• 5. ENSURE THAT ANCILLARY EQUIPMENT OR DRESSING APPROPRIATELY AND FIXED.
 PROGNOSIS

• CEREBRAL PALSY IS NOT A PROGRESSIVE DISORDERS (MEANS THE BRAIN DAMAGE DOES NOT
WORSEN), BUT THE SYMPTOMS CAN BECOME- MORE SEVERE OVER THE TIME DUE TO
SUBDURAL DAMAGE. A PERSON WITH THE DISORDER MAY IMPROVE SOMEWHAT DURING
CHILDHOOD- IF HE OR SHE RECEIVES EXTENSIVE CASE FROM SPECIALISTS BUT ONCE BONES
AND MUSCULATURE BECOMES MORE ESTABLISHED , ORTHOPEDIC SURGERY MAY BE
REQUIRED.
 BIBLIOGRAPHY

• WONGS, ESSENTIALS OF PEDIATRIC NURSING, 2ND SOUTH ASIA EDITION

• RIMPLE SHARMA, ESSENTIALS OF PEDIATRIC NURSING, 3RD SOUTH ASIA EDITION.
• HTTPS://WWW.SLIDESHARE.NET/GAMANDEEP/CEREBRAL-PALSY-80482237