Multidisciplinary Management of Cerebral Palsy

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Presentation by Pre-Med (2013) Students of Penang Medical College. This presentation is based on a mini research paper on Multidisciplinary Management of Cerebral Palsy. Group members consist of Nurul Najihah,Daniel Koshy & Maheshwaran

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  • Birth asphyxia - Asphyxia means lack of oxygen. Birth asphyxia happens when a baby's brain and other organs do not get enough oxygen before, during or right after birth
  • Multidisciplinary Management of Cerebral Palsy

    1. 1. Multidisciplinary Management of Cerebral Palsy Nurul Najihah,Daniel Koshy,Maheshwaran http://www.nationwidechildrens.org/Document/Get/42099 http://www.hcocinc.com/wp-content/uploadsbigstock_Little_Boy_Sitting_Isolated_6867877.jpg
    2. 2. Questions that public would have in mind 1.What is Cerebral Palsy ? 2.What causes Cerebral Palsy? 3.What are the types of Cerebral Palsy? 3.What are the signs and symptoms? 4.How many children are affected worldwide? 5.What is the role of doctor, pharmacist and physiotherapist
    3. 3. What is Cerebral Palsy? - It refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination Spastic - Classification of cerebral palsy Dyskinetic Ataxic Mixed Rudolph’s Fundamentals of Pediatrics http://nyp.org/health/pedneuro-cpalsy.html#top
    4. 4. What causes Cerebral Palsy? (The Etiology) Templates http://medicina.ufm.edu/images/3/3c/Apgar.jpg 1. Injuries to the infant’s brain during birth - Birth asphyxia - hypoxia > 4 mins during birth) - APGAR Score (numbered rating that reflects a newborn's physical health). Good Score is more than 7/10 Reddihough D,Collins K,Others. The epidemiology and cause of cerebral palsy.Australian Journal of Physiotherapy. 2003;49(1);7-14
    5. 5. What causes Cerebral Palsy? (Etiology) Templates 2. Metabolic disorders - Lesch-Nyhan Syndrome - Deficiency of Arginase (causes spastic diplegia) 3. Due to intake of certain toxins by mother during pregnancy (accidentally ingested) - eg: methyl mercury 4. Infection during perinatal period -Intrauterine infections eg: TORCH Virus (Toxoplasmosis,Rubella,Cytomeglovirus,Herpes) 5. Cerebro vascular accident (CVA) - rapid loss of blood supply to the brain - due to ischemia caused by thrombosis, arterial embolism or hemorrhage Reddihough D,Collins K,Others. The epidemiology and cause of cerebral palsy.Australian Journal of Physiotherapy. 2003;49(1);7-14
    6. 6. What are types of Spastic Cerebral Palsy? Most common type of overall cerebral palsy, occurring in 90% of all cases according to the Society for Cerebral Palsy in Europe (SCPE)
    7. 7. http://forkneedlepen.files.wordpress.com/2013/03/typesofcp.gif
    8. 8. What are the signs and symptoms? • Delayed development milestones – Head control, roll over, sitting, crawling and walking • Low muscle tone (hypotonia) – Problems with mobility – Poor Muscle control • Infantile reflexes persist for long time – Sucking and startle reflex • Failure to speak simple sentence by 24 months • Seizures http://www.healthcentral.com/adhd/h/hypotonia-fatigue-adhd.html https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/signs-and-symptoms-of-cp/
    9. 9. How many children are affected? According to an article published by American Academy of Family Physicians, It is the most common childhood physical disability and affects 2 to 2.5 children per 1,000 born in the United States. There is insufficient statistics for cerebral palsy in Asia and Malaysia ? ? ? ? ?
