Introduction,Stages  of  Postnatal  Development,Infancy,Childhood,Adolescence ,Senescence,Definition ,Causes Prenatal Perinatal Postnatal ,Types Of Cerebral Palsy,Muscle Tone Diagnosis , treatment

1. Bhawna
MPT (Pediatrics)

2. Introduction
 The brain controls all that we do. Different parts of the
brain control the movement of every muscle of the
body.
 In cerebral palsy, there is damage to, or lack of
development in, one of these areas of the brain.
 'Cerebral' – refers to the brain.
 'Palsy' – can mean weakness or paralysis or lack of
muscle control.

3. Stages of Postnatal Development
 Neonatal period
• birth to end of 4th week
• newborn begins to carry on respiration, obtain
nutrients, digest nutrients, excrete wastes, regulate
body temperature, and make cardiovascular
adjustments

4. Infancy
 end of 4th week to one year
 growth rate is high
 teeth begin to erupt
 muscular and nervous systems mature
 communication begins

5. Childhood
 one year to puberty
 growth rate is high
 permanent teeth appear
 muscular control is achieved
 bladder and bowel controls are established
 intellectual abilities mature

6. Adolescence
 puberty to adulthood
 person becomes reproductively functional and
emotionally more mature
 growth spurts occur
 motor skills continue to develop
 intellectual abilities continue to mature

7. Adulthood
 adolescence to old age
 person remains relatively unchanged anatomically and
physiologically
 degenerative changes begin

8. Senescence
 old age to death
 degenerative changes
 body becomes less able to cope with demands placed
on it
 death results from various conditions and diseases.

11. Definition
 Cerebral palsy (CP) is defined as a chronic,
nonprogressive, neurological disorder of the immature
brain.
 Chronic disability of central nervous system origin
characterised by aberrant control of movement of
posture, appearing early in life.
 Approximately 1-2 per 100 live births is a
reasonable estimate of the incidence.

12.  Damage to the cerebrum before, during, or within 5
years of birth can cause cerebral palsy.
 The cerebrum is also responsible for memory, ability to
learn, and communication skills.

13. Causes
 Prenatal - The Prenatal or Antenatal development is
the process in which an embryo or fetus (or foetus)
gestates during pregnancy, from fertilization until
birth. Antepartum usually refers to the period between
the 24th/26th week of gestational age and birth of a
child.
 Perinatal- Pertaining to the period immediately before
and after birth. The perinatal period is defined in
diverse ways. Depending on the definition, it starts at
the 20th to 28th week of gestation and ends 1 to 4
weeks after birth.
 Postnatal- Postnatal (Latin for ‘after birth’, from post
meaning “after” and natalis meaning “of birth”) is the
period beginning immediately after the birth of a child
and extending for about six weeks.

14. Prenatal
 Drugs taken by mother
eg. Antihypertensive, steroids, alcohol consumption,
smoking, drug abuse.
 Lack of nutrition
 Any infection to mother
 Age of mother
 Genetic factors eg. Blood disorders
 Radiation
 Consanguineous marriage
 Hypoglycemia (deficiency of glucose in the bloodstream)
 Trauma to mother
 Jaundice with in the uterus

15. Perinatal
 Insufficient oxygen reaching the fetus
 Prematurity
 Asphyxia during labor and delivery
 Antipartum haemorrhage
 Multiple pregnancy
 Forceps delivery
 Breech delivery
 Suction labour
 Trauma

16. Postnatal
 Severe jaundice or kernicterus (Kernicterus: A
disorder that is due to severe jaundice in the newborn,
with deposition of the pigment bilirubin in the brain
that causes damage to the brain, potentially leading to
athetoid cerebral palsy, hearing loss, vision problems,
or mental retardation. Also known as bilirubin
encephalopathy.)
 Delayed cry
 Infection like meningitis, encephalitis.
 Intracranial bleeding

18. C:UsersAdministratorDesktopmdcpTypes of cerebral palsy
(1).mp4

20.  Topographical Distribution-Topographical
classification describes body parts affected. The words
are a combination of phrases combined for one single
meaning. When used with Motor Function
Classification, it provides a description of how and
where a child is affected by Cerebral Palsy. This is
useful in ascertaining treatment protocols.
 Plegia/Plegic - Means Paralyzed
 Monoplegia-Means only one limb is affected. It is
believed this may be a form of hemiplegia/hemiparesis
where one limb is significantly impaired.

