for pediatrics UG teaching

1. Dr M.Sanjeevappa
M.D.(paeds)
Asst.Professor
Dept. of Paediatrics
GMC ,Ananthapuramu

2.  Brain grossly differentiates into cerebrum
and cerebellum during 1st Trimester of
embryonic life.
 Neurons begin to develop in 2nd trimester.
 By the end of 2nd trimester all neurons are
formed and any damage occurring now is
irreversible.
 Synaptic connections occur in 3rd trimester.

3.  Cerebral palsy is a chronic neurodevelopmental
disorder.
 never the same disease twice.
 Some children with CP graduate from universities and
become health professionals.
 Some children with CP may be unable to roll or feed
and may be entirely dependent for all activities of daily
living.

4.  First described in 1862, by William John Little,
an orthopedic surgeon.
 Cerebral Palsy was known as Little’s
Disease for decades.
 The term cerebral Palsy originated with
William Osler and Sigmund Freud.
 Incidence : about 2 per 1000 live births in high
resource settings.

5.  Cerebral palsy (CP) describes a group of permanent
disorders of movement and posture causing activity
limitation, that are attributed to non progressive
disturbances that occurred in the developing fetal or
immature brain.
 The motor disorders of CP are often accompanied by
disturbances of sensation, perception, cognition,
communication, and behaviour, by epilepsy, and by
secondary musculoskeletal problems.

6.  Two distinct cohorts of children present with CP.
 Cohort one :
Infants born preterm
Infants born at term experiencing a neonatal
encephalopathy.
 Cohort two:
Developmental surveillance provided through a
community-based workers.
Parental observation of “stiffness” or gait
disturbances.

7.  Prenatal (44%)
◦ First trimester :
Teratogens.
Chromosomal abnormalities.
Genetic syndromes.
Brain malformations.
◦ Second trimester :
Intrauterine infections.
Problems in fetal/placental functioning

8.  Labor and delivery (19%)
Preeclampsia.
complications of labor.
 Perinatal (8%)
PREMATURITY
Sepsis/CNS infection,
asphyxia.
 Childhood (5%)
Meningitis.
traumatic brain injury.
toxins.
 Not obvious (24%)

9.  Spastic : hyper tonicity with poor posture control
 Dyskinetic / athetoid : abnormal involuntary
movement / slow wormlike writhing.
 Ataxic : wide-based gait.
 Mixed-type / dystonic : combination of spasticity
and athetosis

11. Gross Motor Function Classification System(GMFCS)

13. Physical signs :
 poor head control after 3 months of age.
 stiff or rigid arms or legs.
 pushing away or arching back.
 floppy or limp body posture.
 cannot sit up without support by 8 months.

14.  uses only one side of the body, or only the arms to
crawl.
 clenched hands after 3 months(cortical thumb.)
 leg scissoring.
 Seizures.
 sensory impairment (hearing, vision).
 after 6 months of age, persistent tongue thrusting.

15.  Extreme irritability or crying.
 Feeding difficulties.
 Little interest surrounding.
 Excessive sleeping.

16.  Stiff or floppy posture.
 Excessive lethargy or irritability /high pitched cry.
 Poor head control.
 Weak suck /tongue thrust /tonic bite /feeding difficulties.
 Persistence of primitive infantile reflexes.

17.  Intellectual impairment.
 Seizures.
 Drooling of saliva.
 Feeding difficulties.
 Orthopedic complications.
 Dental carries.

18.  Physical Assessment.
 Observe LBW, preterm, and those with low
Apgar scores at 5 minutes.
 Observe infants who have seizures, intracranial
hemorrhage, metabolic disturbances.
 Diagnosis may not be confirmed until after 6
months of age.

19.  Magnetic resonance imaging (MRI).
 Ultrasound.
 Computerised tomography (CT) scan.
 Electroencephalogram (EEG).
 Electromyogram (EMG).
 Additional tests: Vision impairment, Hearing
impairment, Speeh impairments, Intellectual
disabilities, Movement disorders

20. Medical
 To enhance functional abilities of CP child.
 Therapy is chiefly symptomatic and preventive.
The broad aims of therapy are :
 To establish locomotion, communication and self help.
 To gain optimum appearance and integration of motor
functions.
 To correct associated defects as early and effectively .
 To provide educational opportunities adapted to the
individual child’s needs and capabilities.
 To promote socialization experiences with other
affected, unaffected children

21.  physiotherapy is directed toward good skeletal
alignment for child with spasticity.
 Physiotherapy can help the child's strength,
flexibility, balance, motor development and mobility.
 physiotherapy uses orthotic devices, such as braces,
casting and splints to support and improved walking.

23.  Using alternative strategies and adaptive
equipment, occupational therapists work to
promote the child's independent participation in
daily activities and routines in the home, the
school and the community.
 Adaptive equipment may include walkers,
quadrupedal canes, seating systems or electric
wheelchairs.

25.  Speech-language therapist can help improve the
child's ability to speak clearly or to communicate
using sign language.
RECREATION THERAPY
 This therapy can help improve the child's motor
skills, speech and emotional well-being.

26.  To reduce the effects of cerebral palsy and prevent
complications:
 Analgesic drugs to reduce intense pain or muscle spasm.
 Botulinum toxin type A, used to reduce spasticity in
targeted muscle of the upper and lower extremities.
 Dantrolene sodium, baclofen, and diazepam to improve
muscle coordination and to muscle relaxation.
 Anticonvulsants drug, to relieve or stop seizures

27.  Surgery used to correct problems with bones
and joints, by lengthening any muscles and
tendons that are too short and causing
problems.
ORTHOPEDIC SURGERY :
 To correct contracture or spastic deformities,
to provide stability for an uncontrolled joint, to
address bone malalignment, and
to provide balanced muscle power.
 Example : tendon transfer, muscle lengthening.

28.  Selective dorsal rhizotomy (SDR) is a surgical
procedure that can help children with severe
muscle stiffness in their legs to improve their
walking.

30.  To improve feedings, correct GERD and correct
associated dental problems.

32. THANK YOU….