Cerebral Palsy

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Cerebral Palsy

  1. 1. CEREBRAL PALSY By: Ida Sherri L. Corvera BSN III - NM
  2. 2. • In 1860s, known as "Cerebral Paralysis” or William “Little’s Disease” John Little • After an English surgeon (1810-1894) wrote the 1st medical descriptions
  3. 3. CEREBRAL PALSY (CP) • Cerebral“- Latin Cerebrum; – Affected part of brain • “Palsy " -Gr. para- beyond, lysis – loosening – Lack of muscle control
  4. 4. CEREBRAL PALSY • A motor function disorder – caused by 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
  5. 5. CEREBRAL PALSY A Heterogenous Group of Movement Disorders – An umbrella term – Not a single diagnosis
  6. 6. CP Affects ements Balance ation Posture
  7. 7. CAUSES OF CEREBRAL PALSY
  8. 8. 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 dev’t
  9. 9. CAUSES • Development Malformations – The brain fails to develop correctly. • Neurological damage – Can occur before, during or after delivery – Rh incompatibility, illness, severe lack of oxygen * Unknown in many instances
  10. 10. CHIEF CAUSE Severe deprivation of oxygen or blood flow to the brain – Hypoxic-ischemic encephalopathy or intrapartal asphyxia
  11. 11. TYPES OF CEREBRAL PALSY
  12. 12. 1. Accdg. to Neurologic Deficits • Based on the - extent of the damage - area of brain damage • Each type involves the way a person moves
  13. 13. 3 MAIN TYPES 1. PYRAMIDAL - originates from the motor areas of the cerebral cortex 2. EXTAPYRAMIDAL - basal ganglia and cerebellum 3. MIXED
  14. 14. 2. Accdg. to Type of Movement Photo from: Saunders, Elsvier.
  15. 15. 4 MAIN TYPES PYRAMIDAL 1. Spastic CP EXTAPYRAMIDAL 2. Athethoid CP 3. Ataxic CP MIXED 4. Spastic & Athethoid CP
  16. 16. TYPES SPASTIC -Stiffness ATHETOID --Fluctuating Uncontrolled Tone Movements ATAXIC -Unsteady, Unsteady, uncoordinated uncoordinated
  17. 17. Types of Spastic CP According to affected limbs: * plegia or paresis - meaning paralyzed or weak: • Paraplegia • Diplegia • Hemiplegia • Quadriplegia • Monoplegia –one limb (extremely rare) • Triplegia –three limbs (extremely rare)
  18. 18. DEGREE OF SEVERITY 1. Mild CP- 20% of cases • Moderate CP- 50% - require self help for assisting their impaired ambulation capacity. • Severe CP- 30%; -totally incapacited and bedridden and they always need care from others.
  19. 19. Signs and Symptoms OF CEREBRAL PALSY
  20. 20. d. e. c. f. b. g. a. h.
  21. 21. Early Signs Infancy (0-3 Months) • Stiff or floppy posture • Excessive lethargy or irritability/ High pitched cry • Poor head control • Weak suck/ tongue thrust/ tonic bite/ feeding difficulties
  22. 22. Early Signs • Abnormal or prolonged primitive reflexes Moro’s reflex Asymmetric tonic neck reflex Placing reflex Landau reflex
  23. 23. CHILD with CP ch al ea nt r e t o m es ow elop ton Sl v e i l es d m
  24. 24. Behavioral Symptoms • Poor ability to concentrate, • unusual tenseness, • Irritability
  25. 25. ASSOCIATED PROBLEMS OF CEREBRAL PALSY
  26. 26. • Hearing and visual • Bladder and bowel problems control problems, • Sensory integration digestive problems problems (gastroesophageal reflux) • Failure-to-thrive, Feeding • Skeletal deformities, problems dental problems • Behavioral/emotional • Mental retardation and difficulties, learning disabilities in • Communication some disorders • Seizures/ epilepsy
  27. 27. Diagnosis OF CEREBRAL PALSY
  28. 28. DIAGNOSIS • Physical evaluation, Interview • MRI, CT Scan EEG • Laboratory and radiologic work up • Assessment tools – i.e. Peabody Development Motor Skills, Denver Test II
  29. 29. ASSESSMENT
  30. 30. 1. SUBJECTIVE - INTERVIEW
  31. 31. a. History Taking –Include all that may predispose an infant to brain damage or CP •Risk factors •Psychosocial factors •Family adaptation
  32. 32. b. Child’s Health History • Often admitted to hospitals for corrective surgeries and other complications. – Respiratory status – Motor function – Presence of fever – Feeding and weight loss – Any changes in physical state – Medical regimen
  33. 33. 2. OBJECTIVE - Physical Examination
  34. 34. CRITERIA P osturing / Poor muscle control and strength O ropharyngeal problems O S trabismus/ Squint S T one (hyper-, hypotonia) T E volutional maldevelopment E eflexes (e.g. increaseddeep tendon) R R *Abnormalities 4/6 strongly point to CP
  35. 35. Treatment OF CEREBRAL PALSY
  36. 36. - No treatment to cure cerebral palsy. - Brain damage cannot be corrected. • Crucial for children with CP: –Early Identification; –Multidisciplinary Care; and –Support
  37. 37. I. Nonphysical Therapy “The earlier we start, the more improvement can be made” -Health worker
  38. 38. • General management - Proper nutrition and personal care B. Pharmacologic Botox, Intrathecal, Baclofen - control muscle spasms and seizures, Glycopyrrolate -control drooling Pamidronate -may help with osteoporosis.
  39. 39. C. Surgery -To loosen joints, -Relieve muscle tightness, - Straightening of different twists or unusual curvatures of leg muscles - Improve the ability to sit, stand, and walk.
  40. 40. Selective posterior rhizotomy In some cases nerves need to be severed to decrease muscle tension of inappropriate contractions.
  41. 41. D. Physical Aids • Orthosis, braces and splints • Positioning devices • Walkers, special scooters, wheelchairs E. Special Education F. Rehabilitation Services- Speech and occupational therapies G. Family Services -Professional support
  42. 42. H. Other Treatment - Therapeutic electrical stimulation, - Acupuncture, - Hyperbaric therapy - Massage Therapy might help
  43. 43. II. Physical Therapy 'The ultimate long-term goal is realistic independence. To get there we have to have some short-term goals. Those being a working communication system, education to his potential, computer skills and, above all, friends'. - Parent of boy with CP
  44. 44. A.Sitting - Vertical head control and control of head and trunk. B. Standing and walking - Establish an equal distribution of weight on each foot, train to use steps or inclines
  45. 45. C. Prone Development D. Supine Development o Head control on supine and positions
  46. 46. NURSING RESPONSIBILITIES
  47. 47. NURSING RESPONSIBILITIES C. Functioning as a member of the health team D. Providing counseling and education for the parents and promote optimal family functioning C. Promoting physical and psychological health
  48. 48. D. Assisting with feeding management and toilet training E. Assisting with rehabilitation therapies (physical, occupational and speech) F. Providing counseling for educational and vocational pursuits G. Preventing child abuse H. Providing care during hospitalization
  49. 49. I. Prevent physical injury C. Prevent physical deformity K. Promote a positive self-image
  50. 50. "Time and gravity are enemies of very aging body, especially mine." - Adult with CP

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