Cerebral Palsy (CP)

Presented by :
Smt. Priya B. shinde,
M.Sc. Nursing 1st Year
D.Y. Patil College of Nursing,
Kolhapur
 Classification of cerebral palsy
Cerebral palsy can be classified based on motor deficit
and distribution of handicaps:

1. Spastic cerebral palsy (pyramidal CP) (65%)

2. Extrapyramidal cerebral palsy (dyskinetic CP)
(30%)
3. Atonic cerebral palsy (cerebellar CP) (5%)
4. Mixed type CP. (25%)
CONT…
Classification According to Severity
• Mild cerebral palsy (20%):
• Patients are ambulatory
• Fine movements are impaired only.
• Moderate cerebral palsy (50%):
• These children achieve ambulation by self-help.
• There is impaired gross motor, fine motor and speech
development.
• Severe cerebral palsy (30%):
• The children present with multiple defects
• Unable to perform usual activities of daily living.
Classification of cerebral palsy
 Clinical manifestation:

Early signs of cerebral palsy include one or more of

the followings.
These include asymmetric movements
• Listlessness
• Irritability
• Difficulty in feeding or swallowing or poor
• Sucking with tongue thrust.
• Excessive high pitched or feeble cry
• Poor head control and slow weight gain.
Cont…

Late signs include one or more of the followings.

These are delayed gross motor development
• Persistent infantile reflexes
• Weakness anal postures
• Drooling recurrent infections
• Constipation or incontinence of stool
• Malocclusion of teeth
• Delayed or defective speech and
• Evidence of mental retardation
• Common problems are
• Seizures
Cont…
• Gastroesophageal reflux (GER) visual defects
(coloboma, squint,blindness and reactive error)
• Hearing impairment
• Perceptual disorders
• Mental retardation
• Speech disorder
• Growth failure
• Behavioural problems
• Special Features of Different Types of CP
• 
 1. Spastic Cerebral Palsy
Depending upon the involvement of spasticityQuadriplegia
• Paraplegia
• Hemiplegic
• Triplegia
• Diplegia
• Monoplegia.

• Early diagnostic features are persistens neonatal relaxes.

• Feeding difficulties
• Scissoring of liner limbs due to spasms of adductor muscles
• Other features are opisthotonic posture pseudo bulbar palsy.
• Restricted voluntary movements
• Deep tendon reflexes become brisk positive ankle clonus and convulsions.
• The child may have multiple handicaps and neurological deficits with
behavioural problems Permanent contractures may develop without muscle
training
 2. Extrapyramidal Cerebral Palsy

• It is found in about 30% of patients of all CP.

• The child presents with
• dyskinesia,like atherosis
• choreiform movements
• dystonia tremor
• Ripidity
• Arms legs, neck and trunk may be involved.
• Mental retardation deafness are commonly found as associated
problems.
• The lesions of the extra pyramidal tract and basal ganglia are
considered as the cause of involuntary, uncoordinated,
uncontrollable movements of the muscle groups.
• Cerebral damage due to kenicterus is considered as the
etiological factors
 3. Atonic Cerebral Palsy
(Cerebella Involvement)
This type occurs in less than 5% of the patients.
• Hypotonia
• byporellesia

• Ataxia and tremors appear by the age of two years

 Mixed Type Cerebral Palsy

• Some patients with CP have features of diffuse

neurological involvement of mixed type
•  A common combination is spastic and athetoid
 Diagnostic Evaluation

• a. Physical examination
• b. History collection
• c. Laboratory Investigations Routine
blood and urine examination
• CT scan
• MRI
• EEG
 Management:
• Treatment for cerebral palsy
• A lifelong multi dimensional process focused on
the maintenance of associated conditions.
Treatment may include one or more of the following:
• 1. Physical therapy
• 2. Occupational therapy
• 3. Speech therapy.
• 4. Drugs
• To control seizures,
• Alleviate pain, or relax muscle spasms
• (e.g. benzodiazepines, baclofen and intrathecal
phenol/baclofen)
Cont…

• Hyperbaric oxygen and the use of Botox to relax

contracting muscles.
• 5. Surgery to correct anatomical abnormalities or
release tight muscles.
• 6. Braces and other orthotic devices and rolling
walkers.
• 7. Communication aids such as computers with
attached voice synthesizers.
Cont…
• Treatment is usually symptomatic and focuses on
helping the person to develop as many motor skills
as possible.

1. Physical therapy
2. Occupational therapy
3. Speech therapy
4. Biofeedback
5. Massage therapy
Cont…
• Drug Therapy
• Botulinum Toxin A injections are given into muscles
that are spastic or sometimes dystonic, the aim being
to reduce the muscle hype tone in most often lower
extremity muscle tone can also facilitate bracing and
the use of orthotics.
• Most often lower extremity muscles are injected and
reinjection is needed every 4-6 months.
Surgical management
Orthopaedic surgery
• Muscle lengthening 
• Rizotomy
 Nursing Management:
• Nursing assessment: It should includes
• The detection of ability to perform activities of daily living
(ADL)
• Developmental milestones,
• Neurological reflexes,
• Feeding behaviour,
• Nutritional status,
• Bladder and bowel habits,
• Problem related to vision,
• Hearing and language,
• Associated health hazards or congenital anomalies,
• Present problems,
• Parent-child interactions,
• Treatment compliance
Nursing interventions:
• specialized care
• Increasing mobility
• improvement of coordinated
• prevent contractures
• Adequate rest period
• Avoidance of stress and frustration
• Administration of prescribed drugs
• Physiotherapy
• Education in special school
 Prevention of Cerebral Palsy:
• Prevention of cerebral palsy can be done by
• Adequate ante natal care with
• Prevention of maternal infections, fetal problems and
perinatal hazards.
• Prevention of birth injury,
• prenatal asphyxia
• neonatal hyperbilirubinemia are important measures
for prevention of CP.
• Early diagnoses and prompt initiation of appropriate
management of etiological factors along with the
condition reduce the incidence of neurological,
psychosocial and emotional handicaps of the child.
 Prognosis:

• Cerebral palsy is not a progressive disorde

• But once bones and musculature become more
established, orthopaedic surgery may be required.