What is Cerebral Palsy (CP) <ul><li>form of paralysis believed to be caused by a prenatal brain defect or by brain injury during birth, most marked in certain motor areas and characterized by difficulty in control of the voluntary muscles. </li></ul>
Three Main Types of CP <ul><li>Hemiplegia - the leg and arm on one side of the body are affected. </li></ul><ul><li>Diplegia - both legs are affected significantly more than the arms. Children with diplegia usually have some clumsiness with their hand movements. </li></ul><ul><li>Quadriplegia - Both arms and legs are affected. The muscles of the trunk, face and mouth can also be affected </li></ul>
Causes of CP <ul><li>Cerebral palsy results from damage to part of the brain. The term is used when the problem has occurred to the developing brain, usually before birth. For most people with cerebral palsy, the cause is unknown. The risk is greater in babies born preterm and with low birthweight. Whilst the reasons for this remain unclear, cerebral palsy may occur as a result of problems associated with preterm birth or may indicate an injury has occurred during the pregnancy that has caused the baby to be born early. In some cases, damage to the brain may occur: - in the early months of pregnancy, for example, if the mother is exposed to certain infections such as German Measles; - due to the baby not growing at the correct rate during the pregnancy; - at any time if there is a lack of oxygen supplied to the baby. This is of particular concern during birth. Current research suggests that in some cases this may be due to abnormalities already present in the baby which affect the baby during the birth process; - in the period shortly after birth, if an infant develops a severe infection such as meningitis or encephalitis, which, in rare cases, may result in brain damage; - accidentally in the early years of life; for example, with a near drowning or car accident. Ongoing research is vital for the management of cerebral palsy. An Australian CP Register has been set up to record the incidence and will guide future research in prevention, intervention and service provision. </li></ul>
Conditions related to CP <ul><li>Disorders of hearing - People with cerebral palsy sometimes also have hearing problems. Disorders of eyesight - People with cerebral palsy may have squints or other visual problems. Epilepsy - People with cerebral palsy may also have recurring seizures (fits). Intellectual disability and learning difficulties - Children and adults with cerebral palsy vary widely in their intellectual and learning capabilities. Some will show the same intellectual capabilities as other children, in spite of their physical difficulties. Others will have some degree of intellectual disability, ranging from mild through to very significant. Perceptual difficulties - understand how lines are connected to form letters. People with cerebral palsy can have problems with perception as the brain may have difficulty interpreting the messages it receives from the senses. Speech difficulties - Because the muscles of the mouth may be affected, some people with cerebral palsy may find talking difficult. Some people may be mildly affected whilst others cannot say any words at all. People who cannot speak clearly may use a communication board or electronic communication device. Eating and drinking difficulties - Cerebral palsy may affect the muscles that open and close the mouth and move the lips and the tongue. Some children have difficulty chewing and swallowing certain foods. Perception is making sense of information gained from the senses. This enables people to do things such as move around obstacles, judge size and shape of objects. </li></ul>
The Discover of CP <ul><li>William John Little </li></ul><ul><li>William John Little was an English surgeon who, in the 1860s, identified spastic diplegia in children. He suffered childhood poliomyelitis with residual left lower extremity paraparesis, complicated by severe talipes. As a youth he was an apothecary's apprentice, surrendering his indentures at the age of 18 and entering medical school at the London Hospital. He was admitted to the Royal College of Surgeons in 1832. He later travelled to Germany to study the technique of subcutaneous tenotomy with its originator, Louis Stromeyer, who subsequently corrected Little's deformed foot by this method. </li></ul><ul><li>His doctoral dissertation (1837) was the first monograph on tenotomy ever published, and he became the apostle of this operation for the correction of skeletal deformity secondary to neuromuscular disease. Little founded the Royal Orthopaedic Hospital of London. Among his many publications was "On the Deformities of the Human Frame" (1853) in which he first described pseudohypertrophic muscular dystrophy (antedating Guillaume Duchenne's paper by eight years), as well as cerebral spastic palsy (Little's Disease). The techniques originated by Stromeyer and applied by Little are used today in the surgical management of muscular dystrophy. William Little was one of the first to bridge the gap between neurology and orthopaedics and his important work continues to impact on both these fields. </li></ul>
