unlearn, relearn and learn

1. “CEREBRAL PALSY”
BY
S. GRACELET MELITA
2ND YEAR M.SC(N)

4. DEFINITION:
 A group of disorders arising from a malfunction of motor centers and
neural pathways of the brain.
 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.
 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. CAUSES:

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

7. TYPES:

9. TYPES:
 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.

11.  2) Dyskinetic (Extrapyramidal):
 ATHETOID
 ATAXIC

12.  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.

15.  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.
 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

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

18. SIGNS AND SYMPTOMS:
 The signs and symptoms of Cerebral Palsy appear early on during infancy
even though specific diagnosis may be delayed until the child is two years
old or later. Children with Cerebral Palsy often display developmental
delays, marked by slow progress in achieving developmental milestones
such as learning to walk, sit or crawl.

19.  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:
 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. Developing handedness before age 18 months:
This indicates weakness or abnormal muscle tone on one side, which may
be an early sign of CP Difficulty in muscle coordination while performing
voluntary movements

20.  Involuntary or uncontrollable movements because of muscle spasm
 Stiffness or floppiness in muscle tone
 Exaggerated reflexes (spasticity)
 Weakness of the arm or leg on one side
 Crouched gait
 Walking on tiptoes because of tightness in tendons
 Excessive drooling
 Gastro-oesophageal reflux
 Difficulty in swallowing or speaking
 Delayed motor skill development
 Difficulty with precise movement such as tying shoelaces

21.  How is Cerebral Palsy diagnosed?
 Cerebral Palsy is mostly diagnosed in children during the first 2 years of
their life. However, in certain situations where a child exhibits mild
symptoms of Cerebral Palsy, it may not be easy for a doctor to reach a
reliable diagnosis before the age of 4 – 5 years.
 Techniques that enable doctors to study the brain including neuro-
imaging methods such as magnetic resonance imaging (MRI), cranial
ultrasound, computed tomography (CT) scan, electro-myogram (EMG)
electro-encephalogram (EEG), can be used to diagnose Cerebral Palsy.

22.  Unfortunately, there is no single test available to confirm Cerebral Palsy
definitively. Lab tests can recognize other disorders that cause similar
symptoms to those related to Cerebral Palsy. Even though the symptoms
can change over a period of time, Cerebral Palsy is non-progressive in
nature. Doctors may require regular visits and a series of tests to monitor
and evaluate the child’s development and motor skills. This would also
help the doctor to rule out other conditions that result in symptoms similar
to Cerebral Palsy.

23. 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.

24.  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.

25.  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.

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

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

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

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

30.  1) PHYSICAL THERAPY
 The goal is to maximize function and minimize disabling contractures.
involves: Stretching Physical exercises,
 Other activities that develop - Muscle strength - Flexibility - Control

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

32.  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

33.  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.

34.  OTHER THERAPIES
 Speech/language therapy: This therapy helps the child
overcome communication problems.
 Vision problems: An ophthalmologist is consulted for children who have
strabismus and visual problems

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

36.  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

37. 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.

38.  Preventing infection and injury
 Promoting a positive self image
 Encouraging self help
 Toilet training
 Assisting with physical therapy
 Assisting with speech therapy
 Preventing child abuse
 Counseling for educational and vocational training.

39. Common Medications Used to Treat
Cerebral Palsy
 Each child with cerebral palsy is likely to have a unique combination of medications to treat
their specific condition. Some medications are short-term, while others are long-term.
Medications and dosages are often used in combination and will likely be adjusted over time.
 Common classes of medications for children with cerebral palsy include:
 Anticonvulsants
 Antidepressants
 Anti-inflammatories
 Muscle relaxants
 Benzodiazepines
 Nerve blocks
 Botox ( neurotoxin which directly acts on motor neurons to reduce muscle activity)
 Baclofen ( antispasmodic)
 Anticholinergics
 Stool Softeners

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

41. 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

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

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

44.  Should I enroll my child in a special education program?
 Your child has a legal right to education. These laws also protect your
rights as a parent to be fully informed about or to challenge educational
decisions concerning your child.
 Whether to send your child to a mainstream or special school is a
decision, based on your child’s special education needs and your
preferences.

45.  Whatever you decide, it is important to be involved with your child’s
education. If your child is in a mainstream school, he or she may need an
adapted curriculum and may sometimes be required to attend special
classes.
 You should try and enroll your child in classes with other children of the
same age. Think of ways you can stimulate your child’s thinking skills
without making tasks too difficult. Remember, it is okay for your child to
sometimes fail. Keeping the child’s positive image of himself/herself alive is
essential, and will help him/her to succeed in life.

46. FREQUENTLY ASKED QUESTIONS
 Q: Is Cerebral Palsy treatable?
 There is no cure for Cerebral Palsy, but interventions, including treatment,
therapy, special equipment, and, in some cases, surgery can help children
with Cerebral Palsy.
 Q: Is Cerebral Palsy life-threatening?
 With the exception of a few cases of severe Cerebral Palsy, most children
with the condition are expected to live well into adulthood.

