CEREBRAL PALSY

CEREBRAL PALSY
A disorder in the movement and posture caused by an injury to the immature brain.

Movement Posture Immature brain

Diagnostic Procedures

MRI CT Scan EEG Laboratory and radiologic work up Physical evaluation Interview

Causes/Etiology
Prenatal causes (before birth)
Maternal characteristics

Perinatal causes (at the time of birth to 1mo) Postnatal causes (in the first 5 mos of life)

Prenatal causes
Hemorrhage/bleeding Infections Environmental factors

High-risk mothers
Age Difficulty in conceiving or holding a baby to

term Multiple births History of fetal deaths/miscarriages Cigarette smoking Maternal alcoholism and drug addiction Social status; mother with MR Mothers medical condition
>30 sticks per day

Perinatal Causes
High or low BP Umbilical cord coil Breech delivery Oversedation of drugs Trauma i.e. forceps or vacuum delivery *** complications of birth

Postnatal Causes
Trauma, head injury Infections Lack of oxygen Tumor, cyst

Spastic

Spastic Cerebral Palsy

Tense and contracted muscles The most common form of cerebral

palsy. 70-80% of all people with the condition are affected by this type. Have stiff and awkward movements. 3 types:
Diplegia: affects one side Hemiplegia: affects both arms or legs Quadriplegia: affects all limbs

Ataxic

Ataxic Cerebal Palsy

Poor balance and lack of

coordination. Results in stumbles and falls. Also, caused by damage to the cerebellum. Accounts for 10% of individuals with cerebral palsy

Athetoid

Athetoid Cerebral Palsy

Uncontrolled motion in the

face, arms, and torso. Usually interferes with speaking, feeding, reaching, grabbing, and any other skills that require motor skills. Caused by damage to the cerebellum.

Classification of CP
Topographical Classification

(based on the location of the motor disability)

1. 2. 3. 4. 5. 6.

monoplegia diplegia triplegia quadriplegia hemiplegia paraplegia

Motor cortex- planning the voluntary movement

Basal ganglia correct the timing of movement

The interneurons send inhibitory or excitatory impulses to the lower motor neuron and regulate its activity.

The extrapyramidal system corrects the force of contraction of the muscles involved. The cerebellum coordinates the speed and direction of movement. Muscle spindles in the contracting muscle, golgi tendon organs in the tendons and mechanoceptors in the joints send information on the degree of contraction to the medulla spinalis, cerebellum and the somatosensory cortex.

The lower motor neuron sends contraction impulse to the muscle through the peripheral nerve. This is the final common pathway from the nervous system to the muscle.

Pharmacological treatment
A medication called botulinum toxin is given

through injections. Used to reduce excessive muscle tightness. The insertion of a baclofen pump. Usually placed in the left abdomen. It is a pump that is connected to the spinal cord, whereby it sends bits of Baclofen alleviating the continuous muscle flexion. Baclofen is a muscle relaxant and is often given PO to patients to help counter the effects of spasticity.

Surgery and Orthoses

Surgery usually involves one or a combination

of: Loosening tight muscles and releasing fixed joints, most often performed on the hips, knees, hamstrings, and ankles. In rare cases, this surgery may be used for people with stiffness of their elbows, wrists, hands, and fingers.

 Straightening abnormal twists of the leg bones, i.e. femur

(termed femoral anteversion or antetorsion) and tibia (tibial torsion). This is a secondary complication caused by the spastic muscles generating abnormal forces on the bones, and often results in intoeing(pigeon-toed gait). The surgery is called derotation osteotomy, in which the bone is broken (cut) and then set in the correct alignment. Cutting nerves on the limbs most affected by movements and spasms. This procedure, called a rhizotomy, "rhizo" meaning root and "tomy" meaning "a cutting of" from the Greek suffix 'tomia' reduces spasms and allows more flexibility and control of the affected limbs and joints. Orthotic devices such as ankle-foot orthoses (AFOs) are often prescribed to minimise gait irregularities. AFOs have been found to improve several measures of ambulation, including reducing energy expenditure and increasing speed and stride length.

Non-pharmacological treatment

Physical, occupational, speech therapy Special education Feeding management Family and patient counseling program Vocational and functional training program Others: acupuncture

A disabled child has the right to enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the childs active participation in the community. -UN Convention on the Rights of
the Child. 1989.