Cerebral palsy is a group of disorders that affect movement and posture due to non-progressive damage to the developing brain. It is the most common motor disability in childhood. The document discusses the various types of cerebral palsy including spastic, dyskinetic, ataxic and mixed. Treatment focuses on managing symptoms through physical, occupational and speech therapy as well as bracing, medication and surgery. The goal is to improve functional ability and quality of life.

1. Conditions and treatment

2. Cerebral palsy
 Cerebral palsy (CP) is a group of disorders that
affect a person's ability to move and maintain
balance and posture.
 CP is the most common motor disability in
childhood.
 Cerebral= means having to do with the brain.
 Palsy= means weakness or problems with using
the muscles.

3.  In CP
 Muscles are unaffected.
 Brain is unable to send the appropriate signals
necessary to instruct muscles when to contract
and relax.

5. types


6. Commonly associated with a
spectrum of
developmental disabilities
such as –
I. Mental retardation (60%)
II. Epilepsy (33%)
III. Visual , hearing (deafness-
10%) and speech defects
IV. Strabismus(50%)
V. Cognitive dysfunction
VI. Sensory problems
VII. Emotional and behavioral
problems.

10. CP CASES

11. Types of CP
1) Spastic (Pyramidal)
 characterized by persistent primitive reflexes,
positive babinski reflex, ankle clonus, exaggerated
stretch reflex, eventual development of contractures.
 Type of spastic cerebral palsy:
 Hemiplegia: motor dysfunction on one side of the
body, upper extremity more affected than lower.
 Diplegia: all extremities affected, but lower
extremities more effected than upper.
 Tetraplegia (quadriplegia): all four extremities
involved.
 Triplegia: involving three extremities.
 Monoplegia: involving only one extremities..
 Paraplegia: pure cerebral paraplegia of lower

13. `2) Dyskinetic (Nonspecific,
extrapyramidal)
 Athetoid: characterized by slow, wormlike, writhing
movements that usually involve the extremities, trunk,
neck, facial muscle and tongue
 chorea (sudden, involuntary, irregular
movements), may involve proximal or distal muscle
groups.
 Dystonic: involuntary , sustained twisting
movements of the trunk or extremities, abnormal
posture
 presents as hypertonia, involuntary postures and
movements, or a combination
 Involvement of the pharyngeal and oral muscle
causing drooling and dysarthria (imperfect speech

15.  Ataxic (Nonspastic, extrapyramidal)
 Wide-based gait
 Rapid, repetitive movement performed poorly
 Disintegration of movements of the upper
extremities when the child reaches for objects

18. 3. Mixed cp

20. Treatment
 No treatment to cure cerebral palsy.
 Brain damage cannot be corrected.
 Crucial for children with CP:
 Early Identification;
 Multidisciplinary Care; and
 Support

21. Nonphysical Therapy
A. General management –
 Proper nutrition and personal care
B. Pharmacologic
 Botox, Intrathecal, Baclofen - control muscle
spasms and seizures, -Delivered directly to the spinal
fluid
 Glycopyrrolate -control drooling
 Pamidronate -may help with osteoporosis.

22. C. Surgery –
 To loosen joints,
 -Relieve muscle tightness,
 - Straightening of different twists or unusual
curvatures of leg muscles
 - Improve the ability to sit, stand, and walk.

23. D. Physical Aids
 Orthosis, braces and splints
 - Keep limbs in correct alignment
 - Prevent deformities.
 Positioning devices
 -Enable better posture
 Walkers, special scooters, wheelchairs - make it
easier to move about.

24. E. Special Education –
 To meet the child's special needs
 - Improve learning.
 - Vocational training can help prepare young
adults for jobs

25. F. Rehabilitation Services-
 Speech and occupational therapies may improve
the ability to speak, and perform activities of daily
living and to do some suitable works to have their
own income.

26. G. Family Services
 - Professional support helps a patient and family
cope with cerebral palsy.
 - Counselors help parents learn how to modify
behaviors.
 - Caring for a child with cerebral palsy can be
very stressful.
 - Some families find support groups helpful.

27. H. Other Treatment
 - Therapeutic electrical stimulation,
 - Acupuncture,
 - Hyperbaric oxygen therapy
 - Massage Therapy might help

28. II. Physical Therapy
 'The ultimate long-term goal is realistic
independence.

31.  Down Syndrome is also called
Trisomy 21
 Trisomy21 is a congenital
condition that makes an extra
copy of the 21st chromosome.
 This extra chromosome causes
mental and physical
developmental delays.

32. Testing for Down Syndrome during
pregnancy
 It affects about 1 in every 800
babies.
 Women age 35 and older have a
higher risk of having a child with the
condition.
 Amniocentesis and chorionic villus
sampling(CVS) used to detect
possible abnormalities in unborn
children.
 The main advantage of CVS over
amniocentesis is that it is done
much earlier in pregnancy, at 10 to
12 weeks rather than 15 to 20
weeks.

