Cerebral Palsy Day-23.pptx

CEREBRAL PALSY DAY
Dr. Mansoor Alam
Consultant Developmental Specialist
Institute for Child Development, New Delhi

WORLD CEREBRAL PALSY DAY
 World Cerebral Palsy Day-6th October
 Indian National Cerebral Palsy-3rd October

CEREBRAL PALSY DAY
 World Cerebral Palsy Day is observed on October
6. Cerebral Palsy is a lifelong disability with no
known cure. The day celebrates lives of 17 million
people living with Cerebral Palsy, bringing people
living with cerebral palsy, their families, allies,
supporters and organisations across more than 100
countries together.
 In 2012, Cerebral Palsy Alliance created World
Cerebral Palsy Day on October 6. The day aims to
ensure that children and adults with cerebral palsy
have the same rights, access and opportunities as
rest of the world.

INDIAN CEREBRAL PALSY DAY
 3rd October, every year
 In remembrance of Dr Perin K Mulla Feroze, a lady
doctor from Mumbai.

CEREBRAL PALSY DAY
 There are many different ways you can spread
cerebral palsy awareness. One of the most popular ways
to show your support for National
Cerebral Palsy Month is to wear
the colour green
 Green is commonly associated with
new life, growth, and nourishment, which seems fitting
given the nature of cerebral palsy. Cerebral palsy
manifests in childhood, and is often the result of serious
birth injuries

THEME OF CP DAY-2023
 The theme for the day is #MillionsOfReasons – as
cerebral palsy affects more than 17 million people
worldwide, there are millions of reasons to support the
day and make your voice heard on October 6.
 World Cerebral Palsy Day is a movement of people with
cerebral palsy and their families, and the organisations
that support them, in more than 75 countries.
 The World Cerebral Palsy Day vision is to ensure that
children and adults with cerebral palsy have the same
rights, access and opportunities as anyone else in our
society.

TODAY…
 Quick facts about cerebral palsy (CP)
 Definition
 Causes of CP
 Risk factors
 Classification
 Diagnosis
 Assessments
 Treatment and Management
 F-words in CP Management

QUICK FACTS
 CP is the most common physical disability in childhood
CP occurs in approximately 1 in 400 live
Births worldwide
 It is caused by an injury to the developing
brain, which mostly happens before birth
 There is no single cause but researchers
have identified a number of factors that may
lead to the brain injury
 Babies can now be diagnosed as at ‘high
risk of CP’ at three months of age or even before
 There are many evidence-based interventions
for CP and new international clinical guidelines will soon
be available.

CEREBRAL PALSY
Cerebral palsy (CP) is a physical disability that affects
movement and posture
 CP is an umbrella term for a group of disorders that affects a
person’s ability to move
 CP is due to damage to the developing brain before, during or
after birth
 CP affects people in different ways. It can affect body
movement, muscle control, muscle coordination, muscle tone,
reflex, posture and balance.
 Although CP is a permanent life-long condition, some of these
signs of cerebral palsy can improve or worsen over time
 People who have CP may also have visual, learning, hearing,
speech, epilepsy and intellectual impairments.

THE CLINICAL PICTURE
OF A PERSON AS A WHOLE

DEFINITION
 Cerebral palsy describes a group of permanent disorders
of the development of movement and posture causing
activity limitation that are attributed to non-progressive
disturbances that occurred in the developing fetal or
infant brain.

DEFINITION
 The motor disorders of cerebral palsy are often
accompanied by disturbances of sensation,
perception, cognition, communication and behavior,
by epilepsy, and by secondary musculoskeletal
disorders”

CEREBRAL PALSY
Three part definition:
A disorder of movement and Posture caused by a non-progressive
Injury to the immature brain
Change in muscle tone and posture, both at rest and with voluntary
activity.
First year or two of life – included in most definitions
Upper age limit of post-natal brain insult- unclear

HISTORY
 Dr. Little was the first person who identified cerebral palsy. CP
was earlier known as little diseases
 It is not widely known that Sigmund Freud (1889) was the
leading European authority on CP of the late 19th Century. He
authored three Monographs on CP in the 1890’s.
 Freud was the first to point out that prematurity and birth
asphyxia might reflect a fetus already damaged in-utero
 Even less well known is that William Osler wrote the only
19th century monograph on CP published in the US
 Osler’s special interest was in clinical expression and brain
pathology

CP is classified in many ways to
understand and deal the condition
Based on the site of insult to the brain
Based on involvement of body parts
Based on severity of the damage to
the brain
10/6/2023
16
CLASSIFICATION / TYPES OF CP

