Cerebral Palsy (Morta Kate)

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Ivy Joy Macapia Ricca Manalo Kate Morta Charice Sapongay
Eunice and Pearl Trixie Respicio Rhoanne Pariñas Kristine Maglelong
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C O M P L I C AT I O N S I N P R E G N A N C Y A N D C H I L D B I R T H
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Cerebral Palsy
 Cerebral palsy (CP) is the most common motor disability in childhood.
 “Cerebral” - brain. “Palsy” - paralysis.
 CP is a group of disorders that affect a person's ability to move and maintain
balance and posture.
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DEFINITION &
BACKGROUND
 “Cerebral Paralysis” is also known as “Little’s Disease” named after an English surgeon, Dr. John
Little , the first person to study cerebral palsy and define it in 1853
 A motor function disorder
 caused by permanent, non-progressive brain lesion
 Non-curable, life-long condition
 present at birth (neurodevelopmental disease) or shortly thereafter.
 CP is a disorder of the movement, muscle tone,/ posture that is caused by an insult to
the immature, developing brain, most often before birth.
 Damage doesn’t worsen

 A Heterogenous Group of Movement Disorders.
– An umbrella term
– Not a single diagnosis NUR221
SIGNS AND
Abnormal
Strength
Abnormal Abnormal
Muscle Tone Reflexes
SYMPTOMS Loss of
control or
SYMPTOMS Persistent
Coordination OF C.P. Motor delay
CP
Affects
Posture or
Cognitive
Balance
Deficit
problem
Associated
Handicaps
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EARLY
SIGNS
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Child with C.P. are slow to reach

Developmental Milestones
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Abnormal Developmental
Patterns after 1 year of age:
 “W sitting” – knees flexed, legs
extremely rotated
 “Bottom shuffling” Scoots along the
floor
 Walking on tip toe or hopping
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Cerebral Palsy
 Main problem:
 Mentation and thought processes are not
always affected;
 Trapped in their bodies with their
disabilities
 Ability to express their intelligence may
be limited by difficulties in
communicating. NUR221
EPIDEMIOLO
GYCP is the most common and costly form of
chronic motor disability
Prevalence: 2/ 1000
Prevalence of CP is increased in low birth weight
infants (< 1000g)
CP incidence higher in premature and twin birth
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Diagnosis
A USEFUL diagnosis is when the specific type, affected
limb, severity and cause, if known, are identified.
 Physical evaluation, Interview

 MRI, CT Scan EEG
 Laboratory and radiologic work up
 Assessment tools
i.e. Peabody Development Motor Skills, Denver Test II
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The Peabody
Development Motor
Scales  In-depth assessment
 6 Subtests include:
 Reflexes
 The subtests yield a
 gross motor quotient
 A fine motor quotient
 Stationary  A total motor
 Locomotion quotient.
 Object Manipulation  Ages covered: from birth
 Grasping, through five years of age
 Visual-Motor
Integration. NUR221
Denver Test II
 Developmental Screening Test
 Cover 4 general functions:
 Personal social (eg. Smiling),
 Fine motor adaptive (eg. Grasping & drawing)
 Language (eg. Combining words)
 Gross motor (eg. Walking)
Ages covered: from birth to 6 years

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ASSESSMENT
1. SUBJECTIVE
b. Child’s Health History
 INTERVIEW  Often admitted to
a. History Taking hospitals for corrective
 Include all that may surgeries and other
predispose an infant to complications.
brain damage or CP
 Risk factors
 Psychosocial factors
 Family adaptation
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Physical CRITERIA
P osturing / Poor muscle control and
Examination strength
2. OBJECTIVE
O ropharyngeal problems
S trabismus/ Squint
T one (hyper-, hypotonia)
E volutional maldevelopment
R eflexes (e.g. increaseddeep tendon)
*Abnormalities 4/6 strongly point to CP
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Posturing / Poor muscle control

