This are notes abouts cerebral palsy ..Read and make note ..its all about believing in yourself

1. BY JOHN MBAWA

2. Definition
 Also called little's disease
 It is a broad term usually to describe a number of non-
progressive motor disorders resulting from prenatal,
perinatal, and postnatal
 CNS damage usually occur before 5 years of life
 It is characterized by impaired voluntary movement
 Cerebral palsy is not a specific disease but a group of
disorders of valid causes

3. Incidence
 Occurs in about 0.1 – 0.2% of all children
 Incidence is higher in pre-matures and
small for gestation age

4. Etiology
 It is hard to establish
 Common associated factors includes
 Birth trauma
 Asphyxia neonatorum
 Neonatal jaundice
 Sever systemic disease e.g. meningitis
 Sever dehydration
 CNS trauma
 In utero disorders e.g. congenital malformations of
the brain

5. Pathology
 Usually cerebral atrophy with cavity
formation
 Also atrophy of Basal ganglia leading to
rigidity and extrapyramidal movements
 The brain is usually reduced in weight

6. Clinical manifestations
 Classified according to nature of observed
motor deficit;
a) Spastic type
b) Athetoid type
c) Ataxic type
d) Mixed type

7. 1.Spastic type
Presents about 70% of cases.
Usually from upper motor neuron deficit
CLINICAL FEATURES
 Reflex hyper excitability
 Persistent neonatal reflexes e.g.
hyperactivity of grasp reflex (fisting)

8. Clinical features
 Tonic neck reflexes
 Vertical suspension of the infant leads to
arching of the back
 Rigid extension of and abduction of the with
internal rotation of the leg
 In severe cases there is crossing of the legs
(scissoring)

9. Clinical features
 Increased muscle tone
 Brisk tendon reflexes with sustained angle
clonus.
 Toe walking
 Persistent Babinski’s sign after 2
years(extensor plantar response)

10. Clinical features
 Spasticity, rigidity which becomes evident as the
child grows
 Affected limbs are week and affected limbs shows
increased risk of forming contractures
 Pseudo bulbar palsy-which leads to swallowing
difficulty and excessive dribbling of saliva

11. Classification of spastic palsy
May present as;
 Diplegia,
 hemiplegia,
 paraplegia,
 quadriplegia

12. Spastic Diplegia

13. Spastic Diplegia
 The most common type
 Speech / intellect: normal – slightly impaired
 UL : gross motor OK
minor incoordination of fine motor skills
 LL : spastic :
hip: flexion, adduction, int. rotation
knee: flexor / extensor spasticity /or equal
ankle: equinus
foot: pes valgus
 Most walk independently by 4 years

14. Spastic Hemiplegia
 30 % of all CP
 One side affection
upper > lower
extremity
 50 % mentally
retarded
 33 % seizures

15. Spastic Quadriplegia
 All four limbs involved – and
trunk
 Often mentally retarded
 With seizures
 Most ( 80 % ) non walkers

16. 2.ATHETOID
 Also called extrapyramidal or dyskinetic
 Accounts for 20% of he cases
 Usually secondary to basal ganglia
involvement
 Presents with slow rhythm involuntary
movement

17. Clinical manifestations
 It affects the following;
 The extremities
 The proximal part of the limbs
 Arthetoid- when it affects extremities
 Dystonia- when it affects proximal part of the
limbs/trunk
 Chorio form- when it affects extremities with
abrupt jerky distal movements

18. Clinical manifestations
 Dysarthria is present and is usually severe
 Movement are increased with emotional,
tension, and disappear during sleep.

19. 3.ATAXIC TYPE
 Accounts for 10% of all cases
 Usually secondary to cerebrum involvement
or its pathway
 It is common during infancy

20. Clinical features
 Presents with hypotonia
 Reduced tendon reflexes
 Usually by second year patient patients
starts getting retention tremors and ataxia
 That ataxia usually presents with a wide
based gait
 May be associated with mental retardation

21. Associated disorders to all types
 Convulsion usually present in 25% of all
cases and especially in spastic type .
 Strabismus and other facial defects
 Deafness
 Upward gaze in Athetoid patients which
may be commonly caused by kernicterus

22. Associated disorders to all types
 Mental retardation can be severe especially
in spastic quadriplegic type and in mixed
form
 Hemiplegic in quadriplegic type may show
near normal intelligence

23. Diagnosis
 History of predisposing or etiological factors
like asphyxia
 History of neonatal seizure/hypotonia or
hypertonia
 Specific syndromes can only be recognized
at age of 2years

24. Diagnosis cont.
 Before age of 2years the child will show
lagging motor development
 Persistent neonatal reflexes
 Hyper-reflexia
 Altered muscle tone

25. Treatment
 This is a life-long condition
 Cause of treatment is to help patient
develop maximum independence in their
motor and social handicap
 The objective includes;

26. Treatment
1. Physiotherapy
2. Occupational therapy
3. Orthopedic surgery
4. Application of braces
5. Speech therapy

27. Treatment cont.
 With proper management many patients
especially those with spastic hemiplegia and
paraplegia may live almost normal live
 Where it is accompanied by seizures it will
require anticonvulsants therapy
 Many patients may require varying degree of
life-long suspension and assistance that is
life-long process of rehabilitation.

28. Treatment cont.
 Many need schooling training in daily
activities of living likes washing and cooking
 Families of these patients should get
involved in management of these patients

29. Prognosis
 Depends on severity of associated intellectual
handicap
 If the intellectual capacity is good the prognosis will
be good
 Motor handicap child can make good adjustment
 Response of family to handicap availability of adequate
education and therapeutic facilities can modify
prognosis.

30. Thank you