Spastic Rigidity
Dyskinetic Floppy
Ataxia Mixed

10/6/2023
17
CLASSIFICATION
BASED ON SITE OF INSULT OF THE BRAIN

Quadriplegia
Triplegia
Diplegia
Hemiplegia
Monoplegia
10/6/2023
18
CLASSIFICATION
BASED ON INVOLVEMENT OF BODY PARTS

Mild
Moderate
Severe
Profound
10/6/2023
19
BASED ON SEVERITY OF THE CONDITION

Spastic hemiplegia CP
Spastic diplegia CP
Spastic quadriplegia CP
Spastic triplegia CP
Spastic monoplegia CP
10/6/2023
20
DIFFERENT FORMS OF CP

Dystonic CP
Athetoid CP
Ataxic CP
Hypotonic CP
Mixed CP
10/6/2023
21
DIFFERENT FORMS OF CP

ADVANCE CLASSIFICATION
Based on involvement of body parts
Bilateral CP
Bilateral Symmetrical CP
Bilateral Asymmetrical CP
Unilateral CP
Unilateral Symmetrical CP
Unilateral Asymmetrical CP

ADVANCE CLASSIFICATION
Based on Functional Ability
 Gross Motor Level- GMFCS (5 Functional Level)
 Mobility Level-FMS (5 Functional Level)
 Manual Ability Level-MACS (5 Functional Level)
 Visual Ability Level-VFCS (5 Functional Level)
 Communication Ability Level- CFCS (5 Functional Level)
 Feeding Ability Level- EDACS (5 Functional Level)
Lowest Ability to Highest Ability
 Level-5: Lowest Ability Level
 Level-1: Highest Ability Level

General Features
Infantile hemiplegia is a movement defect of one side of
the body only, either the right side or the left. The
disability is not always uniform. In the typical spastic
form in the older child, the following patterns are seen.
 The upper limb is held with the arm adducted and
internally rotated,
 The forearm flexed and pronated, the wrists flexed, and
the fingers flexed with the thumb pressed into the palm.
10/6/2023
24
CP SPASTIC HEMIPLEGIA

10/6/2023
25
CP SPASTIC HEMIPLEGIA

Symmetrical or near symmetrical involvement
the legs are more involved that the arms.
The hips knees and ankles may flex and the child
can sit in the tailor position on the base of his
spine.
The arms may be mildly, moderately or severely
affected.
Very mild cases of spastic diplegia may involve
the legs and feet only. There may be a tendency
to walk in planter flexion only.
10/6/2023
26
CP SPASTIC DIPLEGIA

10/6/2023
27
CEREBRAL PALSY SPASTIC DIPLEGIA

These children show asymmetrical involvement; and
the arms are more involved than the legs.
The arms may be mildly, moderately or severely
affected. If the arms are moderately affected, one
hand is better than the other because the child will
use one hand for play.
10/6/2023
28
CP SPASTIC TRIPLEGIA

10/6/2023
29
CEREBRAL PALSY SPASTIC TRIPLEGIA

These children show symmetrical or near symmetrical
involvement; and the arms are more involved than the
legs.
Both hands are severely involved and he finds
difficulty in feeding himself and playing with toys.
If a child with spastic quadriplegia is maintained in
one position for the greater part of the day,
particularly if it is a flexed posture, he may develop
flexion contracture in muscles and in the capsules of
joints. Severe deformities and joints dislocations can
result.
10/6/2023
30
CP SPASTIC QUADRIPLEGIA

10/6/2023
31
CP SPASTIC QUADRIPLEGIA

Dystonia is a movement disorder in which
involuntary sustained or intermittent muscle
contractions cause twisting and repetitive
movements, abnormal postures, or both.
Dystonia in cerebral palsy (CP) presents as
hypertonia, involuntary postures and movements, or a
combination
10/6/2023
32
CP DYSTONIA

10/6/2023
33
CEREBRAL PALSY DYSTONIA

Athetoid cerebral palsy is a type of cerebral
palsy characterized by athetosis, or uncontrolled
movements. This lack of control usually causes a
person with athetoid cerebral palsy to make erratic
movements, especially when the person is in motion.
10/6/2023
34
CP ATHETOSIS

10/6/2023
35
CEREBRAL PALSY ATHETOSIS

Ataxia is the least common form of cerebral
palsy. Ataxia means 'without order' or
'incoordination'. Ataxic movements are characterized
by clumsiness, imprecision, or instability. ...
Ataxia causes an interruption of muscle control in the
arms and legs, resulting in a lack of balance and
coordination.
10/6/2023
36
CP ATAXIA

10/6/2023
37
CEREBRAL PALSY ATAXIA

Hypotonia is diminished muscle tone. The infant or
child with hypotonic cerebral palsy appears floppy -
- like a rag doll.
In early infancy, hypotonia can be easily seen by the
inability of the infant to gain any head control when
pulled by the arms to a sitting position (this symptom
is often referred to as head lag).
10/6/2023
38
CP HYPOTONIA

