cerebral palsy in pediatrics, its type and its management

1. Cerebral palsy
Maryam Majid Al Ezairej
Collage of medicine
RAKMHSU

2. introduction
 "A group of disorders of the development of movement and posture causing
activity limitations that are attributed to non-progressive disturbances that
occurred in the developing fetal or infant brain. The motor disorders of
cerebral palsy are often accompanied by disturbances of sensation, cognition,
communication, perception, and/or behavior and/or a seizure disorder."

3. Epidemiology
 The incidence of cerebral palsy has not changed in more than 4 decades,
despite significant advances in the medical care of neonates.
 In developed countries, the overall estimated prevalence of cerebral palsy is
2-2.5 cases per 1000 live births
 All races are affected by this disorder. Lower socioeconomic status [29] and
male sex [12] may be increased risk factors for cerebral palsy.

4. Aetiology
•Infection
- German measles
- Shingles
•Diabetes
•Toxemia of
pregnancy
•Rh
incompatibility
•Asphyxia
•Birth injury
•Prematurity
Caused by developmental, genetic,
metabolic, ischemic, infections
Antenatal
factors (80%)
Intrapartum
(10%)
Postpartum
(10%)
 Very high fever
 Brain infection
 Head injury
 Lack of oxygen
 Poisoning
 Intracranial
hemorrhage or
blood clot

5. Physiologic
identify forms of motor
impairment
Spastic CP
Dyskinetic CP
Ataxic CP
Mixed CP
Distribution
identify location of
musculoskeletal
involvement
Spastic diplegia
Spastic
quadriplegia
Spastic
hemiplegia
Classification

7. Spastic cp
 The most common form of CP (70-80%)
 Due to injury to upper motor neurons of pyrimidal tract
 Often exhibit truncal hypotonia in 1st year of life
 Patients have signs of upper motor neuron involvement, including
hyperreflexia, clonus, extensor Babinski response, and persistent primitive
reflexes.

8. dyskinetic CP
 10-15%
 Result of injury to basal ganglia (associated with kernicterus)
 Characterized by variable tonal abnormalities & involuntary movement
(athetosis, chorea)
 Fewer seizures & >normal cognitive function

9. Ataxic CP
 <5% of CP cases – rare
 Results from cerebellar injury
 Abnormalities of voluntary movement and balance
 Wide-based, unsteady gait, abnormal muscle tone

10. Mixed CP
 10-15% of all cases
 > 1 type of motor pattern is present & when 1 pattern does not clearly
dominate another
 Associated with > complications: sensory deficits, seizures, cognitive-
perceptual impairments

11. 5 CLINICAL SIGNS OF CP
 1. Abnormal tone
 2. abnormal posture
 3. presence of primitive reflexes
 4. delays in motor skills
 5. difficulty in executing movement

12. Associated problems
 Mental retardation
 Seizures
 Sensory integration problems
 Feeding problems
 Behavioral/emotional difficulties

13. diagnosis
 The diagnosis of CP depends on patient's history & on the basis of significant
delay in gross & fine motor function, with abnormalities in tone, posture, &
movement on neurological examination.
 Once diagnosed with CP, further diagnostic tests are optional
 MRI is preferred over CT due to diagnostic yield & safety.
 The CT or MRI also reveals treatable conditions, such as hydrocephalus, AVM,
subdural hematomas etc.
 Diagnosis, classification, & treatment are often based on abnormalities in
tone

14. Diagnostic work up
 MRI
 CT Scan
 EEG
 Laboratory and radiologic work up
 Physical evaluation
 Interview
 Assessment tools i.e. Peabody Development Motor Skills, Bruininx

15. “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.”
-UN Convention on the Rights of
the Child. 1989.

16. Management
 Medical
 Surgical
 Rehabilitative

17. Medical managment
 Oral medications such as baclofen, diazepam, and trihexyphenidyl as well as
therapeutic botulinum toxin (Botox)
 Children with dystonic CP have dopa-responsive dystonia, with improved
motor function using levodopa
 Children with basal ganglia/thalamic injury from perinatal asphyxia may
develop improved expressive speech & hand use with trihexyphenidyl

18. Surgical management
 Bony correction E.g. femur (termed femoral anteversion or antetorsion) &
tibia (tibial torsion). 2ndary complication caused by spastic muscles generating
abnormal forces on bones

19.  Adjunctive therapy:
- Physiotherapy
- Occupational therapy
- Speech therapy
 Psychological therapy
 Adaptive equipment

20. Prognosis
 CP is not a progressive but the symptoms can become more severe over time
 Prognosis depends on intensity of therapy during early childhood
 Tend to develop arthritis at a younger age than normal because of pressure
placed on joints by excessively toned & stiff muscles
 Intellectual level among people with CP varies from genius to intellectually
impaired
 (it is important to not underestimate a person with CP and to give them every
opportunity to learn)
 The ability to live independently with CP varies widely depending on severity
of each case.
 Some individuals with CP are dependent for all ADL.
 Some can lead semi-independent lives, needing support only for certain activities.
 Still others can live in complete independence.

22. Thank you 