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CEREBRAL
  PALSY
 By: Ida Sherri L. Corvera
       BSN III - NM
• In 1860s, known as
                "Cerebral Paralysis” or
  William       “Little’s Disease”
 John Little
               • After an English surgeon
(1810-1894)
                 wrote the 1st medical
                 descriptions
CEREBRAL PALSY (CP)

• Cerebral“- Latin Cerebrum;
  – Affected part of brain


• “Palsy " -Gr. para- beyond,
                lysis – loosening
  – Lack of muscle control
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
CEREBRAL PALSY

 A Heterogenous Group
 of Movement Disorders

  – An umbrella term
  – Not a single diagnosis
CP Affects
ements
                      Balance


ation                 Posture
CAUSES
OF CEREBRAL PALSY
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
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
CHIEF CAUSE

Severe deprivation of oxygen or
    blood flow to the brain

                  – Hypoxic-ischemic
                    encephalopathy
                    or intrapartal
                    asphyxia
TYPES
OF CEREBRAL PALSY
1. Accdg. to Neurologic Deficits

• Based on the
 - extent of the damage
 - area of brain damage


• Each type involves the way
  a person moves
3 MAIN
      TYPES
1. PYRAMIDAL
  - originates from the motor
  areas of the cerebral cortex
2. EXTAPYRAMIDAL
  - basal ganglia and cerebellum


3. MIXED
2. Accdg. to Type of Movement




                   Photo from: Saunders, Elsvier.
4 MAIN TYPES
PYRAMIDAL       1. Spastic CP
EXTAPYRAMIDAL   2. Athethoid CP
                3. Ataxic CP
MIXED           4. Spastic &
                   Athethoid CP
TYPES
                SPASTIC -Stiffness



ATHETOID
--Fluctuating
 Uncontrolled
   Tone
Movements

                               ATAXIC
                               -Unsteady,
                                Unsteady,
                             uncoordinated
                             uncoordinated
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)
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.
Signs and
Symptoms
OF CEREBRAL PALSY
d.
                e.
     c.

                     f.
b.

               g.
     a.   h.
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
Early Signs

• Abnormal or prolonged
    primitive reflexes

       Moro’s reflex
  Asymmetric tonic neck reflex
       Placing reflex
       Landau reflex
CHILD with CP




          ch al
        ea nt
       r e
    t o m es
  ow elop ton
Sl v
   e i l es
  d m
Behavioral Symptoms

 • Poor ability to concentrate,
 • unusual tenseness,
 • Irritability
ASSOCIATED
 PROBLEMS
OF CEREBRAL PALSY
• 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
Diagnosis
OF CEREBRAL PALSY
DIAGNOSIS
•   Physical evaluation, Interview
•   MRI, CT Scan EEG
•   Laboratory and radiologic work up
•   Assessment tools
    – i.e. Peabody Development Motor Skills,
      Denver Test II
ASSESSMENT
1. SUBJECTIVE
  - INTERVIEW
a. History Taking

–Include all that may predispose
 an infant to brain damage or CP

  •Risk factors
  •Psychosocial factors
  •Family adaptation
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
2. OBJECTIVE
-   Physical Examination
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
Treatment
OF CEREBRAL PALSY
- No treatment to cure cerebral palsy.
- Brain damage cannot be corrected.

• Crucial for children with CP:
  –Early Identification;
  –Multidisciplinary Care; and
  –Support
I. Nonphysical Therapy




       “The earlier we start,
the more improvement can be made”
           -Health worker
• 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.
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.
Selective posterior rhizotomy
In some cases nerves need to be severed to decrease
  muscle tension of inappropriate contractions.
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
H. Other Treatment

- Therapeutic electrical stimulation,
- Acupuncture,
- Hyperbaric therapy
- Massage Therapy might help
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
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
C. Prone Development
D. Supine Development

 o Head control on supine and positions
NURSING
RESPONSIBILITIES
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
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
I.   Prevent physical injury

C. Prevent physical deformity

K. Promote a positive self-image
"Time and gravity
are enemies of very aging body,
 especially mine." - Adult with CP

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Understanding Cerebral Palsy

  • 1. CEREBRAL PALSY By: Ida Sherri L. Corvera BSN III - NM
  • 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. CEREBRAL PALSY (CP) • Cerebral“- Latin Cerebrum; – Affected part of brain • “Palsy " -Gr. para- beyond, lysis – loosening – Lack of muscle control
  • 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. CEREBRAL PALSY A Heterogenous Group of Movement Disorders – An umbrella term – Not a single diagnosis
  • 6. CP Affects ements Balance ation Posture
  • 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. 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. CHIEF CAUSE Severe deprivation of oxygen or blood flow to the brain – Hypoxic-ischemic encephalopathy or intrapartal asphyxia
  • 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. 3 MAIN TYPES 1. PYRAMIDAL - originates from the motor areas of the cerebral cortex 2. EXTAPYRAMIDAL - basal ganglia and cerebellum 3. MIXED
  • 14. 2. Accdg. to Type of Movement Photo from: Saunders, Elsvier.
  • 15. 4 MAIN TYPES PYRAMIDAL 1. Spastic CP EXTAPYRAMIDAL 2. Athethoid CP 3. Ataxic CP MIXED 4. Spastic & Athethoid CP
  • 16. TYPES SPASTIC -Stiffness ATHETOID --Fluctuating Uncontrolled Tone Movements ATAXIC -Unsteady, Unsteady, uncoordinated uncoordinated
  • 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. 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.
  • 20. d. e. c. f. b. g. a. h.
  • 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. Early Signs • Abnormal or prolonged primitive reflexes Moro’s reflex Asymmetric tonic neck reflex Placing reflex Landau reflex
  • 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. Behavioral Symptoms • Poor ability to concentrate, • unusual tenseness, • Irritability
  • 25.
  • 27. • 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
  • 29. DIAGNOSIS • Physical evaluation, Interview • MRI, CT Scan EEG • Laboratory and radiologic work up • Assessment tools – i.e. Peabody Development Motor Skills, Denver Test II
  • 31. 1. SUBJECTIVE - INTERVIEW
  • 32. a. History Taking –Include all that may predispose an infant to brain damage or CP •Risk factors •Psychosocial factors •Family adaptation
  • 33. 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
  • 34. 2. OBJECTIVE - Physical Examination
  • 35. 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
  • 37. - No treatment to cure cerebral palsy. - Brain damage cannot be corrected. • Crucial for children with CP: –Early Identification; –Multidisciplinary Care; and –Support
  • 38. I. Nonphysical Therapy “The earlier we start, the more improvement can be made” -Health worker
  • 39. • 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.
  • 40. 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.
  • 41. Selective posterior rhizotomy In some cases nerves need to be severed to decrease muscle tension of inappropriate contractions.
  • 42. 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
  • 43. H. Other Treatment - Therapeutic electrical stimulation, - Acupuncture, - Hyperbaric therapy - Massage Therapy might help
  • 44. 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
  • 45. 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
  • 46. C. Prone Development D. Supine Development o Head control on supine and positions
  • 48. 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
  • 49. 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
  • 50. I. Prevent physical injury C. Prevent physical deformity K. Promote a positive self-image
  • 51. "Time and gravity are enemies of very aging body, especially mine." - Adult with CP