10/6/2023
39
CEREBRAL PALSY HYPOTONIA

Rigidity – is not seen in cases of cerebral palsy
caused by prematurity; however it is a common
feature in cerebral palsy caused by anoxia, such as in
near drowning. Muscles that have rigidity feel heavy
and like “a lead pipe” when they are moved passively.
10/6/2023
40
CP RIGIDITY

Mixed cerebral palsy is a developmental disorder
caused by brain damage that takes place before,
during or shortly after birth. Those diagnosed
with mixed CP have damage to the motor control
centers in several parts of their brain.
10/6/2023
41
MIXED CP

10/6/2023
42
CEREBRAL PALSY MIXED

The exact cause is unknown but it is believed that
C.P occurs during pregnancy when the brain gets
damaged or is underdeveloped.
10/6/2023
43
CAUSES OF CEREBRAL PALSY

Cerebral palsy (CP) is the result of a combination of events either
before, during, or after birth that can lead to an injury in a baby’s developing
brain
 There are multiple causes of CP –but a series
of ‘causal pathways’, i.e.
a sequence of events that combine to cause
or accelerate injury to the developing brain.
 About 45% of children diagnosed with CP
are born prematurely
 For most babies born at term with CP, the
cause remains unknown
 Only a small percentage of CP is due to
complications at birth (e.g. asphyxia or lack
of oxygen).

 Variety of perinatal, prenatal, and postnatal factors
contribute, either singly or multifactorily to CP.
 Commonly thought to be due to birth asphyxia; now
known to be due to existing prenatal brain
abnormalities.
 Premature delivery is the single most important
determinant of CP.
 In 24% of cases, no cause is found.
10/6/2023
45

 Multifactorial but in most cases is unknown.
 Sometime Neuro-imaging may be entirely
normal.
 An increasing amount of literature suggests
a link between various prenatal, perinatal,
and postnatal factors and CP
 Prenatal factors play a significant role in the
etiology of CP.
10/6/2023
46

• This disorder affects the Cerebrum. which
controls voluntary movement
• such as thinking and emotions.
• The cerebral motor cortex
• (at the back of the frontal lobe)
• is usually damaged also.
• Cerebral Palsy may occur due to the damage of
white matter (brain tissue).
10/6/2023
47
WHERE/HOW ?

RISK FACTORS
Risk factors do not cause CP. However, the
presence of some risk factors may lead to an
increased chance of a child being born with
CP.
Some risk factors for cerebral palsy have been
identified. These include:
 premature birth (less than 37 weeks)
 low birth weight (small for gestational age)
 blood clotting problems (thrombophilia)
 an inability of the placenta to provide the developing foetus with oxygen
and nutrients
 bacterial or viral infection of the mother, foetus or baby that directly or
indirectly attacks the infant’s central nervous system
 prolonged loss of oxygen during the pregnancy or birthing process, or
severe jaundice shortly after birth.

General
 Gestational Age < 32 weeks
 Birth Weight < 2500 Grams
Maternal History
 Mental Retardation
 Seizure disorder
 Hyperthyroidism
 Two or more fetal loss
 Sibling with motor deficits
10/6/2023
49
RISK FACTORS ASSOCIATED WITH CP

During Gestation
 Twin gestation
 Fetal growth retardation
 Third Trimester bleeding
 Premature Placental Separation
 Choionitis
 Increased urine protein excretion
 Low placental weight
10/6/2023
50

 Fetal Factors
 Abnormal fetal presentation
 Fetal malformation
 Fetal bradychardia
 Neonatal Seizures
10/6/2023
51

DIAGNOSIS
CP can sometimes be diagnosed early, so
interventions can start as soon as possible
Babies can now be assessed as being at ‘high risk of cerebral palsy’ as
early as 3-5 months of age.
The most sensitive tools are:
 General Movements Assessment in babies <20 weeks (corrected) - 95%
predictive
 Neuroimaging
 Hammersmith Infant Neurological Assessment (HINE) - 90% predictive
See CP: Diagnosis and Treatment poster at www.worldcpday.org

DIAGNOSIS (CONT)
 Diagnosis Making for CP

DIAGNOSIS (CONT)
 Assessing Motor Development
Assessing Motor Development

DIAGNOSIS (CONT)
 Neuroimaging

DIAGNOSIS MAKING
Cerebral Palsy is a complex disorder so diagnosis
making is always difficult. There is no specific test
which can confirm the presence of CP.
CP is diagnosed through observations, assessments
and clinical investigations.

