Cerebral Palsy

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  • William John Little
    He is an English surgeon
    Suffered childhood poliomyelitis with residual left lower extremity paraparesis, complicated by severe talipes
    He 1st identified Cerebral Palsy in his publication "On the Deformities of the Human Frame" in the 1860s
    One of the first to bridge the gap between neurology and orthopaedics
    CP was then known as "Cerebral Paralysis" or “Little’s Disease
  • CP affectd
  • The cortex controls thought, movement and sensation. An abnormality in the movement area of the cortex can result in spastic cerebral palsy
    Part 2The basal ganglia helps movement become organised, graceful and economical. An abnormality can result in athetoid cerebral palsy.Part 3The cerebellum coordinates movement, posture and balance. An abnormality can result in ataxic cerebral palsy. 
  • According to affected limbs
    DiplegiaBoth legs and both arms are affected, but the legs are significantly more affected than the arms. Children with diplegia usually have some clumsiness with their hand movements.
    HemiplegiaThe leg and arm on one side of the body are affected.QuadriplegiaBoth arms and legs are affected. The muscles of the trunk, face and mouth can also be affected. 
  • to establish locomotion, communication and self-help, gain optimal appearance and integration of motor functions; correct associated defects as effectively as possible and provide educational opportunities based on the individual’s needs and capabilities
  • Physical Therapy - helps strengthen muscles
  • Physical Therapy - helps strengthen muscles
  • Cerebral Palsy

