2. WHAT IS CEREBRAL PALSY ?
• Permanent disorder of movement and
posture(motor impairment) due to lesion in
developing brain.
• Non progressive brain lesion resulting in
progressive musculoskeletal pathology
• !!! Spinal cord and muscles are normal
3. Why cerebral prevalence has been
increased?
• Because of increased survival of very
low birth weight infants.
5. SPASTICITY
• VELOCITY DEPENDENT
INCREASE IN MUSCLE TONE
• CAN FELT
• REMAINS ALL THE TIME
• TENDONS , BONE AND
JOINT SURGERY IS NEEDED
DYSTONIA
• INVOLUNTARY TWISTING
MOVEMENTS
• CAN BE SEEN
• REDUCES DURING SLEEP
AND REST
• ARTHRODESIS WORKS
7. • Pyramidal problems are due to ischemic
encephalopathy leading to spastic cerebral
palsy.
• Extrapyramidal problems are due to neonatal
jaundice causing dyskinesia and
choreoathetosis.
8.
9. Geographical classification
• Monoplegia – only one limb affected.
• Hemiplegia and double hemiplegia - both
upper and lower limbs . But UL>LL
• Paraplegia – both lower limbs
• Diplegia – both upper and lower limbs
affected but LL> UL.
• Quadriplegia - both lower and upper limbs
equally affected.
11. GROSS MOTOR FUNCTION
CLASSIFICATION SYSTEM
• Firstly described by Dr Robert Palisano
and Dr Peter rosenbaum.
it includes description of gross motor function of
children on basis of sitting ,walking and wheel chair
mobility.
Important system to classify functional mobility of child
It predicts how the mobility of the child would remain for
life long
The original GMFCS had some limitations. These
limitations included an upper age limit of 12 years and
rating of the child based on their best capability rather
than their typical performance when forced by the
rating scale to choose a single category.
12.
13.
14. GMFCS
• Help to see walking ability of child
• Help in managing
• Help to predict complications like hip
subluxation mainly seen in GMFCS 4 and 5
15.
16. Treatment according to GMFCS
scoring
• GMFCS1 – less physiotherapy is needed.
• GMFCS 2- balance / coordination training
• GMFCS 3 – balance training , strengthening,
prevent/ treat ortho deformity
• GMFCS 4 – wheelchair training, , look for hip
dislocation.
• GMFCS5- realistic goals.
17. • Treatment can change FUNCTIONAL
MOBILITY SCORE but not GMFCS.
18. Functional mobility scale
• Functional mobility scale was designed by Graham and
colleagues as a measure of ambulatory performance in
children with CP.
• The FMS is the only existing functional scale that
accounts for the fact that children may demonstrate
different ambulatory abilities and use different
assistive devices to walk various distances.
• FMS categorizes the assistance needed for a child to
walk 3 distances . The distances are not specifically
measured but are used as estimates to represent
household , school and community ambulation.
Ratings are given for each distance category .
19. • Like GMFCS , the FMS assesses a childs
average performance in daily life rather than
their maximum capability.
• FMS specifically addresses ambulation, and ,
therefore , is not intended to substitute for
the GMFCS , which assesses mobility on a
more general level.
21. • The child who ambulates independntly for all
distances and on all types of surfaces would
be given a rating of 6,6 and 6 .
• A child who ambulates independently on level
surfaces in the home , uses crutches at school,
and a wheelchair for shopping trips and family
outings would be given a rating of 5,3, and 1 .
22. FUNCTIONAL MOBILITY SCORE
• FMS 1 – wheel chair bound , stand for transfer
• FMS 2 – uses walker / frame and needs
support
• FMS 3 – use crutches and walk independently
• FMS4 – use stick and walk independently
• FMS 5 – Walk independently on levelled
surfaces
• FMS 6- walk independently on all surfaces.
23. • If a child having GMFCS 3 , can walk for 5
meters with help of stick , can walk for 50
meters with help of crutches , can walk in
community using wheel chair …
• Then rating that describes the current
function would be 3, 2, 1 .
24. How to check whether there is
spasticity /contracture on basis of
tardieu scale
• R1 – angle on fast stretch
• R2- angle on sustained stretch
• Spasticity angle = R2- R1
• Low spasticity angle means contracture
• High spasticity angle means spasticity