and strength
 Test hand strength by lifting the child off the ground
while the child holds the nurses hands.
 Observe for presence of limb deformity, as decreased
use of extremity leads to shortening.
 Upon extension of extremities on vertical
suspension of the infant,
 If infant back bend backwards like and arch
may indicate CP is severe
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ANATOMY AND
PHYSIOLOGY OF THE
AFFECTED SYSTEMS
Cerebral Palsy is a problem in one or more of these areas causing abnormal muscle tone
posture and movement in the clinical presentation. Cerebral palsy is a disorder that also
manifests shortly after birth
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Cerebral
Cortexcortex, the largest part of
 The cerebral
the brain, is the ultimate control and
information-processing center in
the brain.
 The cerebral cortex is responsible for
many higher-order brain functions such
as sensation, perception, memory,
association, thought, and voluntary
physical action.
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Basal Ganglia
 The basal ganglia, or basal nuclei, are a group
of Subcortical Structure found deep within the
white matter of the brain. The function of the
basal ganglia is to fine-tune the
voluntary movements.
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Cerebellum:
 in the back of the brain,
 controls balance, coordination and
fine muscle control (e.g., walking).
 It also functions to maintain posture
and equilibrium.
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The cerebrum is divided two cerebral hemispheres (halves): left and

right. The right half controls the left side of the body. The left half
controls the right side of the body.
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Anatomy and Physiology of the

Motor Nervous system
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Pathophysiology
Prenatal and Neonatal brain
development
 Radiation  Head trauma  Genetic
 Infection  Infection Mutation
 Hypoxia  Hypoxia
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WHAT CAUSES CEREBRAL

PALSY?
BEFORE BIRTH DURING BIRTH
 Congenital abnormalities  Brain injury due to
in brain development oxygen deficiency during
 Infection in the mother difficult labor
during pregnancy  Braine hemorrhage in
premature babies
UNKOWN FACTORS
AFTER BIRTH
?
 Infection of the brain such
as encephalitis and
meningitis
 Head trauma causing
concussion of brain
hemorrhage
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CAUSE
S
 An insult or
injury to the
brain
 Fixed, static lesion(s)
 In single or multiple
areas of the motor
centers of the brain
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 Early in CNS deviation.
Development Malformations
 The brain fails to develop correctly.
Neurological damage
 Can occur before, during or after
delivery Rh incompatibility, illness,
severe lack of oxygen
*Unknown in many instances
 Severe deprivation of
oxygen or blood flow to the
brain
 Hypoxic-ischemic encephalopathy
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or intrapartal asphyxia
Treatment
Treatment for cerebral palsy usually involves a
multidisciplinary approach, pulling from
a number of clinical specialties like neurologists, rehabilitation
specialists, occupational therapists,
speech therapists, and others—hopefully to find a unique
approach for each patient,
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Physical therapy can be used to build

strength and improve walking ability, along
with stretching
to reduce contracture, which is a permanent
shortening of muscle tissue from being
hypertonic
or contracted for so long.
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Pharmacologic
Botox – is a neurotoxic protein control muscle spasms and
seizures,
Intrathecal Baclofen
-Delivered directly to the spinal fluid
-used to reduce abnormal muscle tone
Glycopyrrolate –an anticholinergic drug used to control

drooling
Pamidronate – a nitrogen-containing bisphosphonate used to
prevent osteoporosis.
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Surgery
-To loosen joints,
-Relieve muscle tightness, - Straightening of
different twists or unusual curvatures of leg
muscles
- Improve the ability to sit, stand, and walk.
cutting certain nerves to reduce their associated
movements or spasms.
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Orthopedic Surgery
 most common type of surgery for patient with cerebral palcy .
 procedures that address the musculoskeletal system.
 a procedure that have the potential to relax spastic muscles, repair joints, correct
deformed bones, and relieve pain.
Common types of orthopedic surgical procedures
 Osteotomy- This type of surgery is used to make improvements sa joints.
 Muscle lengthening- Surgery can lengthen and release muscles so that they are less stiff and a child can move
better.
 Tendon lengthening- When tendons are too tight, it restricts movement and causes pain.
 Tendon or muscle cutting- cutting muscles or tendons can actually relieve tightness and pain, while also
improving movements and reducing spasticity. A cut tendon can also be replaced by donor tissue.
 Arthrodesis- It involves permanently fusing bones together. This can help reduce spasms, and can also make
walking easier.
 Scoliosis repair- Scoliosis can be repaired surgically to assist with posture and movement, as well as prevent
respiratory problems
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Selective Dorsal Rhizotomy