    1. 1. By: Livson Thomas M.Sc (N) 2nd Year
    2. 2.  WILLIAM JOHN LITTLE (1810-1894) In 1860s, known as "Cerebral Paralysis” or “Little’s Disease”  After an English surgeon who wrote the 1st medical descriptions William John Little.
    3. 3.  Cerebral“- Latin Cerebrum;   Af fected par t of brain “Palsy " -Gr. para- beyond, lysis – loosening  Lack of muscle control
    4. 4.  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. A Heterogenous Group of Movement Disorders – An umbrella term – Not a single diagnosis
    6. 6. ements ation Balance Posture
    7. 7. 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 deveation
    9. 9.  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. Severe deprivation of oxygen or blood flow to the brain – Hypoxic-ischemic encephalopathy or intrapartal asphyxia
    11. 11. OF CEREBRAL PALSY
    12. 12.  Based on the - extent of the damage - area of brain damage  Each type involves the way a person moves
    13. 13. 1. PYRAMIDAL - originates from the motor areas of the cerebral cortex 2. EXTAPYRAMIDAL - basal ganglia and cerebellum 3. MIXED
    14. 14. 2. According to Type of Movement Photo from: Saunders, Elsvier.
    15. 15. 1. Spastic CP 2. Athethoid CP 3. Ataxic CP 4. Spastic & Athethoid CP
    16. 16. TYPES SPASTIC -Stiffness ATHETOID --Fluctuating Uncontrolled Tone Movements ATAXIC -Unsteady, Unsteady, uncoordinated uncoordinated
    17. 17. According to af fected limbs : * plegia or paresis - meaning paralyzed or weak:       Paraplegia Diplegia Hemiplegia Quadriplegia Monoplegia –one limb (extremely rare) Triplegia –three limbs (extremely rare)
    18. 18. 1. Mild CP- 20% of cases 2. Moderate CP- 50% - require self help for assisting their impaired ambulation capacity. 3.Severe CP- 30% -totally incapacited and bedridden and they always need care from others.
    19. 19. OF CEREBRAL PALSY
    20. 20. d. c. e. f. b. a. g. h.
    21. 21. 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.  Abnormal or prolonged primitive reflexes Moro’s reflex Asymmetric tonic neck reflex Placing reflex Landau reflex
    23. 23. ch al ea nt r e to m es ow elop ton Sl v e il e s d m
    24. 24.    Poor ability to concentrate, unusual tenseness, Irritability
    25. 25. OF CEREBRAL PALSY
    26. 26.      Hearing and visual problems • Bladder and bowel control problems, digestive problems Sensory integration (gastroesophageal reflux) problems Failure-to-thrive, Feeding • Skeletal deformities, dental problems problems • Mental retardation and Behavioral/emotional learning disabilities in difficulties, some Communication • Seizures/ epilepsy disorders
    27. 27. OF CEREBRAL PALSY
    28. 28.     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. - INTERVIEW
    30. 30.  Include all that may predispose an infant to brain damage or CP  Risk factors  Psychosocial factors  Family adaptation
    31. 31.  Of ten 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
    32. 32. - Physical Examination
    33. 33. P osturing / Poor muscle control and strength O ropharyngeal problems S trabismus/ Squint S T one (hyper-, hypotonia) T E volutional maldevelopment E R eflexes (e.g. increaseddeep tendon) R * Abnormalities 4/6 strongly point to CP
    34. 34. OF CEREBRAL PALSY
    35. 35. -  No treatment to cure cerebral palsy. Brain damage cannot be corrected. Crucial for children with CP :  Early Identification;  Multidisciplinar y Care; and  Suppor t
    36. 36. I . Nonphysical Therapy
    37. 37. A. 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.
    38. 38. C. Surger y -To loosen joints, -Relieve muscle tightness, - Straightening of dif ferent twists or unusual cur vatures of leg muscles - Improve the ability to sit, stand, and walk.
    39. 39. Selective posterior rhizotomy In some cases ner ves need to be severed to decrease muscle tension of inappropriate contractions.
    40. 40. D. Physical Aids    Or thosis, braces and splints Positioning devices Walkers, special scooters, wheelchairs E. Special Education F. Rehabilitation Ser vices- Speech and occupational therapies G. Family Ser vices - Professional support
    41. 41. H. Other Treatment -   Therapeutic electrical stimulation, Acupuncture, Hyperbaric therapy Massage Therapy might help
    42. 42. II . Physical Therapy
    43. 43. 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
    44. 44. C. Prone Development D. Supine Development o Head control on supine and positions
    45. 45. NURSING RESPONSIBILITIES A. Functioning as a member of the health team
    46. 46. B. Providing counseling and education for the parents and promote optimal family functioning - Encourage family members to express anxieties, frustrations and concerns Provide emotional support and help with problem solving as necessary. Explore support networks. Refer them to support organizations
    47. 47. C. Promoting physical and psychological health - Administer prescribed medications - Encourage self-care by urging the child to participate in activities of daily living (ADLs) (e.g. using utensils and implements that are appropriate for the child’s age and condition). - Provide rest periods to foster relaxation. Provide safe & appropriate toys - As necessary, seek referrals for corrective lenses and hearing device to decrease sensory deprivation related to vision and hearing losses
    48. 48. D. Assisting with feeding management and toilet training Promote adequate fluid and nutritional intake.  Position upright after meals - During meals, maintain a quiet, unhurried atmosphere with as few distractions as possible. The child may need special utensils and a chair with a solid footrest - Teach him to place food far back in his mouth to facilitate swallowing. - Encourage the child to chew food thoroughly, drink through a straw, and suck on a lollipop between meals to develop the muscle control needed to minimize drooling. -
    49. 49. E. Assisting with rehabilitation therapies (physical, occupational and speech) Promote mobility by encouraging the child to perform age-and condition-appropriate motor activities - Inform parents but their child will need considerable help and patience in accomplishing each new task. - Encourage them not to focus solely on the child’s inability to accomplish certain -
    50. 50. - Explain the importance of providing positive feedback. - Facilitated communication. Talk to the child deliberately and slowly, using pictures or sign language to reinforce speech when needed - Technology such as computer use may help children with severe articulation problems.
    51. 51. F. Providing counseling for educational and vocational pursuits G. Preventing child abuse H. Providing care during hospitalization Prepare the child and family for procedures, treatments, appliances and surgeries if needed. Assign the child a room with children in the same age-group.
    52. 52. I. Prevent physical injur y by providing the child with a safe environment, appropriate toys, and protective gear (helmet, kneepads) if needed. J. Prevent physical deformity by ensuring correct use of prescribed braces and other devices and by performing ROM exercises.
    53. 53. K. Promote a positive self-image in the child: - Praise his accomplishments Set realistic and attainable goals Encourage and appealing physical appearance Encourage his involvement with age and condition appropriate peer group activities.

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