35. Common physical signs include
 Decreased muscle tone at birth
 Excess skin at the nape of the neck
 Flattened nose
 Upward slanting eyes
 Small ears
 Small mouth
 Wide, short hands with short fingers
 Separated joints between the bones of the skull
 Single crease in the palm of the hand
 White spots on the colored part of the eye

37. Management
 Early Intervention and Educational
Therapy
 Treatment Therapies:
 PT: includes activities and exercises
that help build motor skills, increase
muscle strength, and improve posture
and balance.
 OT
 Speech language therapy
Emotional and behavioral therapies
 Drugs and Supplements
 Assistive Devices

41.  Hydrocephalus
 Greek
 • “Hydro” – water
 • “Cephalus” - head
 A Condition resulting from imbalance in CSF production
and absorption.
 The formation rate of CSF to be about 20 ml/hour or 500
ml/day in adults and children.
 Incidence
 • 3 / 1000 live births
 • Occurs in 80-85% children born with
meningomyelocele
 • Incidence is equal in males and females

42. SYMPTOMS AND SIGNS
 • Irritability
 • Poor feeding
 • Headache
 • Nausea, vomiting
 • Visual impairment
 • Dementia
 • Incontinence
 • Gait disturbances
 • Accelerated head
growth
 Bulging fontanelles
 • sun set eyes
 • Developmental
delay
 • Exotropia
 • Papilledema
 • Bradycardia
 • Apnea / Death

43. Spina bifida
 Spina bifida is a birth defect that occurs when
the spine and spinal cord don't form properly. It's
a type of neural tube defect.

46. Symptoms
 back pain,
 leg weakness or paralysis of the legs.
 bowel incontinence and urinary incontinence.
 loss of skin sensation in the legs – the child is
unable to feel hot or cold, which can lead to
accidental injury.
 Twisted or abnormal legs and feet; for
example, clubfoot

47. Treatment
 Walking and mobility aids. ...
 Bowel and bladder management. ...
 Surgery for hydrocephalus. ...

48. Poliomyelitis

49. Poliomyelitis
 Poliomyelitis, or polio, is a highly
infectious viral disease that can be
deadly. The polio virus, which can
cause paralysis when it invades the
nervous system, is usually
transmitted through contaminated
food and water.
 While there is no cure for polio, it
can be prevented by immunisation.

50.  Sufferers of polio have the following
symptoms:
 • In mild cases — headache, slight fever,
nausea and vomiting.
 • In slightly more severe cases — moderate
fever, muscle pain, a stiff neck and
back, fatigue
 • In most severe cases — fever, muscle pain
or spasms, muscle weakness, stiffness,

51. Treatment
There is no cure for polio; it can
only be prevented by
vaccination.
 antibiotics are used to treat
urinary tract infections.
Analgesics are used to reduce
headaches and muscle pain.

52. Physiotherapy management
 Active and Passive Movements of
Joints
 Stretching exercises for contracture
 Posture Splinting and Supportive
device
 Strength training (weight
or resistance training) — for 3
days per week for 12 weeks.
 Aerobic exercises — for 20 minutes

53. Post-operative Treatment:
 active and passive movement of joints,
 to getting the patient up and walking.
 Breathing exercises may also be necessary
postoperatively for those patients with respiratory
insufficiency.
 Teaching of Relatives and Friends of Patients: Relatives
or friends of patients should be taught passive stretching of
muscles and contracted joints, supervision of muscle re-
education, correct fitting of splints, and assisting the patient
to walk.
 Teaching Patients to Walk:
 Patients who have never walked,or
those who have been crawling for a
long time, or who walk badly, must be
taught to walk in calipers
and crutches.

54. Stroke

55. Stroke
 It is the second leading cause of death in the
world.
 Approximately 800,000 people have a stroke
each year; about one every 40 seconds.
 Stroke occur due to problems with the blood
supply to the brain: either the blood supply is
blocked or a blood vessel within the brain
ruptures, causing brain tissue to die.
 A stroke is a medical emergency, and treatment
must be sought as quickly as possible.

59. Treatment
Medical treatment
Rehabilitation
PT
OT
SLT

60. PREVENTION
 The best way to prevent a stroke is to address
the underlying causes.
 This is best done by living healthily, which means:
 Eating a healthy diet
 Maintaining a healthy weight
 Exercise regularly
 Not smoking
 Avoiding alcohol or moderating consumption

63. Definition
 Amputation is the removal of limb,
part or total limb from the body.
 Generally the amputation of Lower
Limb are more common than those
of upper limb

64. ABOVE KNEE AMPUTATION

65. KNEE DISARTICULATION
 Disarticulation is removing the limb through a
joint.

66. Incidence
 Age
 Common in 50 – 70 year
 Gender
 Male – 75%
 Female – 25%
 Limbs
 Lower limbs 85%
 Upper limbs – 15%

67. Indications of Amputation
 Trauma – RTA, Gun shot
 Malignant tumors
 Nerve injuries & infection
 Extreme heat & cold – burn, gangrene
 Severe infection

68. TREATMENT
 MEDICAL MANAGEMENT
 PHYSIOTHERAPY
 ROM EXERCISES

69. Pressure sores

70.  DEFINITION:
 A Pressure Ulcer or Pressure Sore
or Decubitus Ulcer or Bedsore is
localized injury to the skin and other
underlying tissue, usually over a
body prominence, as a result of
prolonged unrelieved pressure.