DIAGNOSIS MAKING
Delayed milestones, mostly with gross motors and
fine motors
Persistence of primitive reflexes
No evidence of progressive disease / No loss of
milestones achieved previously

DIAGNOSIS MAKING
There is motor delay- variation by more than 50%
with abnormal movements and poor postural control
A child with CP may have a combination of
associated disorders such as Epilepsy, Visual deficits,
Hearing Deficits, Drooling, Feeding problems, Poor
Cognition, Poor speech, etc

DIAGNOSIS MAKING
 Observation and documentation ( Videography)of
the child while the child is in static, dynamic and
transitory postures during play, etc
 Documenting medical history starting from
pregnancy. Medical issues related to prenatal,
perinatal and postnatal to establish a good scientific
basis of the diagnosis

DIAGNOSIS MAKING
 Getting X-rays or Ultrasound (Skull / Hips / Spine),
 Getting MRI / CT scan of the Brain / Spine
 Getting EEG -to rule out epileptic syndrome

DIAGNOSIS MAKING
 Getting Blood Tests -to rule out other diseases
 Getting Chromosomal Study -to rule out genetic
disorder
 Getting Vision Test, Hearing Test, etc to have a
baseline

ASSOCIATED IMPAIRMENTS
 Children with CP may also have a range of physical
and cognitive impairments
 Children with CP always have some or the other
associated disorders
 In a recent study of 100 Children with CP, 34
associated disorders has been found.
 Lesser the number of comorbid conditions-
better the prognosis

ASSOCIATED DISORDERS
 All children with CP have some or the other associated
problems. There are three types of co morbidities have
been identified. The three co morbidity categories are
cocausal, complications, and co‐occurring.
 Cocausal: Disorders caused by the same injury to the
developing brain that caused CP (i.e. epilepsy and
cognitive impairment)
 Complications: Disorders that are complications of the
main CP condition (i.e. scoliosis and hip dislocation)
 Co‐occurring: Disorders not caused by the injury to the
developing brain, nor are complications of the main CP
condition

ASSOCIATED DISORDERS
In actual sense these associated factors are
considered the basis of prognosis (outcomes from the
treatment). Coping with these disabilities may be
even more of a challenge than coping with the motor
impairments of cerebral palsy. There is a common
saying “Lesser the number of associated
problems-more the chances of better future”.

EPILEPSY / SEIZURES / CONVULSIONS
 Children with CP can have focal / partial
seizures, generalized seizures, petit mal /
absence seizure, myoclonic seizure, tonic-
atonic seizure (drop attacks), etc

Management / Treatment Options
 Medicinal Treatments- Anti-epileptic Drugs
(AED) based on the types of seizure
 Neuro-surgery to remove the part of the brain
responsible for the seizures (lobotomy)
Vagus Nerve Stimulation
Ketogenic-a special diet, etc

VISUAL IMPAIRMENTS-EYE PROBLEMS
Children with CP may have cerebral visual
impairment (CVI), Eye Visual Impairment,
Strabismus, Poor visual acuity (Myopia or
Hypermetropia), Nystagmus, Lazy eye, etc
Treatment / Management options
Visual Aids-Spectacles
Eye Surgery
Vision therapy

HEARING IMPAIRMENTS / DEFICITS
Children with CP may have hearing loss (conductive
hearing loss, sensorineural hearing loss),etc
Treatment / Management Options
 Hearing aids
 Surgeries to correct malformation or injuries
 Cochlear implant
 Auditory Training, etc

SPEECH IMPAIRMENTS
Children with CP can have problems such as
aphasia, dyspraxia, dysprosody , dysarthria,
stuttering, dysphagia, resonance disorders, etc
 Use of Bliss Board
 Speech and language therapy, etc

FEEDING DISORDER
Very common problems in the form sucking
difficulties, swallowing difficulties, chewing difficulties,
drooling etc
 Combination therapy
 Nutritional modifications
 GERD is managed with medication

DROOLING-EXCESSIVE PRODUCTION OF
SALIVA (SIALORRHEA)
Drooling can be in the form of posterior drooling or
anterior drooling
1. Optimizing positions and conditions
2. Oro-motor and oro-sensory therapies
3. Behavioral therapies
4. Oral appliances
5. Anti-cholinergic agents
6. Botulinum toxin Injections
7. Surgical intervention

MENTAL RETARDATION-INTELLECTUAL DISABILITY-
LOW INTELLIGENCE-LOW COGNITION
33% children with CP may have low / subnormal
cognition or poor mental ability. They have average or
lower than average IQ.
 Medications
 Occupational therapy
 Cognitive therapy
 Special Education
 Vocational / Life Skills training

BLADDER RELATED ISSUES
Children with CP have urinary incontinence or
enuresis, Urinary infections, and indication issues
 Medicinal Management-
 Specialized Exercises- Kegel Exercises
 Toilet Training Program

