CEREBRAL PALSY

Motor Dysfunction

Nursing Care of a Family When

aChild Has a Neurologic Disorder

Learning Objective:
By the end of the lecture the student will be able to know :
Define The Pathophysiology of Cerebral Palsy
Explain the Cause Of Cerebral Palsy
Identify The Types Of Cerebral Palsy
Assessment Child With Cerebral Palsy
Discuss the Nursing Process

Pathophysiology
Cerebral palsy (CP) is a group of nonprogressive disorders of
upper motor neuron impairment that result in motor
dysfunction. Affected children also may have speech or ocular
difficulties, seizures, cognitive challenges, or hyperactivity
Muscle spasticity can lead to orthopedic or gait difficulties
CP occurs in approximately 2 of every 1000 births

cause of CP
The exact cause of CP is unknown
but the disorder is associated with low birth weight,
premature , birth injury
It apparently is caused by brain anoxia leading to cell
destruction of the motor tracts
If intrauterine anoxia occurs for some reason such as
faulty placental implantation, placenta previa, or
abruptio placentae

 Nutritional deficiencies, drugs, and maternal infections such as

(cytomegalovirus or toxoplasmosis)
It occurs more frequently in infants born From
occipitoposterior rather than anterior birth positions.
Head injury such as can result from child abuse, shaken baby
syndrome, trauma, or severe dehydration in the newborn
Infections such as meningitis or encephalitis in the newborn
In the past, kernicterus resulting from neonatal
hyperbilirubinemia was considered a cause of the athetoid type
of CP

.Types of Cerebral PALSY

Spastic Type
Spasticity is excessive tone in the voluntary muscles that results
in loss of upper motor neurons a child with spastic CP has
hypertonic muscles, abnormal clonus, exaggeration of deep
. tendon reflexes, abnormal reflexes
If infants with CP are held in a ventral suspension position, they
arch their backs and extend
.their arms and legs abnormally

Children tend to assume a scissors gait because tight adductor

thigh muscles cause their legs to cross when held upright.

Types of Spastic
A. Hemiplegia( involvement may affect both
extremities on one side)
B. Quadriplegia (all four extremities)
c. paraplegia , diplegia ,(or primarily
the lower extremities)

.Types of Cerebral PALSY

Dyskinetic or Athetoid Type
Involves abnormal involuntary movement. Athetoid means worm
. like
Is characterized by involuntary slow and writhing movements,
which usually affects the hands, feet, arms and legs and tongue
Because of poor tongue and swallowing movements, the child
. drools and speech is difficult to understand
While spastic cerebral palsy is characterized by increased muscle
tone and tension, this type of cerebral palsy causes mixed muscle
tone, where some muscles are too tense, while others are too
. .relaxed

Ataxic Type
This type of cerebral palsy is caused by brain damage to the
.cerebellum, located towards the base of the brain
The cerebellum is responsible for orchestrating muscle
movement for balance and coordination. When this part of the
brain is damaged it can lead to ataxic cerebral palsy,
characterized by difficulty with balance and coordination of
. movements

 Mixed Type
Some children show symptoms of both spasticity and athetoid
movements. Ataxic and athetoid movements also may be
present together. This combination results in a severe degree of
physical impairment.

Moreover, patients with ataxic cerebral palsy may experience

:some or all of the following symptoms
Hypotoniapoor or low muscle tone
Gait problemssuch as a wide gait (walk)
Tremorsparticularly when attempting fine motor movements
such as writing or tying a shoe; these are also called intention
tremors because they often occur when a person tries to execute
a voluntary, or intentional muscle movement.
On neurologic examination, they are unable to perform the
finger-to-nose test or to perform rapid, repetitive movements
.(tests of cerebellar function) or fine coordinated

motions

Physical findings

Delayed motor development .

Abnormal head circumference .
Abnormal postures .
Abnormal reexes Newborn.
Abnormal muscle performance and tone .

Assessment of Cerebral Palsy

The diagnosis of CP is based on history and physical assessment. Any episode of possible
anoxia during prenatal life or at birth should be documented .
Determining the extent of involvement in an infant can be difficult, because a neurologic
assessment in infants is difficult. The full extent of the disorder, therefore, may be recognizable
only when the child is older and attempts more complex motor skills, such as walking.
A skull radiograph or ultrasound may show cerebral asymmetry. However, the skull shape
usually is normal. A CT or MRI scan usually is negative. The EEG may be abnormal.

Nursing Diagnosis
Deficient knowledge related to understanding of complex disease
condition
Goal
The Parents / family will be able to demonstrate understanding of the
needs of child care that is characterized by taking an active role in child
. care
Interventions
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.

Nursing Diagnosis

Nursing Diagnosis: Impaired verbal communication related to neurologic

impairment
Goal
The child will be able to demonstrate an appropriate level of learning ability
and communication
Interventions
Most children with CP benefit from speech therapy, which helps them
learn to speak slowly and to coordinate their lips and tongue to form
speech sounds
provide an alternative form of communication, such as flash cards or a
picture board
Involve the family in training a child to communicate.
Touch-screen computer programs are often used in school settings to aid
communication

:Nursing Diagnosis
Risk for disuse syndrome related to spasticity of muscle groups
Risk for self-care deficit related to impaired mobility
Risk for delayed growth and development related to activity
restriction secondary to CP

Long-term Care
Because CP is not always diagnosed early in infancy, parents may
not learn that their child has a chronic disease until 2 to4 years later.
Help them to encourage their children with CP to reach their fullest
potential within the limits of their dis-order. Evaluations at health
care visits should note not only whether the child is achieving goals
but also whether the child and family members nd satisfaction and
acceptance in the childs achievements. Listen to parents during
health care visits and encourage them to discuss the difculties of
daily living, such as feeding problems. They may grieve because
their child is not able to accomplish all of the major things they had
wished for during pregnancy, and they may feel defeated by the dayto-day strain of caring for their childs multiple special needs. Care
of a child with a chronic illness is discussed further in C

Reference :

Pilliteri, A.(2010). Maternal and

child health nursing , 6th ed .
Lappincott williams&wilkins .
Philadelphia

Afnan aiysh

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