Cerebral palsy is a disorder of movement and posture caused by an injury to the immature brain. It was first described in the 19th century by William Little. Cerebral palsy can be caused before, during, or shortly after birth by factors such as maternal infections, bleeding in the brain, complications at birth, or lack of oxygen. The types of cerebral palsy include spastic, which causes stiffness, flaccid, which causes floppiness, athetoid, which causes fluctuating tone, and ataxic, which causes unsteady movements. Treatment involves physical, occupational and speech therapy as well as medications and sometimes surgery. Prognosis depends on the severity and type of cerebral

1. CEREBRAL PALSY
Presentation prepared by:
Md. Sohel Rana
Clinical Physiotherapist
CRP-Mirpur

2. Historical Background
 WILLIAM LITTLE
– 19TH CENTURY
 Senior physician at the London Hospital
 Founder of the Royal Orthopedic Hospital
– 1853
– 1862 (Obstetrical Society of London)
 Paper entitled “The Influence of Abnormal Parturition,
Difficult Labor, Premature Birth and Asphyxia in
Relation to Deformities”

3. Little’s Disease
 Approx 200 cases
studied
 Outline of
characteristics and
traits
 Causes
 Fundamental approach
to treatment and mgt

4. In the US in Early 1940’s :
Cerebral Palsy

5. Definition (history of)
 PERLSTEIN (1949)
– CP is a condition characterized by paralysis,
weakness, incoordination or any other
aberration of motor function due to pathology of
the motor centers of the brain.
 DENHOFF (1951)
– CP is a condition in which interferences with the
control of the motor system arise as a result of
lesions occurring from birth trauma.

6.  SWARTZ (1951)
– CP is an aggregate of handicaps: emotional,
neuromuscular, sensory caused by damage or
absent brain structures.
 CROTHERS and PAINE (1959)
– A term which covers individuals who are
handicapped by motor disorders which are due
to non-progressive abnormalities of the brain.

7. CEREBRAL PALSY
 A disorder in the movement and posture caused
by an injury to the immature brain.
Movement
Posture
Immature brain

9. Causes/Etiology
 Prenatal causes (before birth)
– Maternal characteristics
 Perinatal causes (at the time of birth to 1mo)
 Postnatal causes (in the first 5 mos of life)

10. Prenatal causes
 Hemorrhage/bleeding
 Infections
 Environmental factors

11. Maternal Characteristics
 Age
 Difficulty in conceiving or holding a baby to term
 Multiple births
 History of fetal deaths/miscarriages
 Cigarette smoking >30 sticks per day
 Maternal alcoholism and drug addiction
 Social status; mother with MR
 Mother’s medical condition

12. Perinatal Causes
 High or low BP
 Umbilical cord coil
 Breech delivery
 Oversedation of drugs
 Trauma i.e. forceps or vacuum delivery
 *** complications of birth

13. Postnatal Causes
 Trauma, head injury
 Infections
 Lack of oxygen
 Stroke in the young
 Tumor, cyst

14. Types of CP
 ** CP depends on the
1. extent of the brain damage
2. which part of the brain is damaged

15. Types of CP
 Spastic CP
– stiffness
 Flaccid SP
– floppy
 Athetoid CP
– Fluctuating tone
 Ataxic CP
– Unsteady; incoordinated
 Mixed CP
– Most common is spastic athetoid

16. Classification of CP
 Topographical Classification (based on the location of the motor disability)
– 1. quadriplegia
– 2. diplegia
– 3. paraplegia
– 4. triplegia
– 5. hemiplegia
– 6. hemiplegia
– 7. monoplegia
– 8. double hemiplegia

17. Perlstein 1949, 1952
 Degree of Severity
– 1. Mild CP
– 2. Moderate CP
– 3. Severe CP

18. 5 CLINICAL SIGNS OF CP
 1. Abnormal tone
 2. abnormal posture
 3. presence of primitive reflexes
 4. delays in motor skills
 5. difficulty in executing movement

19. Associated Clinical Conditions
 Mental retardation
 Seizures
 HI, VI
 Sensory integration problems
 Feeding problems
 Behavioral/emotional difficulties

20. Diagnostic Procedures
 MRI
 CT Scan
 EEG
 Laboratory and radiologic work up
 Physical evaluation
 Interview
 Assessment tools i.e. Peabody
Development Motor Skills, Bruininx

21. Treatment strategies and
interventions
 Physical, occupational, speech therapy
 Special education
 Feeding management
 Orthosis
 Surgery
 Pharmacologic i.e botox injection, anti spasticity
drugs
 Family and patient counseling program
 Vocational and functional training program
 Others: acupuncture, hyperbaric thx, thera suit

22. prognosis

23. “A disabled child has the right to enjoy a
full and decent life, in conditions which
ensure dignity, promote self-reliance and
facilitate the child’s active participation in the
community.”
-UN Convention on the Rights of
the Child. 1989.