 It has the potential to reduce spasticity and relieve pain permanently, but it is also risky
 The surgery involves cutting nerves that are causing spastic muscle movements.
 Cutting the correct nerves can provide a child with better movement, greater comfort, and
significant pain relief, but it can also result in loss of movement in specific muscles as well as
numbness
After Surgery
A child having surgery for CP will need physical therapy and lots of recovery time. Depending
on the type of surgery, therapy may go on for weeks or months. A child may need to relearn how
to use certain muscles or how to walk. This takes time, but in many cases, great benefits are
seen that last for many years.
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Nursing diagnosis
 Impaired Physical Mobility
 Imbalanced Nutrition: Less than
Body Requirements
 Impaired Verbal Communication
 Ineffective Therapeutic Regimen
Management
 Risk for Injury
 Risk for Delayed Growth and
Development
 Risk for Self-Care Deficit
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Assessment Nursing Inference Nursing Planning Nursing Rationale Evaluation
Diagnosis
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“Suddenly my Risk for injury Seizures are  After 8 hours of  Explore with the patient  Lack of sleep, flashing  After 8 hours of
daughter started related to loss of disturbances in nursing intervention the various stimuli that lights and prolonged nursing
shaking large muscle normal brain the patient will my precipitate seizure television viewing may intervention the
uncontrollably” as coordination as function resulting demonstrate activity cause potential seizure patient was able
verbalized by the evidence by active from abnormal behaviors, lifestyle  Discuss seizure warning activity. to demonstrate
mother seizure. electrical discharges changes to reduce risk sign and usual seizure  Enables the patient to behaviors, lifestyle
in the brain which factors that protect pattern. protect self from injury. changes to reduce
Objective: Weakness can cause loss of self from injury.  Keep padded side rails  Minimizes injury should risk factors that
• Facial grimace consciousness, up with bed in the seizure occur while protect self from
• Irritability uncontrolled body lowest position. patient is in bed. injury.
• Active tonic and movements.  Evaluate need for  Use helmet may provide
clonic seizure. protective head gear. added protection for
• Over secretions  Maintain strict bed rest if individuals during aura or
of saliva prodromal signs of aura seizure activity.
Vital Signs: experienced  Patient may feel restless
T 37.3  Turn head to side or to ambulate of even
P 110 suction airway as defecate during aural
Rr 20 indicated. Insert plastic phase that inadvertently
BP 120/90 O2 Sat 97% bite block only if jaw are removing self from safe
relaxed. environment and easy
observation.
 Help maintain airway and
reduces risk of oral
trauma but should not
be forced or inserted
when teeth are clenched
because dental of soft
tissue may damage
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Cerebral Palsy (Morta Kate)

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Who’s reporting?

Ivy Joy Macapia Ricca Manalo Kate Morta Charice Sapongay

Eunice and Pearl Trixie Respicio Rhoanne Pariñas Kristine Maglelong

Febrile Cerebral Wilm’s Bronchia Diabetes

 “Cerebral” - brain. “Palsy” - paralysis.

 Damage doesn’t worsen

Child with C.P. are slow to reach

 Physical evaluation, Interview

Ages covered: from birth to 6 years

Posturing / Poor muscle control

The cerebrum is divided two cerebral hemispheres (halves): left and

Anatomy and Physiology of the

WHAT CAUSES CEREBRAL

Physical therapy can be used to build

Glycopyrrolate –an anticholinergic drug used to control

Selective Dorsal Rhizotomy

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