21.  Diplegia-Usually indicates the legs are affected more
than the arms; primarily affects the lower body.
 Hemiplegia-Indicates the arm and leg on one side of
the body is affected.
 Triplegia -Indicates three limbs are affected. This
could be both arms and a leg, or both legs and an arm.
Or, it could refer to one upper and one lower extremity
and the face.
 Double hemiplegia- Indicates all four limbs are
involved, but one side of the body is more affected
than the other.
 Quadriplegia - Means that all four limbs are involved.

22. Muscle Tone
 Many motor function terms describe Cerebral Palsy’s effect
on muscle tone and how muscles work together. Proper
muscle tone when bending an arm requires the biceps to
contract and the triceps to relax. When muscle tone is
impaired, muscles do not work properly together and can
even work in opposition to one another.
Two terms used to describe Muscle Tone are hypertonia
and hypotonia.
 Hypertonia - Increased muscle tone, often resulting in very
stiff limbs. Hypertonia is associated with spastic cerebral
palsy.
 Hypotonia - Decreased muscle tone, often resulting in
loose, floppy limbs. Hypotonia is associated with non-
spastic cerebral palsy.

23. Accordingly to clinical features
 Spastic
 Athetoid
 Ataxic
 Flaccid or atonic

24. Spastic (cortex involved)
 Hypertones
 Increased tendon jerk and occasionally clonus in ankle
(C:UsersAdministratorDesktopmdcpPatellar clonus in
child.mp4
C:UsersAdministratorDesktopmdcpAnkle Clonus.mp4
C:UsersAdministratorDesktopmdcpHow to perform
clonus.mp4 )
 Babinski’s sign positive
(C:UsersAdministratorDesktopmdcpvideoplayback (1).mp4
C:UsersAdministratorDesktopmdcpTesting the Babinski
reflex in infants - Clinical examination _ Δ AMBOSS.mp4 )

25.  Clasp knife spasticity (in supine, increase extensor
tone and in prone, increase flexor tone.)
C:UsersAdministratorDesktopmdcpclasp
knife.mp4
 Scissoring gait (extensions, adduction and internal
rotation)
C:UsersAdministratorDesktopmdcpscissoring
gait.mp4
C:UsersAdministratorDesktopmdcpscissoring
gait1.mp4

26. Athetoid (Basal Ganglia Damage)
 Very often these involuntary movements are present at
rest and increase with excitement, fear and effort.
 Voluntary movement are possible but they lack
coordination and finer movements are also lacking.
 Very high IQ (intelligent quotient).
C:UsersAdministratorDesktopmdcpDyskinetic
cerebral palsy, case 1.mp4
C:UsersAdministratorDesktopmdcpathetoid.mp4

27. Ataxic (cerebellar damage)
 Balance and coordination is affected.
 Voluntary movements are clumsy and dissymmetric.
 They usually have hypotonia unless they are associated
with spasticity as seen in mixed type of cerebral palsy.
 Also have nystagmus (rapid involuntary movement of eye),
diadokokinesia, dysarthria, intentional tremors and tendon
jerks are pendular.
 IQ is low.
 It is very rare to see a pure ataxic cerebral palsy.
C:UsersAdministratorDesktopmdcpAtaxic Cerebral
Palsy - Learning to walk.mp4

28. Diagnosis
 Low birth weight
 Increased tone
 Feeding difficulty
 Global development delay
 Abnormalities of posture
 Ct scan
 MRI

29. Treatment
 The major aim of treatment in CP is to achieve
maximum possible functional ability and skills in
keeping with his development age.
 Pharmacotherapy-
1. Spasticity-Diazepam, dantrolene sodium or
baclofan
2.Hypotonia- Strychnine
3.Athetosis- Chlordiazepoxide or Levodopa
4.Epilepsy- Anticonvulsants

30.  Physiotherapy
 Occupational thaerapy
 Surgery
 Prevention