BOWEL RELATED ISSUES
Incidence: 40% to 57% children with CP may have
bowel related issues
 Medications
 Physical therapy

CONSTIPATIONS
Incidence: Around 74% children with CP have
constipation
1. Encourage foods that contain fibres
2. Encourage a good intake of Fluids
3. Limit the period of idle sitting
4. Encourage to change posture regularly
5. Assist with medications to maintain good bowel
habit

DENTAL PROBLEMS
More than 50% children with CP have Dental
problems in the forms of, mal-alignment of the upper
and lower teeth, excessive gagging, gingivitis due to
seizure medications, etc
 Dental care
 Oral hygiene, etc

FAILURE TO THRIVE
Incidence: as many as 33% - 40% children with CP
may have failure to thrive situation
Failure to thrive is a condition which is considered in
children who are consistently underweight.
Management / Treatment Options
 Special Diet-Nutritional supplements
 Managing other medical conditions

OBESITY
There is worldwide tendency of increasing prevalence
of obesity in children.
 Diet Modification
 Weight reduction program

POOR MUSCLE GROWTH
Incidence: Very common in hemiplegic Cerebral
Palsy
 Nutritional supplements-Protein rich food
 Activity oriented exercises, etc

BREATHING PROBLEMS
Incidence: Children with cerebral palsy are very prone
to respiratory complications like upper respiratory
infections (URTI), aspiration, and pneumonia.
Breathing difficulties have been seen due to spinal
curvature (scoliosis)
 Symptomatic medications
 Breathing exercises

VISUAL -PERCEPTION IMPAIRMENTS /
PERCEPTUAL DISORDER
Incidence: About 50% Children with CP may have
visuo-perceptual disorders
 Ophthalmological support
 Vision therapy
 Occupational therapy
 Special education, etc

DELAYED MATURATION
Incidence: Very rare. Sometimes puberty begins
earlier but ends later in white children with CP,
compared with general population
 Symptomatic medical and surgical management
 Transitional Management
 Sex education, etc

ABNORMAL SENSATIONS-SENSORY LOSS
Incidence: Rare, mostly with hemiplegic CP
 Medications
 Physical therapy
 Occupational therapy, etc

SENSORY DYSFUNCTION
Incidence: Around 40% children may have sensory
dysfunction
 Sensory Integration therapy

HYDROCEPHALY (WATER IN THE BRAIN)
Incidence: Around 17.3%.
 Symptomatic medical management
 Need based surgical procedures, insertion of
shunt, Endoscopic third ventriculostomy,

MICROCEPHALY (SMALL SIZE HEAD)
Incidence: Lot children with cerebral palsy may have
Microcephaly. Around 26.5%
 Regular monitoring
 Surgery may be helpful if there is craniosynostosis

SKIN DISORDERS
Incidence: Skin infection and irritation is very common
in CP
 Symptomatic treatment
 Personal hygiene
 Skin care, etc

BEHAVIORAL ISSUES
Incidence: 1 in 4 children with CP have behavioral
disorders.
 Behavioral therapy-ABA, BMT, CBT, etc
 Medications

CONGENITAL HEART DISORDER
Incidence: Very rare. Commonly PDA
 Symptomatic medical and surgical treatments

HORMONAL IMBALANCE
Incidence: Poor growth or delayed puberty due to
multiple pituitary hormone deficiency hormone
deficiency (MPHD)
 Hormonal Therapy

SLEEP DISTURBANCE
Incidence: Difficulty in initiating and maintaining
sleep, sleep wake transition, sleep breathing
disorders, sleep bruxism, excessive day time
sleeping, nightmares and sleep talking , etc
 Modification environment like light system,
temperature and bedding used for the child
 Maintaining sleep diary and diet modification
 Medications, etc

PAIN
Incidence: Pain is very common with children with CP.
Adults are more prone to pain due to poor postures
and joint immobility
 Medications- Antispasmodic medications,
Anticholinergic drugs
 Botox Injection
 Muscle massage, acupuncture, ice packs and heat
therapy, hydrotherapy, and cognitive behavioral
therapy.

