Cerebral Palsy


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Cerebral Palsy

  1. 1. CEREBRAL PALSY Presentation prepared by: Jawen Caguioa EDSP 202
  2. 2. Historical Background <ul><li>WILLIAM LITTLE </li></ul><ul><ul><li>19 TH CENTURY </li></ul></ul><ul><ul><ul><li>Senior physician at the London Hospital </li></ul></ul></ul><ul><ul><ul><li>Founder of the Royal Orthopedic Hospital </li></ul></ul></ul><ul><ul><li>1853 </li></ul></ul><ul><ul><li>1862 (Obstetrical Society of London) </li></ul></ul><ul><ul><ul><li>Paper entitled “The Influence of Abnormal Parturition, Difficult Labor, Premature Birth and Asphyxia in Relation to Deformities” </li></ul></ul></ul>
  3. 3. Little’s Disease <ul><li>Approx 200 cases studied </li></ul><ul><li>Outline of characteristics and traits </li></ul><ul><li>Causes </li></ul><ul><li>Fundamental approach to treatment and mgt </li></ul>
  4. 4. In the US in Early 1940’s : <ul><li>Cerebral Palsy </li></ul>
  5. 5. Definition (history of) <ul><li>PERLSTEIN (1949) </li></ul><ul><ul><li>CP is a condition characterized by paralysis, weakness, incoordination or any other aberration of motor function due to pathology of the motor centers of the brain. </li></ul></ul><ul><li>DENHOFF (1951) </li></ul><ul><ul><li>CP is a condition in which interferences with the control of the motor system arise as a result of lesions occurring from birth trauma. </li></ul></ul>
  6. 6. <ul><li>SWARTZ (1951) </li></ul><ul><ul><li>CP is an aggregate of handicaps: emotional, neuromuscular, sensory caused by damage or absent brain structures. </li></ul></ul><ul><li>CROTHERS and PAINE (1959) </li></ul><ul><ul><li>A term which covers individuals who are handicapped by motor disorders which are due to non-progressive abnormalities of the brain. </li></ul></ul>
  7. 7. CEREBRAL PALSY <ul><li>A disorder in the movement and posture caused by an injury to the immature brain. </li></ul><ul><ul><ul><li>Movement </li></ul></ul></ul><ul><ul><ul><ul><ul><li>Posture </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Immature brain </li></ul></ul></ul></ul></ul>
  8. 9. Causes/Etiology <ul><li>Prenatal causes (before birth) </li></ul><ul><ul><li>Maternal characteristics </li></ul></ul><ul><li>Perinatal causes (at the time of birth to 1mo) </li></ul><ul><li>Postnatal causes (in the first 5 mos of life) </li></ul>
  9. 10. Prenatal causes <ul><li>Hemorrhage/bleeding </li></ul><ul><li>Infections </li></ul><ul><li>Environmental factors </li></ul>
  10. 11. Maternal Characteristics <ul><li>Age </li></ul><ul><li>Difficulty in conceiving or holding a baby to term </li></ul><ul><li>Multiple births </li></ul><ul><li>History of fetal deaths/miscarriages </li></ul><ul><li>Cigarette smoking >30 sticks per day </li></ul><ul><li>Maternal alcoholism and drug addiction </li></ul><ul><li>Social status; mother with MR </li></ul><ul><li>Mother’s medical condition </li></ul>
  11. 12. Perinatal Causes <ul><li>High or low BP </li></ul><ul><li>Umbilical cord coil </li></ul><ul><li>Breech delivery </li></ul><ul><li>Oversedation of drugs </li></ul><ul><li>Trauma i.e. forceps or vacuum delivery </li></ul><ul><li>*** complications of birth </li></ul>
  12. 13. Postnatal Causes <ul><li>Trauma, head injury </li></ul><ul><li>Infections </li></ul><ul><li>Lack of oxygen </li></ul><ul><li>Stroke in the young </li></ul><ul><li>Tumor, cyst </li></ul>
  13. 14. Types of CP <ul><li>** CP depends on the </li></ul><ul><li>1. extent of the brain damage </li></ul><ul><li>2. which part of the brain is damaged </li></ul>
  14. 15. Types of CP <ul><li>Spastic CP </li></ul><ul><ul><li>stiffness </li></ul></ul><ul><li>Flaccid SP </li></ul><ul><ul><li>floppy </li></ul></ul><ul><li>Athetoid CP </li></ul><ul><ul><li>Fluctuating tone </li></ul></ul><ul><li>Ataxic CP </li></ul><ul><ul><li>Unsteady; incoordinated </li></ul></ul><ul><li>Mixed CP </li></ul><ul><ul><li>Most common is spastic athetoid </li></ul></ul>
  15. 16. Classification of CP <ul><li>Topographical Classification (based on the location of the motor disability) </li></ul><ul><ul><li>1. quadriplegia </li></ul></ul><ul><ul><li>2. diplegia </li></ul></ul><ul><ul><li>3. paraplegia </li></ul></ul><ul><ul><li>4. triplegia </li></ul></ul><ul><ul><li>5. hemiplegia </li></ul></ul><ul><ul><li>6. hemiplegia </li></ul></ul><ul><ul><li>7. monoplegia </li></ul></ul><ul><ul><li>8. double hemiplegia </li></ul></ul>
  16. 17. Perlstein 1949, 1952 <ul><li>Degree of Severity </li></ul><ul><ul><li>1. Mild CP </li></ul></ul><ul><ul><li>2. Moderate CP </li></ul></ul><ul><ul><li>3. Severe CP </li></ul></ul>
  17. 18. 5 CLINICAL SIGNS OF CP <ul><li>1. Abnormal tone </li></ul><ul><li>2. abnormal posture </li></ul><ul><li>3. presence of primitive reflexes </li></ul><ul><li>4. delays in motor skills </li></ul><ul><li>5. difficulty in executing movement </li></ul>
  18. 19. Associated Clinical Conditions <ul><li>Mental retardation </li></ul><ul><li>Seizures </li></ul><ul><li>HI, VI </li></ul><ul><li>Sensory integration problems </li></ul><ul><li>Feeding problems </li></ul><ul><li>Behavioral/emotional difficulties </li></ul>
  19. 20. Diagnostic Procedures <ul><li>MRI </li></ul><ul><li>CT Scan </li></ul><ul><li>EEG </li></ul><ul><li>Laboratory and radiologic work up </li></ul><ul><li>Physical evaluation </li></ul><ul><li>Interview </li></ul><ul><li>Assessment tools i.e. Peabody Development Motor Skills, Bruininx </li></ul>
  20. 21. Treatment strategies and interventions <ul><li>Physical, occupational, speech therapy </li></ul><ul><li>Special education </li></ul><ul><li>Feeding management </li></ul><ul><li>Orthosis </li></ul><ul><li>Surgery </li></ul><ul><li>Pharmacologic i.e botox injection, anti spasticity drugs </li></ul><ul><li>Family and patient counseling program </li></ul><ul><li>Vocational and functional training program </li></ul><ul><li>Others: acupuncture, hyperbaric thx, thera suit </li></ul>
  21. 22. prognosis
  22. 23. <ul><li>“ A disabled child has the right to enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the child’s active participation in the community.” </li></ul><ul><li>- UN Convention on the Rights of </li></ul><ul><li>the Child. 1989. </li></ul>