Cerebral palsy is defined as a group of non-progressive motor impairment syndromes caused by abnormalities in movement, posture and tone. It has various etiologies including prenatal, perinatal and postnatal factors. It is classified based on the type of motor dysfunction into spastic, dyskinetic, hypotonic and ataxic. Diagnosis involves assessing abnormal signs and developmental milestones. Management is multidisciplinary and aims to minimize disability through rehabilitation therapies, prevention of contractures, drug treatments and assistive devices.
Ataxic cerebral palsy is a rare form of cerebral palsy affecting around 5% to 10% of all people diagnosed. It gets its name from the word ataxia, which means lack of coordination and without order.
Cerebral palsy (CP) is a well-recognized neurodevelopmental
condition beginning in early childhood and persisting throughout
the lifespan. Cerebral palsy describes a group of permanent disorders of the development of movement and posture causing
activity limitation that is attributed to non-progressive the disturbance that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied
by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems. Sometimes we can identify by symptoms of children such as delayed milestones, spasticity, unable to neck control, muscle weakness. there are 4 types of CP that are dependent upon parts of brain damage.
Meaning of Cerebral Palsy , Definition of Cerebral Palsy , Areas affected by Cerebral Palsy , Causes of Cerebral Palsy , Types of Cerebral Palsy ( many basis ) , Signs and Symptoms of Cerebral Palsy , Developmental Milestones of Cerebral Palsy child , Associated problems of Cerebral Palsy , Treatment of Cerebral Palsy ,
Ataxic cerebral palsy is a rare form of cerebral palsy affecting around 5% to 10% of all people diagnosed. It gets its name from the word ataxia, which means lack of coordination and without order.
Cerebral palsy (CP) is a well-recognized neurodevelopmental
condition beginning in early childhood and persisting throughout
the lifespan. Cerebral palsy describes a group of permanent disorders of the development of movement and posture causing
activity limitation that is attributed to non-progressive the disturbance that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied
by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems. Sometimes we can identify by symptoms of children such as delayed milestones, spasticity, unable to neck control, muscle weakness. there are 4 types of CP that are dependent upon parts of brain damage.
Meaning of Cerebral Palsy , Definition of Cerebral Palsy , Areas affected by Cerebral Palsy , Causes of Cerebral Palsy , Types of Cerebral Palsy ( many basis ) , Signs and Symptoms of Cerebral Palsy , Developmental Milestones of Cerebral Palsy child , Associated problems of Cerebral Palsy , Treatment of Cerebral Palsy ,
PTA Seminar Preventing theft in_your_pta, the most common problems in PTA that needs solution, as school head and division tends to cover up. as this will affect the performance, points of the school head, superintendent and teachers.
A group of motor impairment syndromes resulting from disorders of early brain development and often associated with epilepsy and abnormalities of speech, vision and intellect
Evaluation of an infant with hypotonia is described including history, examination and investigations. Clinical algorithm for such evaluation is presented.
3. Definition
A group of non-progressive but changing motor
impairment syndromes characterized by abnormalities of
movement, posture and tone
Its not a specific disease, but a symptom complex
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4. Etiology
PRENATAL(MATERNAL/FETA
L/PLACENTAL)
PERINATAL POST NATAL
• Iodine deficiency, iron
deficiency and poor
nutrition
• Intrauterine infections,
high fever,UTI
• Chorioamnionitis
• Maternal disease-
Diabetes, hypertension,
Hyperthyroidism
• Teratogens-drugs,
Radiation,smoking,
alcohal,intrauterine
environmental toxins
• Fertility problems-
Advanced age at
conception, history of
infertility, recurrent fetal
wastage
• Prematurity/VLBW
• Birth asphyxia
• IUGR
• Hyperbilirubinemia
• intravenricular and
intra cerebral bleed
• Hypoglycemia,
Dyselectrolytemias
• Sepsis, peumonia and
meningitis
• Poor Antenatal care
• poor socioeconomic
status
• Premature separation of
placenta
• CNS infections such as
viral encephalitis,
tubercular meningitis and
pyogenic meningitis
• Head injuries
• Seizure
• Hypoxic damage
• Hyperpyrexic damage
• Twins/abnormal fetal
presentation
• Fetal thrombotic
vasculopathy
• Genetic causes
• Functional polymorphism
in interleukin-6 gene has
recently been associated
with term infants.
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6. Suspected Cerebral palsy
- Child with motor dysfunction-Abnormal muscle tone, abnormal
posture and movement.