ISSUES WITH SECONDARY SEXUAL
CHARACTERS
Incidence: Very common with severely affected adults
 Sex education
 Behavior therapy
 Medications, etc

PSYCHOLOGICAL ISSUES
Incidence: Mental health and psychological
problems, in the forms of depression, anxiety and
conduct disorders, generally triggered by pain,
discomfort or sleep disturbances.
 Psychotherapy
 Medications

www.worldcpday
ASSOCIATED IMPAIRMENTS
Children with CP may also have a range of physical and
cognitive impairments
1 in 4
is unable to walk
1 in 4
is unable to talk
3 in 4
experience pain
1 in 4
has epilepsy
1 in 4
has a behaviour
problem
1 in 2
has an
intellectual
disability
1 in 10
has a severe
vision
impairment
1 in 4
has bladder
control problems
1 in 5
has a sleep
disorder
1 in 5
has saliva control
problems

Team Members
Family
Medical Management Team
Habilitation Service Providers
Life Cycle Approach
Birth to one year
One year to 3 years
Three years to 6 years
Six years to 13 years
Thirteen years to 18 years
Above 18 years
MANAGEMENT AND TREATMENT TEAM

Screening Team
Neonatologist
Child Specialist
Developmental Pediatrician
Medical Diagnosis Making and Medical Management Team
 Pediatric Neurologist
 Pediatric orthopedic Surgeon
 Pediatric Eye specialist
 Pediatric ENT Specialist
 Pediatric Cardiologist
 Pediatric Gastroenterologist

MULTIDISCIPLINARY MANAGEMENT TEAM

Pediatric Nephrologists
Genetic Specialist
Pediatric Dietitian-Nutritionist
Pediatric Endocrinologist
Pediatric Immunologist
Pediatric Physiatrist
Pediatric Plastic Surgeon
Pediatric Pulmonologist

Habilitation Team
 Neonatotherapist
 Early Intervention Specialist
 Developmental Therapy Specialist
 Pediatric physiotherapist
 Pediatric Occupational Therapist
 Special Educator
 Speech and language Pathologist
 Psychologist / Behavior Therapist
MULTIDISCIPLINARY MANAGEMENT
TEAM

Habilitation Team
 Pediatric Optometrist
 Pediatric Hearing Aids Technician
 Postural Aids Specialist
 Orthotician
 Mobility Aids Specialist
 Adaptive and assistive Aids Technician
 Apps and Games designers

MANAGEMENT APPROACHES
 Multidisciplinary
 Interdisciplinary
 Trans disciplinary

Thorough and accurate assessment of children with cerebral palsy by a
multidisciplinary team is essential to ensure chosen interventions meet
the child’s needs.
Most assessments measure a particular aspect of the child’s life. It can
be Physical, Communication, Social-emotional or cognition
The World Health Organization's International Classification of
Functioning, Disability and Health (ICF) has been used to guide
assessment.
The ICF domains include body function and structure, participation,
activity and personal and environmental factors.
ASSESSMENTS OF CEREBRAL PALSY

INTERNATIONAL CLASSIFICATION OF
FUNCTIONING, DISABILITY AND HEALTH

Standardized assessments and outcome
measures may be relevant to one or more
domains of the ICF.
A significant number of assessments are
available and it is often necessary to use a
combination of these.

Selection of assessment tools should be based
on purpose, psychometrics and those most
relevant to the area/s of difficulty.
The functional ability classification scales
should be used to guide assessment and
intervention with all children diagnosed with
cerebral palsy to facilitate communication and
goal setting.

 Communication
 ADL
 Mobility
 Ambulation
ICF MODEL OF INTERVENTION FOR HABILITATION

Further assessment should occur to ensure
realistic goal setting, provide a baseline for
intervention and for evaluation of intervention
programs.
ASSESSMENT GUIDELINES

 History and observation
 Assessment of reflexes and reactions
 Assessment of functional level and motor
development
 Assessment of muscle tone
 Assessment of muscle strength
ASSESSMENT PROTOCOLS

 Assessment of musculoskeletal system deformities
 Assessment of physical fitness
 Assessment of gait
 Assessment of balance
 Assessment of trunk impairment

 Assessment of health-related quality of life
 Assessment of activities of daily life
 Assessments of upper extremity
 Cognition / Psychometric Assessments
 Speech and Communication Assessments

Detailed information should be received from the
family or caretakers in all issues related to the
children including
 Family history
 Prenatal, natal and postnatal period
 Chronologic and corrected age
 Associated problems
 Developmental story
 Adaptive equipment used
 Intervention approaches applied
 Medication taken
 Family Profile
HISTORY AND OBSERVATION

 Observational analysis is crucial to determine
children’s functional skills, spontaneous motions
and motion strategies, and the underlying
fundamental problems. Thus, it can be decided in
which field detailed assessment needs to be carried
out.
 During observational analysis, children must be in a
setting they can be with their family, and they can
feel comfortable and safe.

 There should be various toys and materials in the
setting to reveal the children’s capacity and to draw
their attention.
 The assessment room should not be crowded and
noisy . Video recordings during observation are
rather beneficial as well.