Treatments <ul><li>Early Nutritional Support In one cohort study of 490 premature infants discharged from the NICU, the rate of growth during hospital stay was related to neurological function at 18 and 22 months of age. The study found a signficant decrease in the incidence of cerebral palsy in the group of premature infants with the highest growth velocity. This study suggests that adequate nutrition and growth play a protective role in the development of cerebral palsy. </li></ul><ul><li>Physical therapy (PT) programs are designed to encourage the patient to build a strength base for improved gait and volitional movement, together with stretching programs to limit contractures. Many experts believe that life-long physical therapy is crucial to maintain muscle tone, bone structure, and prevent dislocation of the joints. </li></ul><ul><li>Occupational therapy helps adults and children maximise their function, adapt to their limitations and live as independently as possible. </li></ul><ul><li>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. </li></ul><ul><li>Speech therapy helps control the muscles of the mouth and jaw, and helps improve communication. Just as CP can affect the way a person moves their arms and legs, it can also affect the way they move their mouth, face and head. This can make it hard for the person to breathe; talk clearly; and bite, chew and swallow food. Speech therapy often starts before a child begins school and continues throughout the school years. </li></ul><ul><li>Hyperbaric oxygen therapy Recent studies have demonstrated a dramatic improvement in CP symptomology when hyperbaric oxygen therapy is used as a treatment. Researchers in Brazil found a significant alleviation in symptomology and other characteristics in a study involving 218 cerebral palsy patients. Significant enhancements were documented showing improved vision, hearing and speech as well as a reduction of spasticity by 50%, which occurred in 94% of study patients. </li></ul><ul><li>Nutritional counseling may help when dietary needs are not met because of problems with eating certain foods. </li></ul>
Treatments <ul><li>Both massage therapy and hatha yoga are designed to help relax tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises are sometimes used to try to prevent lung infections. More research is needed to determine the health benefits of these therapies for people with CP. </li></ul><ul><li>Surgery for people with CP usually involves one or a combination of: </li></ul><ul><li>* 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. </li></ul><ul><li>* 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. </li></ul><ul><li>* 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. </li></ul><ul><li>* Botulinum Toxin A (Botox) injections into muscles that are either spastic or have contractures, the aim being to relieve the disability and pain produced by the inappropriately contracting muscle. </li></ul><ul><li>Another way is that a new study has found that cooling the bodies and blood of high-risk full-term babies shortly after birth may significantly reduce disability or death. </li></ul><ul><li>Cord Blood Therapy: There are no published randomized controlled trials or meta-analysis of this treatment modality in cerebral palsy. In March of 2008 a boy that was diagnosed with cerebral palsy appeared on the Today Show with his family. The parents noted that he could not walk on his own and appeared to be "swallowing his tongue" at times. He was eventually diagnosed with cerebral palsy and could only walk with the aid of a walker for a short time. Earlier this year he participated in a clinical trial involving his own cord blood that his parents had saved when he was born. Within 5 days after the procedure he was walking on his own and talking. Something his mother said he was not capable of on his own and it was doubtful he would ever be able to do on his own. The doctors also told his parents that if his rate of progress continues uninterupted until he is 7 he will be pronounced cured. The parents message to the audience was "Bank your babies cord blood or donate it if you do not want to keep it. But you never know when you may need it." </li></ul><ul><li>Conductive education (CE) was developed in Hungary from 1945 based on the work of András Pető. It is a unified system of rehabilitation for people with neurological disorders including cerebral palsy, Parkinson's disease and multiple sclerosis, amongst other conditions. It is theorised to improve mobility, self-esteem, stamina and independence as well as daily living skills and social skills. The conductor is the professional who delivers CE in partnership with parents and children. Skills learned during CE should be applied to everyday life and can help to develop age-appropriate cognitive, social and emotional skills. It is available at specialised centres. </li></ul><ul><li>Biofeedback is an alternative therapy in which people with CP learn how to control their affected muscles. Some people learn ways to reduce muscle tension with this technique. Biofeedback does not help everyone with CP </li></ul>
Thank You <ul><li>For more presentations go to </li></ul><ul><li>http:// adncentral.googlepages.com /education </li></ul>
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