72. Risk Factors
 1. Friction: cause tissue ischemia and skin
breakdown.
 2. Shear
 3. diabetes-Impaired Sensory Perception
 4. Impaired Physical Mobility
 5. Altered Level Of Consciousness
 6. Fecal And Urinary Incontinence
 7. Malnutrition
 8. Dehydration
 9. Excessive Body Heat
 10.Advanced Age

76. Stages / Classification Of
Bedsores
 Staging systems for pressure ulcers are based on
the depth of tissue destroyed.
 Based on the depth there are four stages of
bedsores
 Stage I
 Stage II
 Stage III
 Stage IV
 Unstageable

78. Stage I:
Nonblanchable Redness of Intact
Skin
 Intact skin presents with nonblanchable erythema
(will not turn white on pressure ) of a localized area
usually over a bony prominence.
 Discoloration of the skin, warmth, edema or pain
may also be present
 Stage I indicates “at-risk” persons.
 Involves only the epidermal layer of skin.

79. Stage II: Partial-thickness Skin Loss
Or Blister
 A partial thickness loss of dermis presents as a
shallow open ulcer with a red-pink wound bed
without slough
 Damage to the epidermis and the part of
dermis.
 No subcutaneous tissue is visible.

80. Stage III: Full-thickness Skin Loss
(Fat Visible).
 A stage III ulcer is a full-thickness tissue loss.
Subcutaneous fat may be visible; but bone, tendon, or
muscle are not exposed.
 Epidermis, dermis and subcutaneous tissues
involved
subcutaneous layer has a relatively poor blood supply.
So its difficult to heal.

81. Stage IV: Full-thickness Tissue
Loss
 A stage IV ulcer is the deepest, extending into the
muscle, tendon or even bone.
 Full thickness tissue loss with exposed bone,
tendon or muscle.

82. Unstageable
 Slough (yellowish or tan) or eschar
(brownish black) is covering a full
thickness injury.
 You can not assess the actual depth of
wound because of slough or eschar
covering the injury.

83. Complications
 Cellulitis : serious bacterial skin infection. The
affected skin appears swollen and red and is
typically painful and warm to the touch.
 Bone and joint infections
 Sepsis : occurs when the body's response to
these chemicals is out of balance, triggering
changes that can damage multiple organ
systems.
 Cancer

84. Prevention
 1. Position changes
 Changing position frequently and consistently is
crucial to preventing bedsores. Experts advise
shifting position about every 15 minutes that
you're in a wheelchair and at least once every two
hours, even during the night, if you spend most of
your time in bed.
 2. Skin inspection
 Daily skin inspections for pressure sores are an
integral part of prevention
 Keep the skin clean and dry.

85.  3. Nutrition
 A healthy diet is important in preventing skin breakdown
and in aiding wound healing
 Adequate hydration to maintain the skin integrity.
 4. Lifestyle changes
 Quitting smoking
 Exercise - Daily exercise improves circulation
 5. Use pressure-relieving devices
 such as air mattress, water mattress.
 Keep the head of the bed as low as possible to reduce risk
of shearing.
 Keep sheets dry and wrinkle free.
 Avoid massaging bony prominences.

87. Treatment
 1. Using support surfaces.
 These are special cushions, pads, mattresses
and beds that relieve pressure on an existing
sore and help protect vulnerable areas from
further breakdown.
 2. Cleaning. It's essential to keep wounds clean
to prevent infection. A stage I wound can be
gently washed with water and mild soap, but
open sores should be cleaned with a solution
each time the dressing is changed.
 3. Controlling incontinence

88.  4. Removal of damaged tissue (debridement).
 To heal properly, wounds need to be free of
damaged, dead or infected tissue.
 5. Oral antibiotics.
 6. Healthy diet.
 7. Educating the caregiver
 8. surgery.

89. Physiotherapy
 Exercises : –
 Passive ROM exercises to the paralyzed limb to
improve circulation and prevent contractures are
performed several times a day.
 Active assisted SLR
 – Ankle pump exercises
 –Strengthening of muscles and joints, without
impeding the healing of ulcer.
 Teaching corrective measures like shifting from
bed, turning positions, using assistive devices.