Cerebral palsy is defined as a non-progressive disorder of movement, tone, and posture that is caused by a defect or lesion in the developing brain. It commonly causes developmental disabilities like mental retardation, epilepsy, and speech or sensory problems. Around 70% of cases are caused by events before birth like infections, lack of oxygen, or birth defects. The main types are classified by affected limbs and movement disorders, and include spastic, athetoid, and ataxic cerebral palsy. Treatment focuses on early intervention, physical, occupational and speech therapy to reduce effects over time.

1. Cerebral Palsy

2. Define
Is defined as a :
1) Persistent but not unchanging
2) Disorder of movement, tone and posture
3) Due to non-progressive defect/lesion
4) Of immature brain
( fetal life, infancy, childhood)
( immature brain cut off take as 5 yrs –AAP)

3. 5) Commonly associated with a spectrum
of developmental disabilities such as –
I. Mental retardation (60%)
II. Epilepsy (33%)
III. Visual , hearing (deafness-10%) and
speech defects
IV. Strabismus(50%)
V. Cognitive dysfunction
VI. Sensory problems
VII. Emotional and behavioral problems.

4. Causes
• In about 70 % of cases, CP results from events occurring
before birth that can disrupt normal development of the
brain.
• Some of the known causes include:
• Infections during pregnancy
• Insufficient oxygen reaching the fetus
• Prematurity
• Asphyxia during labor and delivery
• Blood diseases
• Sever jaundice
• Other birth defects
• Acquired CP ( about 10% of children with CP acquire it after birth due
to brain injuries that occur during the first 2 years of life.

5. Types of Cerebral Palsy
•A) Classification by number of limbs involved:
• 1) Quadriplegia- all 4 limbs
• 2) Diplegia- all 4 limbs, legs more severely affected than
arms
• 3) Hemiplegia- one side of the body; arm is usually more
involved than the leg
• 4) Triplegia- three limbs are involved, usually both arms
and a leg
• 5) Monoplegia- only one limb is affected, usually an arm

6. Types of CP (cont.)
•B) Classification by movement disorder:
• 1) Spastic CP- too much muscle tone or tightness.
Movements are stiff, especially in the legs, arms, and/or
back.
• 2) Athetoid CP (dyskinetic CP)- affect movements of the
entire body. Involves slow, uncontrolled body
movements and low muscle tone; hard for person to sit
straight and walk.
• 3) Ataxic CP- least common. Disturbed sense of balance
and depth perception. Poor muscle tone, a staggering
walk and unsteady hands. Results from damage of the
cerebellum.
• 4) Combined classifications- both movement and number
of limbs involved are combined.

8. Site of brain injury
• Cortical
• Sub – cortical
• Periventricular
• Basal ganglia
• Cerebellum
• Brain stem
Pathological
• Periventricular leucomalacia
–spastic diplegia
• Stroke in utero - hemiplegia
• Multifocal encephalomalacia
-quadriplegia
• Cerebellar - ataxic
• Basal ganglia, thalmus,
putamen - dyskinetic

11. Affects on the family
frustration
disappointment
anger

12. Child’s future
• Affects individuals in different ways
• Have normal life span
• Physical challenges intensify with age
• Increased spasticity
• Fatigue
• Loss of strength
• Declining mobility

14. Differential diagnosis
• In the early infancy when the child is in
hypotonic phase, neuromuscular conditions like
myopathies may cause diagnostic confusion.
• Children with mental retardation may have
hypotonia but do not have abnormal motor
patterns or postures

15. • Neurodegenerative conditions which have
onset in early infancy such as Tay-Sach
disease, Krabbe's disease, and Metachromatic
Leucodystrophy can mimic CP.
• The progressive course of these conditions can
be ascertained on the basis of history, and
relevant investigation can confirm the
diagnosis.

16. • Dopa-responsive dystonia and organic
aciduria like glutaric aciduria may look like
dystonic CP.

17. Treatment
• With early and ongoing treatment, effects of CP can be
reduced.
• Early Intervention Services- service for those with CP and
their families that gives support and advice.
• Different kinds of therapy needed:
• Physical therapy- build stronger muscles; skills such as sitting,
walking, balance
• Occupational therapy- develops fine motor skills; dressing, feeding,
writing, and other daily living tasks
• Speech-language pathology- develops communication skills.
Particularly on speaking since muscle tone in tongue and throat may
be affected.

18. Prognosis for People with Cerebral Palsy
• Most people with cerebral palsy experience a normal life span.
Those with severe forms of CP may have a reduced life span. As
people with cerebral palsy age, they may experience long-term
effects of chronic physical impairment, such as the following:
• Increase in shortening of muscles (contractures)
• Joint problems (e.g., pain, loss of flexibility)
• Tight muscles
• Increase in back pain
• Emergence of incontinence
• Increase in incontinence

19. • Reduced energy levels
• Factors that contribute to these effects include:
• Poor wheelchair seating and posture
• Spinal deformities
• Weight gain
• Severe learning disability
• Discontinuance of physical therapy
• Walking when it is increasingly difficult
• Inappropriate orthopedic surgery