Julia Rei Ilagan average of 77/1000 neonatal survivors

BSPT III represents in the average data from

Medical Background: CP (Cerebral prevalent studies. Gestational age of less
Palsy) than 32wks is one of the most powerful
predictors of CP. According to the University
of Cerebral Palsy Association, the estimated
DEFINITION Americans with CP are 500,000. M=F. It

CP is a collection of motor disorders does not cause death but due to other

resulting from the damage or injury to a complications, it shortens life expectancy

normally forming brain that occurs before, ETIOLOGY

during or after birth. Symptoms are related to
Majority of cases has an unknown etiology.
basal ganglia dysfunction such as increase
According to Sigmund Freud, the pre existing
muscle tone and resting tremors. Does not
abnormalities in fetus cause perinatal
preclude other associated problems such as
difficulties. 50% children diagnosed with CP
sensory loss, cognitive deficit, and language
had Apgar Score of 7 or more than 7 at
disorder.
1min.,73% at 5 min. Only in infants receiving
CP is a static, non-progressive an Apgar Score of less 3% at 20min. had
disorder of movement and posture and as a cerebral damage expected.
result the child has poor coordination and
Prenatal Factors
balance or abnormal movement patterns, or
a combination of these characteristics. A 1. Prematurity
spectrum of deficits maybe present. It (like 2. RH Incompatability
mental retardation) is a condition with 3. Fetal Anoxia
numerous causes and protean 4. Twin gestation or multiple birth
manifestations. 5. Antepartum bleeds
6. Eclampsia
7. Maternal Disorders
EPIDEMIOLOGY 8. Drugs, Alcohol, teratogens

The prevalence of CP has risen since 9. Maternal History

1980‟s. Very-low-birth-weight infants( less 10.Maternal Infection

than 1500g) have increase incidence in CP

than infants weighing more than 2500g. And Perinatal Factors

Reference:
Braddom, Randall, Physical Medicine and Rehabilitation
DeLisa, Joel, Physical Medicine and Rehabilitation
O’Sullivan, Susan and Schmitz, Thomas, Physical Rehabilitation
1. Placental Abnormalities as the precipitating factor if not the primary
2. Birth Injuries cause of Cp of all the tissues. The nervous
3. Prolonged Labor system is most sensitive to oxygen depletion.
4. Breech birth It affects the neurons most severely, the glial
5. Asphyxia or supporting tissues less and the blood
6. Prematurity vessels the least. Mild episodes of hypoxia or
7. Smallness for age anoxia cause neuronal necrosis. This will
8. Mechanical anoxia lead to gross scarring of the neurons.
9. Trauma
10.Complications of birth Depression and compression of the
11.Iso-immunizations brain by fractured cranial bone lead to
12.Maternal drug addiction softening of the brain. Intracranial
13.Hypoglycemia hemorrhage is almost always venous in
origin. Spastis diplagia in a very premature
Post Natal Factors infant results from ischemic damage to the
1. Head trauma motor pathways in the internal capsule which
2. Infections controls the motor neurons to the muscle of
3. Tumors the legs and trunk. Intraventricular bleeding
4. Battering in the immature infant may cause distraction
5. Vascular accidents the germinal matrix surrounding the cerebral
6. Anoxia ventricle may result in hydrocephalus. Birth
7. Neoplastic Disorders asphaxia may lead to damage affecting the
8. Developmental disorder cerebral blood flow and blood pressure
leading to spastic quadriplegia or
PATHOPHYSIOLOGY choreoathetosis.
Malformation or insult of the CNS of
Most children with CP are noted to the neonatal will initially affect brain stem
have multiple etiologies with intraventricular function. Alteration in appearance, intensity,
or peri-ventricular bleeds or difficulty or expression of primitive reflexes behavior
maintaining adequate oxygenation because will result. The normal course of early
of prematurity and this being the most disappearance of primitive reflexes through
common associated factors. Common to this inhibition pathways will be affected, with
factors is the fact that they will have anoxia

