Cerebral palsy (CP) is a group of permanent movement disorders caused by damage to the developing brain. The damage can occur before, during, or after birth from injury or illness. CP affects muscle tone, movement, and motor skills. There are several types of CP defined by the parts of the body affected and the brain areas damaged. Common signs include poor muscle control, feeding difficulties, and developmental delays. Diagnosis involves ruling out other causes through exams and tests. Treatment is multidisciplinary and focuses on rehabilitation, physical therapy, medications, and surgery to improve function and independence over time. The earlier treatment begins, the more improvement can be made.

1. CEREBRAL
PALSY
BY: DR. RAHMA SHAHBAHAI

2. William John Little (1810-1894
 In 1860s, known as
"Cerebral Paralysis” or
“Little’s Disease”
 After an English surgeon
wrote the 1st medical
descriptions
Introduction

3.  Cerebral“- Latin Cerebrum;
Affected part of brain
 “Palsy " -Gr. para- beyond,
lysis – loosening
Lack of muscle control
Introduction

4. A motor function disorder
 caused by permanent, non-progressive brain lesion
 present at birth or shortly thereafter. (Mosby, 2006)
 Non-curable, life-long condition
 Damage doesn’t worsen
 May be congenital or acquired
Definition

5. A Heterogeneous Group
of Movement Disorders
–An umbrella term
–Not a single diagnosis

6. Muscle Strength
Movements
Balance
Coordination
Posture
CP affects

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

8. CAUSES
OF CEREBRAL PALSY

9. An insult or injury to the brain
–Fixed, static lesion(s)
–In single or multiple
areas of the motor
centers of the brain
–Early in CNS dev’t

10. CAUSES
Development Malformations
 The brain fails to develop correctly.
Neurological damage
 Can occur before, during or after delivery
 Rh incompatibility, illness, severe lack of oxygen
* Unknown in many instances

11. CHIEF CAUSE
Severe deprivation of oxygen or
blood flow to the brain
–Hypoxic-ischemic
encephalopathy
or intrapartum
asphyxia
CHIEF CAUSE

12. RISK FACTORS
Prenatal factors
 Before birth
 Maternal characteristics
Perinatal factors
 at the time of birth to 1mo
Postnatal factors
 In the first 5 mos of life

13. Prenatal factors
 Hemorrhage/bleeding
 Abruptio placenta
 Infections
 Rubella, cytomegalovirus,
toxoplasmosis,
 Environmental factors
 Maternal Characteristics

14. 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
 Alcoholism and drug addiction
 Mother’s medical condition

15. Perinatal Factors
 High or low BP
 Umbilical cord coil
 Breech delivery
 Over sedation of drugs
 Trauma i.e. forceps or vacuum
delivery
 Complications of birth

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

17. Before
Birth
75%
During
Birth,
5-15%
After
Birth,
10-20%
*Several causes are preventable or treatable
CP Cases

18. TYPES
OF CEREBRAL PALSY

19. Classification of CP
According to:
1. Neurologic deficits
2. Type of movement
involved
3. Area of affected
limbs

20. 1. Accdg. to Neurologic Deficits
Based on the
- extent of the damage
- area of brain damage
 Each type involves the way a person
moves

21. 3 MAIN TYPES
1. PYRAMIDAL
- originates from the motor
areas of the cerebral cortex
2. EXTAPYRAMIDAL
- basal ganglia and
cerebellum
3. MIXED

22. 2. Accdg. to Type of Movement
Photo from: Saunders, Elsvier.

23. 4 MAIN TYPES
PYRAMIDAL 1. Spastic CP
EXTAPYRAMIDAL 2. Athetoid CP
3. Ataxic CP
MIXED 4. Spastic &
Athetoid CP

25. Spastic CP
 Increased muscle tone,
tense and contracted muscles
 Have stiff and jerky or
awkward movements.
 limbs are usually underdeveloped
 increased deep tendon reflexes
 most common form
 70-80% of all affected

26. Types of Spastic CP
According to affected limbs:
* plegia or paresis - meaning paralyzed or weak:
 Paraplegia
 Diplegia
 Hemiplegia
 Quadriplegia
 Monoplegia –one limb (extremely rare)
 Triplegia –three limbs (extremely rare)

27. Diplegia/ Paraplegia Hemiplegia Quadriplegia


28. Athetoid/ Dyskinetic CP
 involves abnormal involuntary movements
 that disappear during sleep and increase with stress.
 Athetoid-Wormlike movements
 Slow, uncontrolled motion, twisting in character, in the face, extremities, and
torso.
 Dyskinesia -Dyskinetic movement of mouth
 drooling and dysarthria.
 Dystonia - when held as a prolonged posture
 20% of the CP cases,

29. Ataxic CP
 Poor balance and lack of coordination
 Wide-based gait
 Depth perception usually affected.
 Tendency to fall and stumble
 Inability to walk straight line.
 Least common 5-10% of cases

30. MIXED CP
 A common combination is
spastic and athetoid
 Spastic muscle tone and involuntary movements.
 25% of CP cases, fairly common

32. Signs and
Symptoms
OF CEREBRAL PALSY

33. a.
b.
c.
d.
e.
f.
g.
h.