 Observation of reflexes is important to illustrate the
severity of the influence in the nervous
system, and observation of balance and protective
reactions is important to support motor
developmental process.
 When these assessments are carried out, the
corrected age of the children should be considered.
It is known that primitive reflexes continue
insistently or disappear later than normal or never
occur in children with CP.
ASSESSMENT OF REFLEXES AND
REACTIONS

 It can be observed that symmetric tonic and
asymmetric tonic neck reflexes still continue in
adolescent stage in a case diagnosed with
dyskinetic-type CP.
 Insistence of these reflexes can complicate the
therapy. It may be necessary to make various
adaptations in the treatment program when the
primitive reflexes continue in advanced ages.
 At the same time, the assessment of protective
reactions is important for determining a treatment
program
ASSESSMENT OF REFLEXES AND
REACTIONS

 It is crucial to assess motor development, functional
skills, and activity limitations for determining the
current state of the children, and there are
frequently used test batteries for this purpose.
 Gross Motor Function Measurement (GMFM)
is a standardized measurement instrument
frequently used to measure the change in gross
motor function.
ASSESSMENT OF FUNCTIONAL LEVEL AND MOTOR
DEVELOPMENT

Gross Motor Function Classification System
(GMFCS)
The Gross Motor Function Classification System
(GMFCS) is a five level classification that describes
the gross motor function of children with cerebral
palsy on the basis of their self-initiated movement
with particular emphasis on sitting, walking, and
wheeled mobility.
FUNCTIONAL MOTOR ABILITY

(GMFCS) Levels
Level-I: Walk independently
Level-II: Walk independently with limitations
Level-III: Use assistive devices such as elbow crutches or
walking frames
Level-IV: Require a wheelchair but may have some form of
independent mobility such as a powered wheelchair or
may assist with transfers
Level-V: Require a wheelchair and are fully dependent in
their mobility
GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM

The Functional Mobility Scale (FMS) has been
constructed to classify functional mobility in
children 4 to 18 years, taking into account a
range of assistive devices a child might use
over three distances: five meters (in and around
the home), 50 meters (in and around (School
/preschool) and 500 meters (in the community).
The FMS is sensitive to detect change after
Specialized interventions.
FUNCTIONAL MOBILITY SCALE (FMS)

Level-I: Handles objects easily
Level-II: Handles most objects but with reduced
speed and/or quality
Level-III: Has some difficulty and needs help to
modify or prepare activities
Level-IV: Handles a limited selection of easily
managed objects in adapted settings
Level-V: Does not handle objects
UPPER LIMB CLASSIFICATIONS
MANUAL ABILITY CLASSIFICATION SYSTEM (MACS)

 Communication is simply the act of transferring
information from one place, person or group to
another.
 Every communication involves (at least) one
sender, a message and a recipient. This may sound
simple, but communication is actually a very
complex subject.
COMMUNICATIONS

 Speech is human vocal communication using
language. Each language uses phonetic
combinations of vowel and consonants sounds that
form the sounds of its words
 Speech disorders affect a person's ability to
produce sounds that create words. ...
 Types of speech disorder include misarticulation,
apraxia, and dysarthria. There are many possible
causes of speech disorders, including muscles
weakness, brain injuries, degenerative diseases,
autism, and hearing loss.
SPEECH

SPEECH AND COMMUNICATION THERAPY

Level-I: Effective sender and/or receiver with familiar and
unfamiliar partners
Level-II: Effective but slower paced sender and/or receiver
with familiar and unfamiliar partners
Level-III: Effective sender and/or receiver with familiar
Partners
Level-IV: Inconsistent sender and/or receiver with familiar
partners
Level-V: Seldom effective sender and/or receiver even
with familiar partners
COMMUNICATION CLASSIFICATION
COMMUNICATION FUNCTION CLASSIFICATION SYSTEM-
CFCS

Level-I
An effective communicator in most situations
Can independently communicate a wide
variety of messages/topics to familiar and
unfamiliar people in most environments
FUNCTIONAL COMMUNICATION CLASSIFICATION SYSTEM
(FCCS)

Level-II
An effective communicator in most situations, but does need
some help
Can communicate a variety of messages/ topics to familiar
people but may experience some difficulties with unfamiliar
people/topics and environments and may need prompts, such
as, prompt questions, repetitions (to make themselves
understood) and loudness
An AAC user who requires assistance with set up,
and/or programming; and whose listener may need some
assistance with orientation/ interpretation of AAC strategies
(FCCS)

Level-III
An effective communicator in some situations.
Can communicate a small range of messages/ topics to
most familiar people
Effective communicator with familiar people and
activities and in familiar settings about their needs and
wants, and things that are happening but require
assistance with unfamiliar people/topics and
environments
Relies on a familiar communication partner to interpret
AAC or speech attempts, and to prepare, set up and
support communication
(FCCS)