Reference:
Braddom, Randall, Physical Medicine and Rehabilitation
DeLisa, Joel, Physical Medicine and Rehabilitation
O’Sullivan, Susan and Schmitz, Thomas, Physical Rehabilitation
either delay or failure in the development of Medical Management:
later postural reflex patterns Muscle relaxants- relax hyperspastic or
hypertonic ms. Such as Baclofen, Dantrolen
PROGNOSIS sodium (for liver function complications;
At the time of initial diagnosis, a clear check every 3 mos.
forecast for future growth, development and Stimulants- given upon awakening in the
care needs may not be possible. Patients morning and at noon such as; Methyl
and families need to understand that CP is Phrenidate
not a disease, but rather a static, non- Anticonvulsants- for seizure and seizure
progressive injury. The importance of early abnormalities in EEG
intervention and therapy should be stressed. Phenothiazines- for hyperactive and
The 30 year old survival rate for individual emotionally disturbed children, for
with CP is 87%, with significant lower survival tranquilization without sedation.
rate if spastic quadriparesis, seizures, severe Diazepam is the most effective to control
to profound MR, are present. athetosis and spasticity. It is
Some rules of thumb( none of them administered 2mg Tid and increase to as
absolute) can be successful despite early much as 5 mg 5xa day.
difficulty predicting functional outcome. If
child with CP does not sit alone by 2.5-3 y/o, PT MANAGEMENT
it is unlikely that the child will walk A. Treatment for motor disabilities
independently. If ambulation is not achieved 1. Bracing
by age 6 independent ambulation is unlikely 2. Effective mobilization
to occur. 3. Opthalmologic care
Hemiparetic and athetotic generally 4. Speech therapist and andrologist
achieved independent ambulation. A good 5. Bilateral ttympanic neurectomy
prognostic sign is the ability to sit by 2 y/o. and unilateral chordatympanectomy
persistence of moro reflex, ATNR or inability for swallowing disturbances resulting
to sit by age of 4 suggest poor prognosis. CP to
can cause life long disabilities, but individual pooling.
with CP can have long, well adjusted and Gait improvements:
productive lives Muscle lengthening
Tendon rerouting
PHARMACOLOGY Wedge osteotomy

Reference:
Braddom, Randall, Physical Medicine and Rehabilitation
DeLisa, Joel, Physical Medicine and Rehabilitation
O’Sullivan, Susan and Schmitz, Thomas, Physical Rehabilitation
B. Muscle education and brace 8. Combined motion training of more
Main point in W.M Phelps treatment than one point.
1. specific diagnostication of each 9. Movement from relaxation-
child as a basis for specific conscious control of movement once
treatment methods. relaxation has been achieved. It is
2. 15 modalities were described and mainly used for children to
specific combinations of these control involuntary movements.
modalities. 10.Relaxation- techniques conscious
Here are the 15 modalities: letting go of the body and its parts(
1. Massage for hypotonic muscles. finks) and tensing and relaxing parts
Contraindicated for spastic and of the body(
athetoid. Jacobson)
2. passive motion through joint range 11.Rest- periods or test are
for mobilizing joint & suggested for spastic and athetoids.
demonstrating to the childs 12.Reciprocation- training
movement required. Speed of movements of one leg after the other
movement is slower for spastic, faster in a bicycling pattern in lying,
for rigidity. crawling, keen, walking and sleeping.
3. AAROM 13.Balance training to sitting balance
4. rest free motion and standing in braces.
5. active motion 14.Reach and Grasp release- use for
6. conditioned motion recommended training of hand function
for babies, young children & 15.Skills of daily living such as
mentally retarded children. Any feeding, dressing, washing and
passive, active or assistive motion toileting.
is done repetitively with the aid of c. Braces and Calipers:
mixed stimulus. Phelps prescribed special braces to
7. Confused motion or synergistic correct deformities to obtain the
motion which involves assistance upright position and to control
to the muscle group in order to athetosis.
contract the inactive muscle group d. Muscle education:
in the synergy.

Reference:
Braddom, Randall, Physical Medicine and Rehabilitation
DeLisa, Joel, Physical Medicine and Rehabilitation
O’Sullivan, Susan and Schmitz, Thomas, Physical Rehabilitation
 This is to obtain muscle balance
between muscle and their weak
antagonists

Reference:
Braddom, Randall, Physical Medicine and Rehabilitation
DeLisa, Joel, Physical Medicine and Rehabilitation
O’Sullivan, Susan and Schmitz, Thomas, Physical Rehabilitation