CEREBRAL PALSY A cademics.

T ouches heart.
E ducates mind.
A rticulates vision.
Models excellence.
Cerebral Palsy
 Nonspecific term applied to neurologic disorder
characterized by early onset & impaired movement
& posture
 Non progressive, accompanied by perceptual
problems, language deficits, & intellectual
involvement

** CP is the leading cause of childhood disability

affecting function & development.
Exact cause is unknown but may result
from injury of or damage to the brain
before, during or shortly after birth
Brain anoxia cell destruction of motor tracts

motor Motor
neuron impairment
dysfunction
accompanied by
perceptual problems,
language deficits,
intellectual development
 Risk Factors of Cerebral Palsy
Time Period Causes Causes
Maternal Gestational
Prenatal • diabetes or hyperthyroidism • chromosome
• exposure to radiation or toxic subs. abnormalities
• malnutrition • genetic syndrome
• seizure disorder or mental • teratogens
retardation • Rh incompatibility
• infections infections
• incompetent cervix • problems in placental
• bleeding functioning
• polyhydramnios • inflammatory response
• genetic abnormalities • unknown
• previous child w/ developmental
disabilities
• previous premature birth
• previous fetal loss
• medication use
• inflammatory response
• severe proteinuria
 Risk Factors of Cerebral Palsy
Time Period Causes Causes
Maternal Gestational
Prenatal • diabetes or hyperthyroidism • chromosome
• exposure to radiation or toxic subs. abnormalities
• malnutrition • genetic syndrome
• seizure disorder or mental • terratogens
retardation • Rh incompatibility
• infections infections
• incompetent cervix • problems in placental
• bleeding functioning
• polyhydramnios • inflammatory response
• genetic abnormalities • unknown
• previous child w/ developmental
disabilities
• previous premature birth
• previous fetal loss
• medication use
• inflammatory response
• severe proteinuria
 Risk Factors of Cerebral Palsy
Time Period Causes
Labor & Delivery Labor & delivery complications
• premature delivery
• PROM
• FHR depression
• abnormal presentation
• long labor
• preeclampsia
• asphyxia
Risk Factors of Cerebral Palsy
Time Period Causes
Perinatal • Prematurity & associated problems
• Sepsis or CNS infection
• Seizures
• Intraventricular hemorrhage
• Periventricular encephalomalacia
• Meconium aspiration
• Days on mechanical ventilation
• Persistent pulmonary hypertension in
NB
• Intrauterine growth retardation
• LBW
• Unknown
TYPES OF CEREBRAL PALSY
Signs & Symptoms
Spastic: Hypertonicity, impaired
gross & fine motor skills, abnormal
postures & overflow of movement
 SPASTIC
CEREBRAL PALSY
According to affected limbs (plegia or paresis)

Lower
extremities
are involved
Signs & Symptoms
Athetoid/Dyskinetic : slow wormlike/writhing
movements, drooling, dysarthria, choreoid &
dystonic manifestation
Signs & Symptoms
Ataxic: wide based gait, rapid, repetitive
performed poorly movements, disintegration
of movements of the upper extremities
Signs & Symptoms

Mixed type or dystonic – combination

of spasticity & athetosis
 B
Clinical Manifestations e Ale
rt !
 Delayed Gross Motor Development
 Alterations of Muscle Tone
 Abnormal Motor Performance
 Abnormal Postures
 Reflex Abnormalities
Clinical Manifestations
 Associated Disabilities & Problems
• visual impairment
• hearing impairment
• communication & speech difficulties
• seizures
• intellectual impairments
Diagnostic Evaluation

