Download to read offline
More Related Content
Similar to Cerebral palsy
Cerebral palsy
- 1. “CEREBRAL PALSY” BY S. GRACELETMELITA 2ND YEAR M.SC(N)
- 4. DEFINITION: A groupof 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.
- 6. CAUSES: Hypoxia /Anoxia Bleeding in the brain Brain infections (encephalitis, meningitis, herpes simplex infections) Infections in the mother during pregnancy (rubella, toxemia)
- 7.
- 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 signsof 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 oruncontrollable 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 isCerebral 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, thereis 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 ScanOf 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 MRIOf 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 isno 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 Acomprehensive rehabilitation program may include 1) Physical Therapy 2) Use Of Special Equipment 3) Spasticity Treatment
- 30. 1) PHYSICALTHERAPY The goal is to maximize function and minimize disabling contractures. involves: Stretching Physical exercises, Other activities that develop - Muscle strength - Flexibility - Control
- 31. 2) SPECIALEQUIPMENT 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: Functioningas a member of health team. Providing counseling and education for parents. Encouraging health maintenance. Providing nutritional needs. Encouraging rest and relaxation.
- 38. Preventing infectionand 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 Usedto 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 NURSINGDIAGNOSIS Impaired physical mobility Self care deficit Potential for injury Impaired verbal communication Body image disturbances Altered family process.
- 41. FOLLOW UP Theoverall 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 Bowelobstruction Hip dislocation and arthritis in the hip joint Injuries from falls Joint contractures Pneumonia caused by choking
- 43. COMPLICATIONS Poornutrition Reduced communication skills (sometimes) Reduced intellect (sometimes) Scoliosis Seizures (in about half of patients) Social stigma
- 44. Should Ienroll 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 youdecide, 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: Whatare 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 Amritfoundation 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 EDUCATIONOPPORTUNITIES 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 PLAYGROUPSAND 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 forParents 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 forCaregivers – 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 GROUPSAND 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 SUPPORTGROUPS 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 PalsyFoundation – 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 forthe 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 SUPPORTORGANIZATIONS 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 CerebralPalsy (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 ORGANIZATIONSONLINE 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 ofMiracles – 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 Rehabilitationin 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 themost 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 ChildNeurology” 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 childrenwith 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.