This document provides information about cerebral palsy (CP), including its causes, types, risk factors, diagnosis, and management. CP is a group of motor impairment syndromes resulting from early brain development disorders. It is the most common and costly form of chronic motor disability. The main types of CP are spastic, dyskinetic, ataxic, and mixed. Treatment involves physiotherapy, occupational therapy, speech therapy, surgery, and early intervention. While CP cannot be cured, early treatment and rehabilitation can help those affected realize their full potential.

1. CEREBRAL PALSY
Prepared by: Mohammed Ahmed Rajab

2. Introduction
◦ Historically known as static encephalopathy
◦ A group of motor impairment syndromes resulting
from disorders of early brain development.
◦ Often associated with epilepsy and abnormalities of
speech, vision and intellect.
◦ However, many children and adult with CP function
at a high educational and vocational level without
sign of cognitive dysfunction

3. Epidemiology
◦ CP is the most common and costly form of chronic
motor disability
◦ Prevalence: 2/1000
◦ Prevalence of CP is increased in low birth weight
infants (<1000g)
◦ CP incidence higher in premature and twin birth

4. Aetiology
•Infection
- German measles
- Shingles
•Diabetes
•Toxemia of
pregnancy
•Rh incompatibility
•Asphyxia
•Birth injury
•Prematurity
Caused by developmental, genetic,
metabolic, ischemic, infections
Antenatal
factors (80%)
Intrapartum
(10%)
Postpartum
(10%)
◦ Very high fever
◦ Brain infection
◦ Head injury
◦ Lack of oxygen
◦ Poisoning
◦ Intracranial
hemorrhage or
blood clot

5. Risk Factors
◦ Before Pregnancy:
- History of fetal wastage
- Long menstrual cycle
- Maternal thyroid disorder
- Family history of mental
retardation
◦ During Labor and Delivery:
- Premature separation of placenta
◦ During Early Postnatal Period:
- Newborn hypoxic ischemic or
bilirubin (kernicterus)
encephalopathy
◦ During Pregnancy:
- Low socioeconomic status
- Tx of mother with thyroid hormone,
estrogen or progesterone
- Maternal seizure disorder
- Polyhydramnios
- Eclampsia
- Bleeding in 3rd trimester
- Twin gestation
- Congenital malformation
- Fetal growth retardation
- Abnormal fetal presentation

6. Physiologic
identify forms of motor
impairment
Spastic CP
Dyskinetic CP
Ataxic CP
Mixed CP
Distribution
identify location of
musculoskeletal involvement
Spastic diplegia
Spastic
quadriplegia
Spastic
hemiplegia
Classification

9. Spastic CP
◦ The most common form of CP (70-
80%)
◦ Due to injury to upper motor neurons
of pyrimidal tract
◦ Often exhibit truncal hypotonia in 1st
year of life

10. •Characterized by at least 2 of following:
-Abnormal movement pattern
-Increased tone
-Pathologic reflexes (Babinski, hyper-reflexia)

11. Dyskinetic CP
◦ 10-15%
◦ Result of injury to basal ganglia (associated with kernicterus)
◦ Characterized by variable tonal abnormalities & involuntary
movement (athetosis, chorea)
◦ Fewer seizures & >normal cognitive function

12. Ataxic CP
◦ <5% of CP cases – rare
◦ Results from cerebellar injury
◦ Abnormalities of voluntary movement and balance
◦ Wide-based, unsteady gait, abnormal muscle tone

13. Mixed CP
◦ 10-15% of all cases
◦ > 1 type of motor pattern is present
& when 1 pattern does not clearly
dominate another
◦ Associated with > complications:
sensory deficits, seizures, cognitive-
perceptual impairments

14. Dystonic CP
◦ Uncommon
◦ Characterized by reduced activity and stiff movement
(hypokinesia) and hypotonia

15. Choreoathetotic CP
◦ Rare
◦ Caused by excess hyperbilirubinemia
◦ Dominated by increased and stormy movement (hyperkinesia)
and hypotonia

16. Clinical Manifestations
◦ Spectrum of developmental abnormalities
◦ Mental retardation
◦ Epilepsy
◦ Motor handicap

17. •Visual, hearing, speech, cognitive &
behavioral abnormalities

19. Diagnosis
◦ History and PE should preclude
progressive disorder of CNS,
degenerative disease, metabolic
disorders, spinal cord tumor,
muscular dystrophy
◦ MRI scan of brain or spinal cord
◦ Test of hearing and visual function
◦ Genetic evaluation

20. Management
◦ CP cannot be cured
◦ Family support – educate parents

21. ◦ Adjunctive therapy:
- Physiotherapy
- Occupational therapy
- Speech therapy
◦ Surgery
◦ Psychologist or psychiatrist

22. Nursing Manegment
◦ Early Intervention
◦ • The earlier disabled children are given
rehabilitation and education, the better they are
able to realize their full potential later in life.
◦ - Early intervention can have a really positive
impact on a child’s life.
◦ Physiotherapy
◦ - Physiotherapy is extremely beneficial and the
children love the interaction

23. ◦ Feeding
◦ • Three finger jaw control helps in swallowing
◦ • Speech therapy helps in better swallowing
◦ - Care and dignity when feeding a disabled child
improve trust and ensure a healthy, happy child.
◦ Children with learning disabilities
◦ - Encourage appropriate use of the curriculum and
teacher’s guide for mentally disabled children.
◦ - A teacher using teaching materials she has made
herself and adapted to the individual needs of this
child.

24. ◦ Children with hearing and visual impairments
◦ - Special technical skills and training are to be
provided to help deaf or blind children.
◦ - Teaching self help skills through play for blind
children.

25. ◦ Drugs:
- Oral Dantrolene sodium, benzodiazepines, baclofen
– treat spasticity
- Botulinum toxin
- Levodopa

26. Thank you!!