Neurologic examination & history taking

MRI
CT scan
Metabolic & genetic testing

Infants should be monitored & evaluated

closely in the first 2 years of life!
NURSING DIAGNOSES
Impaired physical mobility related to
neuromuscular impairment
Self care deficits:
bathing/hygiene/dressing/feeding/toileting
related to physical disability
Delayed growth & development related to
effects of physical disability
Impaired verbal communication related to
perceptual & cognitive impairment
NURSING DIAGNOSES
Body image disturbance related to perception
of disability
High risk for injury related to physical
disability, neuromuscular impairment
(aspiration), perceptual & cognitive
impairment
Altered family processes related to a child
with lifelong disability
PLANNING
Child will receive adequate nutrient intake for
body growth (weight gain).
Child will achieve developmental milestones to
maximum potential.
Child’s airway will remain patent.
Family will cope with child’s illness & functions
to maximum potential.
Goals of Therapy

Early recognition & promotion of an

optimum developmental course to enable
affected children to attain their potential
within the limits of their dysfunction.
 Aims of therapy are to:
1. Establish locomotion, communication, & self-
help
2. Gain optimum appearance & integration of motor
functions
3. Correct associated defects as early & effectively
as possible
4. Provide educational opportunities adapted to the
individual child’s needs & capabilities
5. Promote socialization experiences with other
affected & unaffected children
Therapeutic Interventions
Physical Therapy – Orthotic Devices
-braces
-splints
-casting
Physical Therapy
Adaptive Equipment
-scooters, bicycles, & tricycles
-wheelchairs
-boards
Therapeutic Interventions
Occupational Therapy – Adaptive
Equipment
-utensils for functional use
-switches
-computers
Functional& Adaptive Training
(Occupational Therapy)
Speech-Language therapy
-oral-motor skills
-adaptive communication techniques
Therapeutic Interventions
Special Education
-early intervention programs
-specialized learning programs & support services
in school
-socialization to promote self-concept
development
Education
Therapeutic Interventions
Behavioral Therapy
-neuromuscular electrical
stimulation
Care Coordination
-care coordination of specialized
services & community resources
in collaboration with the child’s
family
Recreation
Medical Therapy
– medications to treat:
-spasticity
-pain
-secondary conditions (seizure
disorder, constipation, UTIs, URIs,
decubitus ulcer)
- primary care for health supervision &
acute childhood illnesses
Therapeutic Interventions

Surgical Intervention
-orthopedic (tendon transfer, muscle strengthening)
-neurologic (neurectomy)
-selective dorsal rhizotomy
Prognosis
Approximately 30-50% are mentally
retarded
A higher percentage have mild cognitive
& learning deficits
As adults – 30% remain @ home
50% w/ Spastic CP are in
independent settings
Vocational rehabilitation & higher
education are now possible!
Nursing Care Management
Reinforce therapeutic plan & assist in
normalization
Address health maintenance needs
Support family
Support hospitalized child
EVALUATION
The client will be able to:
Verbalize understanding of situation &
individual treatment regimen & safety
measures (client &/ or significant other)
Demonstrate techniques/lifestyle changes to
meet self-care needs.
Perform self-care activities within level of
own abilities
Maintain position of function & skin integrity
EVALUATION
The client will be able to:
Maintain or increase strength and function of
affected or compensatory body part
Move safely within environment, maximizing
independence
Identify and use resources appropriately
Verbalize acceptance of self in situation
Verbalize relief of anxiety and adaptation to
altered body image
EVALUATION
The caregiver will be able to
Provide safe mobility within environment &
community
Establish a method of communication in
which the client’s needs can be expressed
Express feelings freely & appropriately
Verbalize understanding of illness, treatment
regimen & prognosis
Encourage & allow client to handle situation
in own way, progressing towards
independence
 SEIZURE
DISORDERS
Seizure
• episodic, stereotypic behavioral syndromes
with an abrupt onset, not provoked by external
stimuli & result in loss of responsiveness.
• are a symptom of an underlying disease
process.
• a single seizure event is not classified as
epilepsy
Epilepsy
 a condition characterized by two or more
unprovoked seizures more than 24 hours
apart and can be caused by a variety of
pathologic processes in the brain.
Incidence & Etiology:

Cause is often unknown/idiopathic

Few children develop febrile seizures
Genetic factors
Acquired
Etiology:
Infancy:
birth injury
anoxic episodes
infection
intraventricular hemorrhage
congenital brain anomaly
Etiology:
In older children:
occur most often secondary to trauma or infection
changes in diet or hydration status
fatigue
not taking prescribed medications
Types of Seizure:

1. Focal Seizure/Partial Seizure

- affects only one area of the brain
- does not lose consciousness
- very quick, lasting only 1-2 minutes

a. Simple Partial Seizure

- can be manifested at any age
- no aura
- symptoms seen are motor or sensory in nature
b. Complex Partial Seizure (
 aka partial psychomotor or temporal lobe
episodes
 manifested from age 3 years through adolescence
 may have an aura
 appear confused or dazed, especially at the onset

c. Simple or Complex Seizures Secondarily

Generalized (simple or complex partial seizures
that evolve into generalized, usually a tonic-clonic
event)
Febrile Seizure
- can be simple or complex, and can develop
with temperatures as low as 37.8°C (100°F)
- brief, clonic, or tonic-clonic nature
2. Generalized Seizures
- secondary to diffuse electrical activity throughout
the cortex & into the brain stem
- causes loss of consciousness
- demonstrate uncontrolled motor involvement with
movements & spasm bilateral & symmetrical in
nature
- occur at any time & last from several seconds to
hours
Types of Generalized Seizure:
a. Tonic-Clonic Seizure/ Grand Mal Seizure
- occur at any age
- onset is usually abrupt & begins when the child
loses consciousness & falls to the ground
- initial phase is tonic - intense muscle
contractions that persists for 10-30 seconds
- then clonic phase – jerking movements, last
from 30 sec – 30 mins. after onset of the seizure
- ends up in postictal or post-convulsive state
Types of Generalized Seizure:
b. Absence Seizure/ Petit Mal seizure
- appears at 4 y/o & generally disappear near
adolescence
- transient loss of consciousness
- child seems to stare into space or the eyes
may roll upward with ptosis or fluttering of the
lids
- manifested by frequent episodes of brief
staring spells, often with fluttering of the eyelids
- return immediately to their baseline mental
status after a seizure
ptosis or fluttering of the lids
Types of Generalized Seizure:
c. Myoclonic Seizure
- sudden repeated contractions of the muscles of
the head, extremities, or torso
- no loss of consciousness, no postictal period
 Types of Generalized Seizure:
d. Atonic and Akinetic Seizure (Drop Attack)
- sudden loss of muscle tone with the head
dropping forward for a few seconds
- losses consciousness & falls to the ground,
most often face down
Unclassified Epileptic Seizure :
- seizures that lack sufficient information to classify
1. West Syndrome (Infantile Spasm)
◦ onset within the first 4-8 months of life
◦ underlying cause is unknown
◦ consist of clusters of myoclonic spasms, typically upon
awakening or falling asleep
◦ with some degree of mental retardation
Unclassified Epileptic Seizure :
2. Lennox-Gastaut Syndrome (LGS)
- diagnosed on the evidence of mixed seizure
types
 onset is between 1-7 years of age
 have multiple seizures daily- Tonic seizures are
most common seizure type
- prognosis is typically poor
Diagnostic Procedures:
• Complete medical history
• Family history
• Complete P.E.
• CBC
• Serum electrolytes
• Lumbar puncture
• Complete neurological
evaluation
• Radiologic imaging
• EEG
Nursing Diagnoses:

• Ineffective breathing patterns as evidenced

during tonic-clonic motions.
• High risk for injury secondary to tonic-
clonic movements as well as diminished
level of consciousness.
• High risk for injury related to medication
administration during the acute episode.
• Interrupted family dynamics related to
caring for a child with a chronic condition.
Treatment:
• Airway must be assured – perform jaw
thrust
• Administer oxygen
• Medications:
- Benzodiazepines (Diazepam [Valium]
- Lorazepam [Ativan]
- Phenytoin (Dilantin)
• Ketogenic Diet
Nursing Management

• patent airway & adequate oxygenation

must be assured
• prescribed medications need to be
administered safe & in an efficient manner
• document the event in detail
• provide a safe environment
• provide care for the emotional needs of the
child & family
• provide family teaching