Cerebral palsy indroduction, defination, types, signs, complications and management

1. Cerebral Palsy

2. Definition
• Cerebral Palsy is a group of permanent, disorders of movement and/or
posture and of motor function, which are due to a non-progressive
interference, lesion, or abnormality of the developing/immature brain.

4. Causes
Prenatal
• Prematurity (Gestational age less than 36 weeks)
• Low Birth Weight (less than 2500 g), which could be due to poor
nutritional status of the mother
• Maternal epilepsy
• Hyperthyroidism
Infections (TORCH = Toxoplasmosis, Other (Syphilis, Varicella-Zoster,
Parvovirus B19,) Rubella, Cytomegalovirus (CMV), Herpes Simplex Virus)
• Eclampsia
• Drug Abuse
• Trauma
• Multiple Pregnancies
• Placental Insufficiency

5. Perinatal
•Premature Rupture of Membranes
•Prolonged and Difficult Labour
•Vaginal Bleeding at the time of admission for labour
•Bradycardia
Postnatal(0-2 years)
•Central Nervous System infection (encephalitis, meningitis)
•Hypoxia
•Seizures
•Coagulopathies
•Neonatal Hyperbilirubinemia
•Head Trauma

6. Anatomical Classifications
• Unilateral: One side of the body is affected
• Bilateral: Both sides of the body are affected
• Quadriplegia, diplegia/Paraplegia and hemiplegia, monoplegia
• Dyskinetic Cerebral Palsy and Ataxic Cerebral Palsy: always involve the whole
body (bilateral).

8. Hemiplegia (Unilateral)
• With hemiplegia, one side of the body is involved with the upper
extremity generally more affected than the lower.
• Seizure disorders, visual field deficits, tactile agnosia, and
proprioceptive loss are likely.
• Twenty percent of children with spastic Cerebral Palsy have hemiplegia.
A focal traumatic, vascular, or infectious lesion is the cause in many
cases.
• A unilateral brain infarct with post-hemorrhagic porencephaly (cysts or
cavities within the cerebral hemisphere) can be seen on Magnetic
Resonance Imaging (MRI).

9. Diplegia (Bilateral)
• With diplegia, the lower extremities are severely involved and the arms are
mildly involved.
• Intelligence usually is normal, and epilepsy is less common.
• Fifty per cent of children with Spastic Cerebral Palsy have diplegia. A history of
prematurity is usual.
• Diplegia is becoming more common as more low- birth-weight babies
survive.
• MRI reveals mild Periventricular Leukomalacia (PVL).

10. Quadriplegia (Bilateral)
• With quadriplegia, all four limbs, the trunk and muscles that control
the mouth, tongue and pharynx are involved.
• Thirty percent of children with Spastic Cerebral Palsy have quadriplegia.
More serious involvement of lower extremities is common in
premature babies.
• Some have perinatal hypoxic ischemic encephalopathy. MRI reveals
Periventricular Leukomalacia (PVL).

11. Classification on the basis of Brain area
involved
1. Spastic Cerebral Palsy - is the most common form of Cerebral Palsy.
Approximately 80% to 90% of children with Cerebral Palsy have Spastic
Cerebral Palsy.
• Spastic Cerebral Palsy is characterized by at least two of the following
symptoms, which may be unilateral (hemiplegia) or bilateral:
• An abnormal pattern of posture and/or movement
• Increased tone (not necessarily constantly)
• Pathological reflexes (hyperreflexia or pyramidal signs e.g. Babinski
response)

12. Dyskinetic CP
• Abnormal movements that occur when the child initiates movement are named
Dyskinesias.
• Dysarthria,Dysphagia and drooling accompany the movement problem.
Intellectual development is generally normal, however severe dysarthria makes
communication difficult and leads the outsider to think that the child has
intellectual impairment.
• DyskineticCerebral Palsy accounts for approximately 10% to 15 % of all cases of
Cerebral Palsy.
• Hyperbilirubinemia or severe anoxia causes basal ganglia dysfunction and
results in DyskineticCerebral Palsy.
• DyskineticCerebral Palsy is characterised by the following Symptoms:
• Abnormal pattern of posture and/or movement, and
• Involuntary, uncontrolled, recurring, occasionally stereotyped movements of
affected body parts

13. Ataxic CP
• Ataxia is loss of balance, coordination and fine motor control.
• Ataxic children cannot coordinate their movements. They are hypotonic during the
first 2 years of life.
• Muscle tone becomes normal and ataxiabecomes apparent toward the age of 2 to 3
years.
• Children who can walk have a wide-based gait and a mild intention tremor
(Dysmetria).
• Dexterity and fine motor control is poor.
• Ataxia is associated with cerebellar lesions. Ataxia is often combined with spastic
diplegia.
• Ataxic Cerebral Palsy is characterized by the following symptoms:
• Abnormal pattern of posture and/or movement
• Lost of orderly muscular coordination, so that movements are performed with
abnormal force, rhythm, and accuracy

15. Mixed CP
• Children with a mixed type of Cerebral Palsy commonly have mild
spasticity, dystonia and/or athetoid movements.
• Ataxia may be a component of the motor dysfunction in children in this
group.
• Ataxia and spasticity often occur together.
• Spastic Ataxic Diplegia is a common mixed type that often is associated
with hydrocephalus.

16. Associated Problems
• Epilepsy
• Visual Problems
• Hearing Loss
• Speech and Communication
• Feeding Difficulty & Failure to Thrive
• Respiratory Problems
• Incontinence
• Intellectual Impairment

17. THANK YOU