    10. 10. Role Of Doctor http://shotofprevention.com/2012/02/24/how-the-doctorparentrelationship-can-impact-immunization-decisions/
    11. 11. Role of Doctor (Coordinator) 1.Doctors carry out physical examination - complete prenatal and postnatal history of the child 2. Doctors look into the development milestones of the child - Head control,turn-over,sitting,standing 3. Carry out diagnostic tests - x-rays (spine ~ scoliosis ,hip ~ dislocation) - electroencephalogram (EEG) ~ seizures - magnetic resonance imaging (MRI) ~ brain abnormalities - feeding studies - genetic studies https://www.unitypoint.org/filesimages/rightcallouts/doctor-with-child.jpg http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#243683104 http://nyp.org/health/pedneuro-cpalsy.html#top , http://cshcn.org/sites/default/files/webfm/file/CriticalElementsofC are-CerebralPalsy.pdf,
    12. 12. Role of Doctor 4. Determines the type of treatment child requires - Conservative treatment Physical – resistive or strength training programs (prevents contracture) ~ Special braces (orthotic devices) improve mobility and stretch spastic muscles Occupational - help individuals address new ways to cope with day-today activities Recreation - encourages participation in art and cultural programs, sports, and other events (improve child’s emotional well-being) Speech and Language Therapy, Treatment for problems with eating and drooling Oral Medications (eg: Baclofen) http://soap.org/abstracts-uploads-spring-2011/1010711131105Xray_Baclofen_pump.jpg
    13. 13. Role of Doctor - Invasive treatment Botulinum Toxin (anti-spasticity management) Selective Dorsal Rhizotomy Insertion of intrathecal baclofen pump ~ helps in ambulation of child 5. Delegates job to physiotherapist and pharmacist for further treatment and counseling
    14. 14. Role Of Pharmacist http://img.dailymail.co.uk/i/pix/2007/12_01/pharmacyREX0212_4 68x331.jpg
    15. 15. Role of Pharmacist 1. Educating parents about the medications given to their child - side effects of medication - effectiveness - Purpose of medication http://uspharmacist.com/content/d/featured%20articles/c/10170
    16. 16. Role of Pharmacist 2. Advise and collaborate with doctors on the suitable medication and dosage needed for cerebral palsy patients - suitable dosage, not to overdose or under dose patient http://www.everydayhealtenh.com/drugs/baclofen
    17. 17. Role of Pharmacist 3. Support the doctor by providing the adverse effects that occur to the patients because of the medication - Information reaches the pharmacist about the adverse effects of medication which is then passed on to the doctor http://www.pharmacynews.com.au/news/latest-news/new-prescribinginitiatives-to-be-investigated http://uspharmacist.com/content/d/featured%20articles/c/10170
    18. 18. Role of Pharmacist 4. Obtain past medical records containing medications taken by the patient and interpret for the doctor - complications - determine whether to change dosage - effectiveness of the medicines - toxicity http://www.jacksongeneral.com/for-visitors---medical-records.php http://uspharmacist.com/content/d/featured%20articles/c/10170
    19. 19. Role Of Physiotherapist http://www.pretoria-south-africa.com/elarduspark-faerie-glen-physiotherapist.html
    20. 20. Role of Physiotherapist Templates 1.Rehabilitation of physical impairments (Conservative Treatment) - second line of treatment - main intervention for spasticity and dystonia - maximize functional control of the body - increase motor function - improve posture of cerebral palsy patients http://www.csp.org.uk/your-health/conditions/cerebral-palsy http://www.tasputraperkim.org.my/images/serv_physio.jpg
