This document discusses cerebral palsy (CP), including its definition, types, causes, signs and symptoms, and treatment/management approaches. CP is a group of disorders that impair movement and posture due to non-progressive brain damage early in development. It has a prevalence of about 4 per 1,000 live births. The main types are spastic, dyskinetic, atonic, and mixed. Causes include genetic factors, issues with the mother or pregnancy, perinatal complications, postnatal infections or injuries, and lack of oxygen. Signs vary depending on severity but may include abnormal movements, poor head control, feeding difficulties, and developmental delays. Treatment aims to manage symptoms, prevent complications, and support development

1. Dr. Md. Monirul Islam
MBBS, BCS, MS (Ortho)
Consultant (Ortho-Surgery)
250 beded Sadar Hospital , Jhenaidah
Presented by :

2. Definition
Heterogeneous group of disorders
characterized by degree of impairment of
movement and posture due to non
progressive neurological deficit as a result of
an insult to the developing brain.

3. INCIDENCE
Prevalence rate is about 4% per 1000 live birth
10% of infants born1000gm or less at birth
5%-10% incidence in pre-term
Birth asphyxia as a cause only in3-21%

4. TYPES/CLASSIFICATIONS
BASED ON MOTOR DEFICIT (MOVEMENT DISORDER)
A. SPASTIC CEREBRAL PALSY :The most common form of cerebral
palsy: about 65-70-%
B. EXTRAPYRAMIDAL CEREBRAL PALSY (DYSKINETIC CP: about 30 %
 Uncontrolled interfere with speaking, feeding, grabbing, reaching and
others skills that require motor skills.
 Caused by cerebral damage due to kernicterus.
C. ATONIC CEREBRAL PALSY: 5% Poor balance and lack of
coordination
D. MIXED FORM : Spastic muscle tone and involuntary movement.
Have damage to the motor cortex and cerebellum

5. Spastic cerebral palsy
Spastic cerebral palsy is the type of cerebral
palsy characterized by spasticity or high
muscle tone often resulting in stiff, jerky
movements.
Itself an umbrella term encompassing :
1. spastic hemiplegia,
2. spastic diplegia,
3. spastic quadriplegia
4. spastic monoplegia

6. ACCORDING TO SEVERITY
A. MILD CEREBRAL PALSY (20%): Patients are
ambulatory, fine movement are impaired only
B. MODERATE CP (50%):These children achieve
ambulation by self-help. There is impaired gross
motor, fine motor and speech development.
C. SEVERE CP (30%):The children present with
multiple defects and unable to perform usual
activities of daily living

7. Prenatal factors/ causes
• 1)Risk factors inherent to the fetus (most
commonly genetic disorders),
• 2)Factors inherent to the mother (seizure
disorders, mental retardation, and previous
pregnancy loss),
• 3)Factors inherent to the pregnancy itself (Rh
incompatibility, polyhydramnios, placental
rupture, and drug or alcohol exposure).
• 4)External factors, such as TORCH (toxoplasmosis,
other agents, rubella, cytomegalovirus, herpes
simplex),

8. Perinatal Factors
1. Asphyxia or trauma during labor,
2. Oxytocin augmentation,
3. Umbilical cord prolapse,
4. Breech presentation
5. Low Apgar scores
6. Low-birth-weight infants (<1500 g)

9. Postnatal Causes
I. Trauma
II. Head injury
III. Infections – Septicemia , Meningitis ,
Enchephalitis
IV. Lack of oxygen
V. Stroke in the young age
VI. Tumor, cyst

10. CLINICAL MANIFESTATIONS EARLY
SIGNS OF CP
i. Asymmetric movement
ii. Restlessness
iii. Irritability
iv. Feeding or swallowing or poor sucking
v. Poor head control
vi. Tongue thrust
vii. Excessive high pitch cry
viii.Slow weight gain

11. LATE SIGNS OF CP
i. Delayed gross motor development
ii. Persistent infantile reflexes
iii. Weakness
iv. Abnormal postures
v. Drooling
vi. Recurrent infections
vii. Malocclusion of teeth
viii. Constipation
ix. Caries teeth
x. Delayed or defective speech
xi. Evidence of mental retardation

12. Medical management
Correction or alleviation of specific neuro-motor deficits
or associated disabilities. Symptomatic management
is done.
• Pharmacotherapy
– Diazepam-for spasticity
– Levodopa-for athetosis
– Carbamazepine-for dystonia
– Anticonvulsants-for epilepsy
– Tranquilizers-for behavioral problem
– Muscle relaxants-to improve muscular functions
• Physiotherapy, Development enrichment experiences

13. Medical management
• Development of vocational and socialization
• Emotional behavioral and social adjustment
• SURGICAL MANAGEMENT:
– Orthopedic correction of:
• Scoliosis
• Contractures
• Dislocations
• Rhizotomyis an attempt to decrease spasticity

15. Preventing CP During Pregnancy
• Avoiding exposure to infections or viruses known
to impact fetal health, such as German Measles,
Cytomegalovirus or Zika
• Getting vaccinated appropriately
• Controlling underlying health issues, such as
blood pressure, diabetes, etc.
• Avoiding alcohol, cigarettes, recreational drugs,
and prescription drugs known to pose risks
during pregnancy
• Identifying any potential Rh incompatibility
between mother and child

16. Preventing CP During Birth
• Monitor maternal and fetal heart rate
• Remain as calm as possible during delivery.
Stress-induced trauma to the infant brain can
be reduced by maintaining a quiet, peaceful
delivery room
• Receive regular checkups This is especially
important in the weeks leading up to giving
birth.

17. Preventing Cerebral Palsy After Birth
a. Making sure child is vaccinated for all
common infant infections
b. Using the correct car seat for child’s weight
and height
c. Using a crib with bed rail
d. Never leaving your child on high countertops
or surfaces unattended
e. Never shake a baby

18. Thank You All