34. Early Signs
• Stiff or floppy posture
• Weak suck/ tongue thrust/
tonic bite/ feeding difficulties
• Poor head control
• Excessive lethargy or
irritability/ High pitched cry
Infancy (0-3 Months)

35. CHILD with CP

36. Behavioral Symptoms
Poor ability to
concentrate ,
unusual tenseness,
 Irritability

37. ASSOCIATED
PROBLEMS
OF CEREBRAL PALSY

38.  Hearing and visual problems
 Sensory integration problems
 Failure-to-thrive, Feeding
problems
 Behavioral/emotional
difficulties,
 Communication disorders
• Bladder and bowel control
problems, digestive
problems
gastroesophageal reflux
• Skeletal deformities, dental
problems
• Mental retardation and
learning disabilities
• Seizures

39. Diagnosis
OF CEREBRAL PALSY

40. 1. SUBJECTIVE
-HISTORY

41. 2. OBJECTIVE
- PHYSICAL EXAMINATION

42. CRITERIA
P osturing / Poor muscle control and strength
O ropharyngeal problems
S trabismus/ Squint
T onia: hyper- hypo
E volutional maldevelopment
R eflexes e.g Increased deep tendon
*Abnormalities 4/6 strongly point to CP

43. DIAGNOSIS
Laboratory studies
 clinical diagnosis.
 There are no definitive laboratory studies

44. To rule out other causes:
 Thyroid function studies: Abnormal thyroid function may be
related to abnormalities in muscle tone or deep tendon reflexes
or to movement disorders
 Lactate and pyruvate levels: Abnormalities may indicate an
abnormality of energy metabolism (ie, mitochondrial cytopathy)
 Ammonia levels: Elevated ammonia levels may indicate liver
dysfunction or urea cycle defect
 Organic and amino acids: may reveal inherited metabolic
disorders
 Chromosomal analysis: if dysmorphic features or abnormalities
 Cerebrospinal protein: levels may assist in determining asphyxia in
the neonatal period

45. Imaging studies
 Cranial ultrasonography: evidence of
hemorrhage or hypoxic-ischemic injury
 CT of brain: congenital malformations,
intracranial hemorrhage, and periventricular
leukomalacia or early craniosynostosis.
 MRI of the brain: The diagnostic neuroimaging
study of choice
 defines cortical and white matter structures and
abnormalities more clearly than does any other
method
 determination of whether appropriate myelination is
present for a given age

46. Others:
 Electroencephalography: Important in the diagnosis
of seizure disorders
 Electromyography and nerve conduction studies:
Helpful when a muscle or nerve disorder is
suspected

47. Treatment
OF CEREBRAL PALSY

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

49. “The earlier we start,
the more improvement can be made”
-Health worker
I. NONPHYSICAL THERAPY

50. A. General management
- Proper nutrition and personal care
B. Pharmacologic
 Botulinum toxin : for children with cerebral palsy with spasticity
 antiparkinsonian drugs (eg, anticholinergic and dopaminergic drugs)
 antispasticity agents (eg, baclofen) have primarily been used in the
management of dystonia, anticonvulsants,
 antidopaminergic drugs, and antidepressants have also been tried

51. C. Surgery
-Intrathecal baclofen pump
insertion: To treat spasticity and/or
dystonia
-Selective dorsal rhizotomy: To treat
velocity-dependent spasticity
- Orthopedic surgical intervention: To
treat scoliosis, joint contractures or
dislocation

52. Selective posterior Rhizotomy
In some cases nerves need to be severed to decrease muscle
tension of inappropriate contractions.

53. D. Physical Aids
 Orthosis, braces and splints
 Positioning devices
 Walkers, special scooters, wheelchairs
E. Special Education
F. Rehabilitation Services- Speech and
occupational therapies
G. Family Services -Professional support

54. H. Other Treatment
- Therapeutic electrical stimulation,
- Acupuncture,
- Hyperbaric therapy
- Massage Therapymight help

55. 'The ultimate long-term goal is realistic independence.
To get there we have to have some short-term goals.
Those being a working communication system, education to his potential,
computer skills and, above all, friends'.
- Parent of boy with CP
II. PHYSICAL THERAPY

56. A. Sitting
-Vertical head control and
control of head and trunk .
B. Standing and walking
-Establish an equal distribution of
weight on each foot, train to
use steps or inclines

57. C. Prone Development
D. Supine Development
Head control on supine and positions

58. Thank you for lessening.

59. References