47.  Q: What are other related conditions that a child with Cerebral Palsy is
likely to have?
 Some conditions that accompany Cerebral Palsy are seizures, problems
with vision, hearing or speech, changes in the spine, joint problems or
Intellectual Disability. Because of the Cerebral Palsy, they may also have
hypertension, incontinence, bladder dysfunction and difficulty in
swallowing.
 Q: Does a person with Cerebral Palsy suffer from depression?
 Persons with Cerebral Palsy are three to four times more likely to have
depression. The level of emotional support, and how one copes with the
stress can both have a significant impact on his/her mental health.

48. SUPPORT GROUPS
 Amrit foundation of India
 Support for Children with CP
 Various forms of therapy and rehabilitation improve patients’ quality of life and reduce the
incidence of complications tied to the disorder. Treatment plans are highly individualized,
addressing conditions present in each case. Therapy for cerebral palsy may include the
following:
 THERAPY OPTIONS
 Physical Therapy – Physical therapy improves motor function, coordination, strength, mobility
and flexibility. This form of treatment is among the most beneficial for large muscle groups
affected by cerebral palsy.
 Occupational Therapy – OT addresses physical symptoms, preparing children for challenges at
home, school and in other public environments. The protocol also helps with cognitive and
social functions, improving learning and reinforcing confidence.
 Speech Therapy – Speech, swallowing, and digestive difficulties commonly occur among
children with cerebral palsy. In addition to other rehabilitative goals, speech therapy strives to
improve muscle coordination in the neck, face, throat and head.

49.  SPECIAL EDUCATION OPPORTUNITIES
 The Individuals with Disabilities Education Act of 2004 guarantees access
to education for United States children suffering from medical
disorders. Those diagnosed with cerebral palsy benefit from these types
of special education:
 Public school
 Private school
 Homeschool
 Tutoring

50.  SPECIALIZED PLAYGROUPS AND SUMMER CAMPS FOR CHILDREN WITH CP
 Studies show recreation has therapeutic benefits for children with CP, inspiring
playgroups and summer camps sensitive to their needs. Adaptive equipment and
wheelchair accessible facilities, for example, enable children to participate in numerous
summer camp activities, including:
 Arts and crafts
 Swimming
 Hikes
 Organized sports
 Fishing
 Campfires
 These and other recreational activities provide social and sensory stimulation,
contributing to increased functioning and better overall health and fitness for children
with cerebral palsy.

51.  Support for Parents of Children with Cerebral Palsy
 Parents of children affected by cerebral palsy require ongoing support
managing the disorder’s extraordinary demands. Fortunately, help is
available from wide-ranging organizations dedicated not only to afflicted
children, but also parents and caregivers.
 TIPS FOR PARENTS AND CAREGIVERS
 Explore Available Resources – A childhood CP diagnosis can be
overwhelming for parents faced with unfamiliar symptoms and
circumstances. Myriad resources soften the blow, providing information,
support, guidance and forums with other parents affected by the

52.  Care for Caregivers – Parents are best-able to provide high levels of care
when their own physical, emotional and mental needs are met. Caregivers
are advised to recognize their limitations, getting adequate sleep, nutrition
and relaxation.
 Enhance Understanding – Information empowers parents to be the best
possible caregivers. Not only does education answer early questions about
the disorder, but it also keeps parents informed about CP treatment
advances and other important developments.
 Work Together – Both within the household and away from home,
enlisting help from a spouse, counselor or support organization eases the
pressure on primary caregivers.

53.  SUPPORT GROUPS AND ORGANIZATIONS ASSISTING CHILDREN AND
FAMILIES
 Families impacted by cerebral palsy benefit from connections made with
support groups dedicated to CP causes. Whether meeting in-person or
online, support groups play a vital role, helping families at every stage of
their journey with cerebral palsy. Among other benefits, participating in a
support organization:
 Keeps parents informed about the disorder
 Reassures caregivers
 Provides encouragement
 Spreads hope and understanding
 Relieves stress

54.  NATIONAL SUPPORT GROUPS
 Within the United States, cerebral palsy support organizations operate
nationally and at the state and local levels. In practice, national bodies
often maintain regional chapters, providing individualized support in
communities across the country.
 March of Dimes – March of Dimes strives to improve health and
treatment outcomes for newborns and mothers. The organization
A Fighting Chance for Every Baby, providing support forums and other
family resources. The support community includes a social network
parents of children diagnosed with cerebral palsy and other brain
disorders.

55.  Cure CP – The name of this non-profit organization states its underlying
mission. The group, founded by 2 families affected by the disorder,
focuses on funding support for research efforts and new therapeutic
methods beneficial to individuals with cerebral palsy.

56.  Cerebral Palsy Foundation – CPF uses research, innovation and
collaboration to make an impact for families facing CP. In particular, the
Foundation strives to identify individual Moments of Impact, when
intervention and insight into the disorder have the power to change lives.