Level-IV
Assistance is required in most situations, especially
with unfamiliar people and environments.
Communicates daily/routine needs and wants with
familiar people
Can initiate and attract attention but needs a familiar
person who is familiar with their routine, recent
/significant experiences and likes and dislikes, and to
interpret their communication
Responds to familiar voices, sounds and routines using
body movement, facial expression and vocalisation
(FCCS)

Level-V
Communicates unintentionally with others, using
movement and behavior
Daily/routine needs and wants are interpreted
by familiar people from observation of the
individual’s emotional state, body movement
and behavior
Needs full assistance from a familiar person to
observe, interpret movements and behaviors,
anticipate, and problem solve based on their
experience, training and observation
(FCCS)

 Academic Performance
 Adaptive Delay or Impairment
 Capacity to Learn/Learning Impairments
 Communication Level
 Emotional Status
 Health
 Intelligence
 Motor Abilities
 Social Ability
 Vision and Hearing
SPECIAL EDUCATION ASSESSMENT

 The assessments help to allocate the following
service and supports to accommodate, modify or
adapt a child’s needs:
 Program Modifications
 Related Services
 Special Accommodations
 Specially Designed Instruction
 Supplementary Aids
 Adapted Equipment
 Adapted Materials
 Assistive Technology
 Augmentative Communication Devices

 The assessment of cognitive functioning is often
challenging in students with motor impairment because
the majority of tests require verbal and motor responses
 A careful consideration of the level of motor,
communication, and/or visual or visual perception
impairment in students with CP and motor impairments
can inform assessors on the choice of cognitive
assessment battery to use
 The use of Assistive Technology, together with
alternative response modes (e.g., partner assisted
scanning) is encouraged to enable access to
standardized cognitive assessment.

For students with significant motor impairments for
whom standardized cognitive assessments are not
appropriate, the use of developmental scales, which
assess progress along a continuum rather than
providing comparative performance data with peers,
may be an appropriate alternative

 For students with severe motor impairments, it is
important to conduct a functional skills assessment.
 A functional skills assessment targets the skills
needed in a given environment and activity, and
includes measures of social and adaptive
functioning with a focus on basic life skills.
 It focuses on practical independent living skills. It
also considers students’ functioning in their
environments, and examines the process of
learning and performance.

 Based on the results of the assessment, intervention techniques
are implemented and evaluated on a regular basis
 The following test accommodations are helpful in supporting
students with significant motor impairments so as to obtain the
best responses during the assessment session
 Body positioning is of specific relevance to students with
significant motor impairments. Students should be positioned in a
way that facilitates the support of the trunk and independent use
of the arms and hands. This can be done via the use of an
Adaptive Seating System.
 Appropriate positioning can reduce pain, permit better fine motor
function, facilitate attention, reduce fatigue, and promote
improved social interaction, thereby optimizing performance.

 Students should be allowed to use assistive
technology such as Augmentative and Alternative
Communication (AAC) devices to enhance their
functional communication.
 Information on the student’s communication style
and modality should be determined before
assessment. It may be helpful to involve the family,
caregivers and therapists who work closely with the
student to assist in understanding the student’s
responses.

TREATMENT AND MANAGEMENT
Treatment
Medicines / Drugs
Antispastic
Anti-Epileptic
Anti-drooling
GERD
Constipation
Chemodenervation
Phenol
Botox

Orthopedic Surgery
STR
SEMLLARS
OSSCS
Ilizarov
Percutaneous

Use of Implants
Use of Intrathecal Baclofen Pump
Use of Deep Brain Stimulation
Use of VP Shunt
Use of Neurosurgery
Selective Dorsal Rhizotomy
Gamma Knife Surgery

Use of Regenerative Medicines
Hyperbaric Oxygen Therapy
Stem Cell Therapy

Complementary and Alternative Medicines
Homeopathy
Unani
Ayurveda
Herbal
Acupuncture
Chinese Medicines
Acupressure
Magneto therapy
Nutritional Therapy

Management
Habilitation and Rehabilitation Services
1. Infant Stimulation Therapy
2. Early Intervention
3. Play Therapy
4. Developmental Therapy
5. Physiotherapy
6. Occupational Therapy
7. Speech Therapy
8. Cognitive Therapy / Special Education
9. Behavioral Therapy
10. Assistive Technology

THANK YOU ALL
For More Information, Please contact me at
Institute for Child Development
C-27, Malviya Nagar
New Delhi-110017
Landline Number: 011-41012124
Mobile / Whatsapp Number: 7838809241
Mail ID: helpicd@gmail.com
Website: www.icddelhi.org

Cerebral Palsy Day-23.pptx

Recommended

Recommended

More Related Content

Similar to Cerebral Palsy Day-23.pptx

Similar to Cerebral Palsy Day-23.pptx (15)

Recently uploaded

Recently uploaded (20)

Cerebral Palsy Day-23.pptx