CEREBRAL-PALSY: A motor function disorder

2. 
 PRESENTATION BY:
 SYLVIA E. SELASSIE, RD, LD
CEREBRAL PALSY

3. 
 Brief history
 Cerebral palsy overview
 Types of cerebral palsy
 Assessment and diagnosis
 Treatment regimen
 Definition of terms
 References
CONTENT

4. 
 In 1860s, referred to as ‘cerebral Paralysis’ or ‘Little’s
Disease’
 After a first medical descriptions by an English
surgeon- William John Little(1810-1894)
BRIEF HISTORY

5. 
 “Cerebral”- Latin Cerebrum
 Affected part of the brain
 “Palsy”- Para-beyond
-lysis- loosening
 Lack of muscle control
CEREBRAL PALSY

6. 
 A motor function disorder
 Due to permanent, non-progressive brain lesion
 Present at birth or shortly thereafter(Mosby, 2006)
 Non-curable, life-long condition
 Damage doesn’t worsen
 May be congenital or acquired
CEREBRAL PALSY

7. 
 A heterogeneous group of movement disorders
 An umbrella term
 Not a single diagnosis

8. 
 Balance
 Posture
 Movements
CEREBRAL PALSY
EFFECTS

9. 
 An insult or injury to the brain
 Fixed, static lesion(s)
 In single or multiple areas of the motor centers of the
brain
 Early in CNS development
ETIOLOGY

10. 
 Development Malformations
 The brain fails to develop correctly
 Neurological damage
 Can occur before, during or after delivery
 Rh incompatibility, illness, severe lack of oxygen
ETIOLOGY

11. 
 Severe deprivation of oxygen or blood flow to the
brain
 hypoxic-ischemic encephalopathy or intrapartal
asphyxia
MAJOR NOTED CAUSE

12. 
 Prematurity
 Blood-type incompatibility
 Placental insufficiency;
 Maternal infection that includes German measles
 other viral diseases
 Neonatal jaundice
 Anoxia at birth
 Bacterial infections of the mother, fetus, or infant that
affect the central nervous system
Causative agents

13. 
 ACCORDING TO NEUROLOGIC DEFICITS
 Based on: extent of brain damage and area of the brain
damage
 Each type involves the way a person moves
TYPES OF CEREBRAL
PALSY

14. 
1. Pyramidal
-originates from the motor areas of the cerebral cortex
2. Extrapyramidal
- basal ganglia and cerebellum
3. Mixed
MAIN TYPES

15. 
 MAIN TYPES:
 PYRAMIDAL : 1. Spastic CP
 Extrapyramidal: 2. Athethoid CP
3. Ataxic CP
 Mixed : 4. Spastic & Athethoid CP
ACCORDING TO TYPE
OF MOVEMENTS

16. 
 -Plegia/paresis-paralyzed or weak
 Paraplegia
 Diplegia
 Hemiplegia
 Quadriplegia
 Monoplegia- one limb(extremely rare)
 Triplegia- three limbs(extremely rare)
ACCORDING TO AFFECTED LIMBS:

17. 
 MILD- 20% of cases
 MODERATE- 50%; require self help for assisting their
impaired ambulation capacity
 SEVERE- 30%; total incapacitation and bedridden
ACCORDING TO
DEGREE OF SEVERITY

18. 
 Hypotonia
 Hypertonia
 Dystonia
ACCORDING TO MUSCLE TONE
ABNORMALITIES

19. 
SYMPTOMS

20. 

21. 

22. 
 Poor ability to concentrate
 Unusual tenseness
 Irritability
BEHAVIOURAL
SYMPTOMS

23. 
PROBLEMS OF
CEREBRAL PALSY

24. 
 Physical evaluation
 MRI, CT Scan
 Laboratory and radiologic work up
 Assessment tools: growth curve monitoring, MUAC,
height and length, Peabody Development Motor
Skills
DIAGNOSIS

25. 

26. 
 Interview
 A. history taking: involves all predisposition factors
such as
 Risk factors
 Psychosocial factors
 Family adaptation
 B. child’s health history: often admitted to hospitals
for corrective surgeries and other complications.
Subjective

27. 
 Respiratory status
 Motor function
 Presence of fever
 Feeding and weight loss
 Any changes in physical state
 Medical regimen

28. 
Objective -Physical
Examination

29. 
 Crucial for children with Cerebral palsy
 Early identification, multidisciplinary care and
support
 Nonphysical: proper nutrition and personal care
Treatment

30. 
 Botox, Intrathecal, Baclofen
 Controls muscle spasms and seizures
 Glycopyrrolate- controls drooling
 Pamidronate- may help with osteoporosis
Pharmacologic
treatment

31. 
 To loosen joints
 Relieve muscle tightness
 Straightening of different twists or unusual
curvatures of leg muscles
 Improve the ability to sit, stand and walk.
Surgery

32. 
Note

33. 
 Physical aids: orthosis, braces and splints;
positioning devices; walkers, special scooters,
wheelchairs
 Special Education
 Rehabilitation services- speech and occupational
therapies
 Family services- professional

34. 
 Spastic CP: Increased muscle tone, persistent infant
reflexes, increased deep tendon reflexes in one of
three patterns: hemiplegia (arm and leg on one side
of the body), diplegia (involving the lower
extremities), and
 quadriplegia (all four extremities and may include
the trunk, head, and neck)
 Dyskinetic CP: Abnormalities in muscle tone that
affect the entire body; includes athetoid CP, which
includes uncontrolled and continuous involuntary
movements
Definition of terms

35. 
 Mixed CP: A condition in which both athetosis and
spasticity are present
 Ataxic CP: Abnormalities of voluntary movement
and balance such as unsteady gait
 Athetoid dyskinetic CP: Normal intelligence but
difficulty walking, sitting, speaking clearly
 Pyramidal: one of the carpal bone
 Athetosis: series of involuntary writhing movements
of the limbs

36. 
 Krause chapter 45
 Ida Sherri L. Cerebral palsy
 Capone G, et al: Down syndrome. In Ekvall SW,
Ekvall VK, editors: Pediatric nutrition in chronic disease
and developmental disorders, New York, 2005, Oxford
University Press
 Stevenson RD: Use of segmental measures to
estimate stature in children with cerebral palsy, Arch
Paediatr Adolesc Med 149:658,2005.
References