- Clinical expression of the case depends on the extent and area of
brain damage, growth of the child, coexisting problems
- Include- Mental retardation
- - Seizure
- - Behavioral problem
- - Speech, Hearing and Language disorders
- Ocular- Strabismus, refractory error, field defect
- Extra pyramidal abnormalities, sensory impairment/integrative
- dysfunction
- Feeding difficulties
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7. Spastic
Most common type
Increased muscle tone
Develop deformities, contractures
Associated problems-Squint, oral motor dysfunction, perceptual and
learning disorder
Quadriplegic CP-
All limbs are affected, Arms> legs
Absent bladder bowel control
Difficulty in speech and feeding
Intelligence deceased
Epilepsy is common
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8. Hemiplegic CP:
- Term baby
- Rt hemiplegia twice as common as left hemiplegia, arm> legs
- Persistent fisting and cortical thumb on affected side
- Absent pincer grasp ,hemiplegic gait, loss of cortical sensation
Diplegic CP:
- In Preterm baby wih IVH and PVL
- Lower limb> Upper limb
- Increased Abductor tone – later Ambulatory problem
- Seizure is uncommon
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9. Dyskinetic
Uncontrolled and purposeless movements
Dystonic:
- Infants are hypotonic with poor head control
- Dystonia evolve gradually, truncal twisting, facial grimacing,
extremity rigidity
Choreo athetoid : Characteristically seen in babies with
hyperbilirubinemia
- Associated problem- high tone hearing loss, upward gaze
palsies
- Seizures are uncommon
- Speech difficulty but intelligence is normal
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10. Hypotonic:
- Marked motor delay, deceased tone, mental retardation
- Preserved or brisk DTR differentiate it from LMN
Ataxic:
- Uncommon form, defective postural function, disturbed
equilibrium, in coordinated movement for all major task
- Tremor on use of hand are common
- Associated problem- spasticity, athetosis, dysarthria and
Nystagmus
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12. Diagnosis
Early diagnosis of CP: -
Warning symptoms:
- Lack of alertness, deceased spontaneus motility
- Inceased abnormal movements,seizure
- Feeding problem, drooling
- Poor quality of sleep
- Fisting after 2 months of age
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13. Family counseling
Its not a mental illness
Cause need to be identified
Holistic evaluation and care needed
Not inherited
Not curable
Management aims at minimizing the disability to improve quality of life
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14. Abnormal signs:-
- Reduced head circumferance or fall in its growth
- Delayed social smile
- Poor head control at 3 months of age
- Delayed appearance of postural reflexes and developmental
milestones
- Persistence of primitive reflexes
- Increased tone , scissoring or assumption of equinus position of
feet
- Visual problem: roving of eyes, no visual following, poor hand
regard after 6 month , persistant squint
- Lack of auditory response
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16. Assement of muscle tone and neonatal reflexes
Popliteal angle
Scarf sign
Abductor angle
Modified Ashworth scale- Abnormal developmental reflexes
- Absence of parachute response and landau reflex and persistence
of other infantile automatism beyond the ages mentioned
Reflexes Persistance beyond
Rooting 3 month
Moro 5-6 months
Palmar grasp 6 month
Tonic neck 5-6 months
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17. Role of Investigations
Brain imaging- Useful in evaluating etiology of CP and suggesting
prognosis
USG- To detect IVH And Periventricular Leucomalasia
CT and MRI- To detect other disease that may confused with CP
Visual and hearing assessment
Tests to detect inherited thrombophilic disorders - Patients in which
an in utero or neonatal stroke
is suspected as the cause of CP.
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18. Management
Multidisciplinary approach:
A recent study indicates that prenatal treatment of mothers with
magnesium lowers the prevalence of CP in their children at
corrected age of 2 yr.
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19. Rehabilitation therapy:
Two major goal
1- To decease complication of
CP
2- To enhance or improve
acquisition of new skills
(A) Physical therapy
(B) Occupation therapy
(c) Speech and language
Therapy
Physiotherapy and motor
atraining
Prevention of contractures
Management of feeding
difficulties
Educational problem
Drug treatment:
- Diazepam
- Baclofen
- Dantrolane
- Tizanidine
Visual problem
Communication problem
Epilepsy
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20. Alcohal and Phenol blocks
Botulism toxinType – A
Plaster casting and orthdoses
Adaptive equipment/Assistive
devices
Orthopedic procedure:
- Selective posterior
rhizotomy
Rehablitation
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