57.  Reaching for the Stars – Organized in 2004, this charitable organization is
run by parents experienced with cerebral palsy. The advocacy group is
committed to driving research, education and other services beneficial to
children with CP and their family members.

58.  LOCAL SUPPORT ORGANIZATIONS
 The Arc – Through hundreds of local chapters, The Arc assists individuals
diagnosed with a range of intellectual and developmental disabilities. As
leading advocate for all people facing these challenges, The Arc provides
support and services beneficial to families affected by cerebral palsy.

59.  Easter Seals – Easter Seals rallies around children and caregivers,
providing support for families affected by CP and other disorders. The
organization contributes to high achievement among children with
disabilities and provides services and resources for caregivers, particularly
parents of newly diagnosed children. The organization’s Child
Development Center Network provides inclusive care, operating more
80 centers across the U.S.

60.  United Cerebral Palsy (UCP) – UCP makes a difference through its
widespread network of community resources. Through education,
advocacy and support services, the organization enhances
productivity, and quality of life for cerebral palsy patients. Focused at the
local level, UPC affiliates influence public policy and education, ensuring
equal access for families facing the disorder.

61.  Family Voices – Family Voices has worked since 1992, promoting high level
health care for children – particularly individuals with distinct health care
needs. The family-led non-profit organization strives to empower families
facing childhood disorders like cerebral palsy, using national, state, and
local resources to ensure the best possible children’s health outcomes.

62.  SUPPORT ORGANIZATIONS ONLINE
 Special Needs Moms for Moms – This support network relies on
technology to bring together families of children with special
forums and social networking to connect parents facing similar
the group strives to inform, support, inspire and facilitate sharing
members.

63.  Mommies of Miracles – The world’s largest virtual support network for
mothers of children with medical complexities and developmental
difficulties, Mommies of Miracles provides an extended network of helpful
resources. The group furnishes access to products and services, as well
grief support and encouragement for its members.

64. JOUNAL INFORMATION:
“Pediatric Rehabilitation in Children with Cerebral Palsy: General Management, Classification of Motor
Disorders”
- Becher, J. G. MD, PhD
Author InformationJPO Journal of Prosthetics and Orthotics: December 2002 - Volume 14 - Issue 4 - p 143-
149
Abstract:
 Cerebral palsy (CP) is the most common physical disability in childhood. The motor impairment
syndrome is obligatory for the diagnosis, but a broad range of neurological deficits can be present as
well. Professionals in pediatric rehabilitation are faced with a diversity of problems in the child and family
(physical, psychological, communicative, and social), so a multidisciplinary approach for treatment is
needed. The International Classification of Functioning offers a framework for team management in the
treatment of children with CP. Based on this concept, an instrument for team conferences, the
Children’s Rehabilitation Activities Profile is described. This instrument can be used for systematic
evaluation of the needs of the children and parents, the total development and evaluation of the goals
of rehabilitation on the level of activities. In children with CP, three main kinds of motor disorders are
seen: spastic paresis; ataxic paresis, and dyskinetic paresis.

65.  In the most common disorder, spastic paresis, many different impairments of muscle
function are described. Spasticity is only one of the components of a spastic paresis. The
clinical consequences of these differences are discussed. In children with walking ability, the
walking pattern is related to the functional prognosis of ambulation at adulthood. A
classification of walking patterns is presented that can be used as a framework for treatment
programs.
 Cerebral palsy (CP) is an umbrella term covering a group of nonprogressive—but, in time,
often changing—motor impairment syndromes secondary to lesions or anomalies of the
immature brain. 1 Onset usually occurs before the first birthday. CP is the most common
physical disability in childhood; the incidence was stabilized in the nineties at around 2–2.5
per 1000 live births. 2
 Although the motor disorder is the most striking symptom, many other pediatric and
neurological impairments are associated with CP, such as failure to thrive caused by feeding
problems or constipation, seizures, visual and auditory impairments, mental retardation,
speech impairments, such learning deficits as dyslexia and nonverbal learning disability, and
behavioral impairments.

66. “Journal of Child Neurology”
published online 22 June 2014 Iona Novak
“Evidence-Based Diagnosis, Health Care, and Rehabilitation for Children With Cerebral Palsy”
Published by: http://www.sagepublications.com

68. CONCLUSION:
 In children with CP, a complex of neurological impairments and developmental risks
with regard to their physical, psychological, and social development can be present.
Pediatric rehabilitation is a complex process, facing all these problems. First, the
diagnosis and functional prognosis of the child with regard to movement abilities,
cognition, and communication must be determined. A multidisciplinary treatment
approach is needed. A tool for team conferences, based on the model of the ICF( the
international classification of functioning), is presented. Because the motor impairment
is the main interest of medical treatment, classification of the motor syndromes and
impairment of muscle functions are described. Finally, a classification of gait patterns
in relation to the degree of involvement for patients with a spastic paresis is described.
This classification can be used to set the prognosis of ambulation and the kind of
interventions needed to optimize the walking ability.