Cerebral palsy (CP) is a motor function disorder caused by non-progressive brain lesions occurring before brain maturity, often accompanied by cognitive dysfunction or seizures and varying symptoms over time. Classification of CP includes types based on limb involvement and muscle tone, with assessments focusing on spasticity, range of motion, and psychosocial factors. Treatment strategies vary by age and include physical therapy, adaptive equipment, pharmacotherapy, and surgery, emphasizing a multidisciplinary approach for effective management and future prevention.

1. CEREBRAL PALSY
Prof. V.P.Sharma
M.S.,(Ortho), DNB(PMR), .FACS, FICS, FIMSA, MAMS, PG (Spine-Aus.)
Professor
Deptt. of Physical Medicine & Rehabilitation
K.G. Medical University, Lucknow
16-10-2014

2. CEREBRAL PALSY
• C.P. refers to a disorder of motor function
resulting from a non progressive brain lesion
occurring before the brain is fully mature.
C.P. refers exclusive to the motor dysfunction
May also have – Cognitive dysfunction or
seizures

3. • Lesion is static, symptoms often change with time.
• Eg. Hypotonia to hypertonia
• increasing dystonia with age
• Bony deformities
• Contractures

4. Classification
1. Limbs involved - Monoplegia
Diplegia
Triplegia
Quadriplegia
Hemiplegia
2 Tone - Hypotomia
Spasticity

5. 3 Associated Movement Disorders -
Dystonia
Chorea
Athetosis
Ataxia

6. Assessment of spasticity
• Evaluation of muscle tone
• R.O.M.
• Associated movements disorders
• Psycho Social Assessment

7. Physical and occupational therapy
1. Spastic
– Passive ROM
– Active ROM
– Spinal mobility
– Use of varied and differential movement pattern
incorporating varied speed and directions
– Equipment to aid with weight bearing movement and
position transitions.
– Promotive muscle Elongation as well as joint mobility
& stability

8. Athetoid
• Postural tone and balance
• Promoting midline & Symmetrical muscle control
• Small graded movements
Hypotonic
• Antigravity positioning of head
• Trunk control
• Promoting automatic reactions
• Stabilization of joins

9. Treatment According to age
Infancy and toddler
• Optimal movement patterns and postures during daily
care activities such as feeding, playing , carrying,
toileting and movement.
• Adaptive equipments
• Special strollers
• Bath chairs
• Feeding equipments
• Fist, hand or limbs splints

11. Pre-school-
• Promote skill acquisition for independent function.
• Therapy promotes strength, endurance and
movement patterns.

12. Mobility issues wheel
chairs crutches,
walkers, strollers, car
seats school chairs,
splints and orthotics

13. Schooling
• Architecture
adaptations
• Home modifications
• Installing wheel chair
lifts
• Classroom
accommodations

15. Ambulation

16. Sports

18. Formal Evaluation tools
• Modified ashworth scale (MAS)
• Measure resistance to passive movements in
upper/lower limbs
• Goniometer measurements PROM / AROM
• Gross motor functional measure
• Assess current level of function and provides goal for
treatment.
• Paediatric evaluations of disability inventory.
• Functional skills in the areas of mobility
• Self care
• Social functions
• Strength measurements by dynamometers

19. Facilitation of movement patterns
• Neuro developmental training NDT/ Bobath
• Inhitit abnormal muscle tone and primitive reflaxes
• Facilitate normal movement patterns via postioning and
handling techniques that promote sensation of normal
movement
• Emphasis is on acquiring functional skills
• Weight bearing
• Weight shifting
• Normalizing tone

20. Electrical stimulation
• FES
• Other Therapies
• Strengthening / Stretching
• Serial casting
• Functional Activities
• Dynamic approach repetition of activities by the patient
• Adaptive equipments
• Sealing system
• Walker
• Canes
• Splinting low temperature thermoplastics

21. Oral Pharmacotherapy
• AIM Spasticity
• Associated movement eg. Dystomia
• CNS acting
• Benzodia zepines Diazepam
• Clonazepam
• Lorazepam
• Tizanidine
• Baclofen
• Peripheral - Dantrolene

22. Benzodiazepines
• Acts via inhibitory neuro transmitter GABA in spinal
cord
• Effect- relief in painful muscular spasm
- Improvement in sleep
- Long term muscle tone
- Anticonvulsiant property
• Side effect - Habituation
- Sedation
- Secrctions
- Rebound seizures with abrupt
withdranwal

23. Baclofen
Action on GABA receptor in spinal cord
• Effect Toletrated long term
• Muscle tone / Active Passive
• Side effect - Sedation
- Truncal hypotomia
- Change in bladder habits

24. Clonidine quanfacine Tizanidine
• Effect- Aplha 2 adrenergic effects
- Anti hypertensive
- Treat movement disorder & eg tics

25. Dantrolene
• works directly on the sarcoplasmic reticulum of
muscle and is effective in decreasing muscle tone
• Side effect - Muscle weakness
- GI upset, fatigue
- Hepato Toxicity

26. Intrathecal Baclofen
• In patients with
spasticity of cerebral
origin
• Continuous infusion of
baclofen in intrathecal
space

27. Surgery
• Maintain mobility & Stability of joints
– Surgery at hip when subluxation or abduction less
them 300

28. Bracing
• Improves function
– prevent worsening of
contractures
– Prevents recurrence of
deformities after surgical
correction

29. Future Direction
• Treatment for CP with focus on prevention of CP as
well as effective and permanent at the level of brain.
Treatment occurs most effectively with a
multidisciplinary approach to assessment and
treatment.

30. 1. The commonest etiologies for cerebral palsy include all
of the following except,
I. Prematurity
II. Cerebral hypoxemia
III. Vitamin C deficiency
IV. Hyperbilirubinemia

31. 2. Which of the following is not a Pre-natal cause of C.P.,
I. Prolonged and difficult labor
II. Premature rupture of membranes
III. CNS infection (encephalitis, meningitis)
IV. Multiple pregnancies

32. 3. Which of the following scale is used for assessment of
spasticity-
I. GCS
II. MAS
III. AS
IV. AIS

33. 4. Which of the following is not a centrally acting anti
spastic medication,
I. Diazepam
II. Tizanidine
III. Dantrolene
IV. Baclofen

34. 5. Among the following which is not used for spasticity
management in C.P.,
I. Stretching Exercises.
II. Bracing.
III. Baclofen
IV. Anti spasmodic drugs.