    21. 21. Role of Physiotherapist 2. Give advice regarding walking aids and equipment with the help of occupational therapist - improve the patient’s co-ordination and body balance - to allow children to go to school - preform daily activities - To enhance the ability of self-care http://www.tasputraperkim.org.my/images/serv_physio.jpg
    22. 22. Role of Physiotherapist 3. Teaching parents physical therapy that have to be carried out at home on daily basis - to maintain effectiveness of Botulinum Toxin A injection - encorage normal postures and movement (legs, arms,head control) http://www.childbirthinjuries.com/Cerebral-Palsy/Treatment/Physiotherapy http://www.ctn-simcoeyork.ca/aboutctn/newsandupdates.php?article=80
    23. 23. Summary  Cerebral Palsy is a neurological disorder  No Known Cure  Mobility of child can be greatly enhanced with correct diagnosis and treatment  Doctors advise on available treatment (conservative and invasive)  Physiotherapist offer physical treatment  Pharmacist advise on medications
    24. 24. Summary Doctor Physiotherapist Pharmacist “Treatment of children with cerebral palsy is a multidisciplinary approach that is highly dependant upon a team of medical professionals”
    25. 25. Reference List Templates 1) Bejing Puhua International Hospital. Bejing Puhua International Hospital. [Online] [Viewed 5 Dec 2013]. Available from: http://www.puhuahospital.com/?gclid=CJux66LqorsCFUcB4godUUQASQ#!cerebralpalsy/c1tc6 2) Cerebralpalsy.org.au. Signs and Symptoms of Cerebral Palsy | Cerebral Palsy Alliance. [Article], [Viewed 5 Dec 2013]. Available from: https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/signs-and-symptomsof-cp/. 3) Csp.org.uk. What is physiotherapy? | The Chartered Society of Physiotherapy. [Article], [Viewed 5 Dec 2013]. Available from: http://www.csp.org.uk/your-health/what-physiotherapy 4) Csp.org.uk. Cerebral palsy | The Chartered Society of Physiotherapy. [Article], [Viewed 4 Dec 2013]. Available from: http://www.csp.org.uk/your-health/conditions/cerebral-palsy 5) Drugs.com. Baclofen Side Effects in Detail - Drugs.com. [Website], [Viewed 6 Dec 2013]. Available from: http://www.drugs.com/sfx/baclofen-side-effects.html 6) Minciu I. CEREBRAL PALSY MANAGEMENT. [Online Journal] Therapeutics, Pharmacology & Clinical Toxicology.; 2011 , [Viewed 3 Dec 2013] 7) Nhs.uk. Cerebral palsy - Treatment - NHS Choices. [Online]. [Viewed 4 Dec 2013]. Available from: http://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Treatment.aspx 8) Ninds.nih.gov. Cerebral Palsy Information Page: National Institute of Neurological Disorders and Stroke (NINDS). [Online], [Viewed 4 Dec 2013]. Available from: http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm
    26. 26. Reference List Templates 9) Nyp.org. Cerebral Palsy - New York Presbyterian Hospital. [Article], [Viewed 3 Dec 2013]. Available from: http://nyp.org/health/pedneuro-cpalsy.html#top , 10) Placzek R, Siebold D, F. Funk J. Development of Treatment Concepts for the Use of Botulinum Toxin A in Children with Cerebral Palsy. [Online Journal], Toxins.; 2010, [Viewed 4 Dec 2013]. 11) Reddihough D, Collins K, Others. The epidemiology and causes of cerebral palsy. Australian Journal of physiotherapy. 2003; 49 (1): 7--14. 12) Tang KL. Interviewed by: Koshy DI. 5 Dec 2013 13) The Centre For Children with Special Need. Cerebral Palsy CRITICAL ELEMENTS OF CARE. [Article] [Accessed 4 Dec 2013]. Available from: http://cshcn.org/sites/default/files/webfm/file/CriticalElementsofCare-CerebralPalsy.pdf 14) Uspharmacist.com. USPharmacist.com > Cerebral Palsy: Pharmacologic Treatment of Spasticity. [Online], [Viewed 6 Dec 2013]. Available from: http://uspharmacist.com/content/d/featured%20articles/c/10170/ 15) Zimbio.com. Untitled. [Online], [Accessed 8 Dec 2013]. Available from: http://www.zimbio.com/Cerebral+palsy/articles/H6K4PmzsnyM/Role+physiotherapy+Cerebral+pals y
    27. 27. Q&A
    28. 28. THANK YOU

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