Nursing Management of child with Cerebral palsy definition types diagnostic evaluation sign and symptoms management nursing care

1. CEREBRAL PALSY
Presented By:
Mr. Arvind joshi
.

3. DEFINITION
 A group of disorders arising from a
malfunction of motor centers and
neural pathways of the brain.

4. DEFINITION
 It is a non – progressive
neuromuscular disorder of the
varying degrees resulting from
damage or a defect in the part of the
brain that controls motor function.

5. DEFINITION
Cerebral palsy is any non
progressive CNS based disorder of
strength , muscle control, posture
or movement due to a brain injury
occurring during early brain growth.

7. CAUSES
 Hypoxia / Anoxia
 Bleeding in the brain
 Brain infections (encephalitis, meningitis,
herpes simplex infections)
 Infections in the mother during
pregnancy (rubella, toxemia)

9. TYPES
1. Spastic
2. Dyskinetic
3. Mixed

10. 1) Spastic (Pyramidal)
 This is the most common type of CP,
accounting for about 70-80% of cases.
 Increased muscle tone.
 The muscles are stiff (spastic).
 Movements are jerky or awkward.
 This type is classified as per the part of
the body is affected: diplegia,
hemiplegia, or quadriplegia.

12. 2) Dyskinetic (Extrapyramidal):
ATHETOID ATAXIC

13. 2) Dyskinetic (Extrapyramidal):
 ATHETOID: The person has
uncontrolled movements that are slow
and writhing.
• The movements can affect any part of
the body, including the face, mouth,
and tongue.
• About 10-20% of cerebral palsy cases
are of this type.

14. 2) Dyskinetic (Extrapyramidal):
ATAXIC: This type affects balance
and coordination.
• Depth perception is usually affected.
• If the person can walk, the gait is
probably unsteady.

16. 2) Dyskinetic (Extrapyramidal):
ATAXIC:
• He or she has difficulty with
movements that are quick or require
a great deal of control, such as
writing.
• About 5-10% of cases of cerebral
palsy are of this type

18. 3) Mixed
This is a mixture of different types of
cerebral palsy.
A common combination is spastic and
athetoid.

19. SIGNS AND SYMPTOMS
 The signs of cerebral palsy are usually
not noticeable in early infancy but
become more obvious as the child’s
nervous system matures. Early signs
include the following:

21. SIGNS AND SYMPTOMS
 Delayed milestones such as controlling
head, rolling over, reaching with one
hand, sitting without support, crawling, or
walking.
 Persistence of “infantile” or “primitive”
reflexes, which normally disappear 3-6
months after birth.

23. SIGNS AND SYMPTOMS
 Developing handedness before age 18
months: This indicates weakness or
abnormal muscle tone on one side,
which may be an early sign of CP

25. DIAGNOSIS
Lab Studies: Various blood and urine
tests may be ordered if your child’s
health care provider suspects that the
child’s difficulties are due to chemical,
hormonal, or metabolic problems.
Ultrasound Of The Brain: Ultrasound is
often used on newborns who cannot
tolerate more rigorous tests such as CT
scans or MRI.

26. DIAGNOSIS
CT Scan Of The Brain: It identifies
malformations, hemorrhage, and certain
other abnormalities in infants more
clearly than ultrasound.
MRI Of The Brain: Children who are
unable to remain still for at least 45
minutes may require a sedative to
undergo this test.

27. DIAGNOSIS
MRI Of The Spinal Cord: This may be
necessary in children with spasticity of
the legs and worsening of bowel and
bladder function.
Electroencephalography (EEG):
Important in the diagnosis of seizure
disorders.

28. DIAGNOSIS
Electromyography (EMG) and nerve
conduction studies (NCS): May be
helpful in distinguishing CP from other
muscle or nerve disorders.

29. TREATMENT
There is no cure for cerebral palsy.
With early and ongoing treatment,
however, the disabilities associated
with cerebral palsy can be reduced.

30. MEDICAL TREATMENT
Goal Of Treatment
To help the individual with cerebral palsy
reach his or her greatest potential
physically, mentally, and socially.

31. REHABILITATION
 A comprehensive rehabilitation program
may include
1) Physical Therapy
2) Use Of Special Equipment
3) Spasticity Treatment

32. 1) PHYSICAL THERAPY
 The goal is to maximize function and
minimize disabling contractures. It
involves:
 Stretching
 Physical exercises, and

33. 1) PHYSICAL THERAPY
 Other activities that develop
- Muscle strength
- Flexibility
- Control

35. 2) SPECIAL EQUIPMENT
Special equipment that may be
helpful to people with CP includes:
- Walkers
- Positioning Devices
- Customized Wheelchairs
- Scooters
- Tricycles

40. SPASTICITY TREATMENT
 Spasticity may be treated by injections
into the muscles or by medications.
 Reduction of spasticity can improve:
- Range of motion
- Reduce deformity
- Improve response to occupational and
physical therapy
- Delay the need for surgery

41. OCCUPATIONAL THERAPY
Helps the individual learn physical skills he or
she needs to function and become as
independent as possible in everyday life.
Examples are feeding, grooming, and
dressing.

42. OTHER THERAPIES
 Speech/language
therapy: This
therapy helps
the child
overcome
communication
problems.

43. OTHER THERAPIES
 Vision problems: An ophthalmologist is
consulted for children who have
strabismus and visual problems

44. MEDICAL THERAPY
This encompasses treatment for all
medical problems whether related to CP
or not.
 Seizures
 Feeding And Digestive Problems
 Breathing Problems

45. EDUCATIONAL SERVICES
 Many children with cerebral palsy, even
those of average or above-average
intelligence, are challenged in “cognitive”
processes such as thinking, learning,
and memory. They can benefit from the
services of a specialist in learning
disabilities

46. NURSING MANAGEMENT
 Functioning as a member of health team.
 Providing counseling and education for
parents.
 Encouraging health maintenance.
 Providing nutritional needs.
 Encouraging rest and relaxation.

47. NURSING MANAGEMENT
 Preventing infection and injury
 Promoting a positive self image
 Encouraging self help
 Toilet training
 Assisting with physical therapy
 Assisting with speech therapy

48. NURSING MANAGEMENT
Preventing child abuse
Counseling for educational and
vocational training.

49. NURSING DIAGNOSIS
 Impaired physical mobility
 Self care deficit
 Potential for injury
 Impaired verbal communication
 Body image disturbances
 Altered family process.

50. FOLLOW – UP
 The overall goal for ongoing care of
individuals with CP is to help them reach
their full physical, mental, and emotional
potential. Generally, this includes living
as much as possible in the mainstream
of their society and culture

51. COMPLICATIONS
 Osteoporosis
 Bowel obstruction
 Hip dislocation and arthritis in the hip
joint
 Injuries from falls
 Joint contractures
 Pneumonia caused by choking

52. COMPLICATIONS
 Poor nutrition
 Reduced communication skills
(sometimes)
 Reduced intellect (sometimes)
 Scoliosis
 Seizures (in about half of patients)
 Social stigma

53. SUPPORT GROUPS