Cerebral palsy is a condition caused by injury to the brain before, during, or after birth that affects muscle movement and coordination. It is the most common physical disability in childhood. The signs and symptoms vary depending on the type and severity but may include difficulties with movement, muscle tone issues, seizures, cognitive impairments, and more. The types are spastic, ataxic, athetoid/dyskinetic, and mixed. Treatment focuses on managing symptoms through therapies, medications, surgery, and assistive devices. Prevention emphasizes prenatal care, immunizations, and neonatal care and resuscitation.

1. Cerebral Palsy
• What is Cerebral Palsy?
• What is its incidence?
• What are its causes and predisposing factors?
• What is its clinical presentation?
• What are its types?
• What are the levels of gross motor skills disabilities?
• What is its prevention?
• How it can be investigated?
• What is its management?

2. Definition
• Cerebral Palsy-a condition caused by injury to
the parts of the brain that control our ability
to use our muscles and bodies.
• Cerebral means having to do with the brain.
• Palsy means weakness or problems with using
the muscles.

3. Epidemiology
• Most common physical disability of childhood.
• Developed countries:- 2-2.5 cases per 1000
live births.
• Developing countries:- 1.5-5.6 cases per 1000
live births.
• It is common in all races and sex.
• The incidence of CP is higher among twins and
triplets than singletons.

4. Causes
Prenatal
• Infections
• Rh incompatibility
• Diabetes
• Toxemia of pregnancy.
• Congenital malformations
• Thromboembolic
phenomenon
• Inherited.
• Idiopathic-30% of the
children.
• Placental insufficiency.
• Brain malformation.
• Fetal stroke
• Congenital infection.
• Chromosomal defects.
• Exposure to toxins.
• Abnormality of neuronal
migration.
• Chorioamnionitis
Perinatal
• Birth asphyxia
• Birth injuries
• Prematurity/IUGR
Postnatal
• Brain infections
• Head injuries.
• Lack of oxygen
• Poisoning
• Bleeding or blood
clots in the brain
• Brain tumors.

5. Risk Factors
Prenatal
• German measles
(rubella).
• Chickenpox
(varicella)
• Cytomegalovirus.
• Herpes.
• Syphilis.
• Exposure to toxins
• Zika virus
infection.
• Thyroid problems
• Intellectual
disabilities
• Preeclampsia
Perinatal
• Breech births.
• Low birth weight.
• Multiple babies.
• Premature birth.
• MAS
• Instrumental
delivery
• Caesarean section
• Respiratory
distress syndrome
• Low blood sugar
Postnatal
• Severe or
untreated
jaundice.
• Bacterial
meningitis.
• Viral encephalitis.

6. Signs and Symptoms
Depending on brain area involved patient can experience diverse
symptoms.
• Delayed milestones
• Reptilian Crawl
• Seizures
• Low APGAR score
• Mental retardation
• Urinary incontinence
• Fecal incontinence
• Apraxia
• Dysarthria
• Crying, screaming
• Sleep disturbances.

7. • Feeding Problems:
-Failure to suck.
-Tongue gagging and choking.
-Vomiting and regurgitation.
• Dribbling.
• Constipation.
• Scissor walking
• Toe walking
• Dental carries
• Nystagmus
• Persistence of primitive infantile reflexes

8. Classification of CP

10. Types of Cerebral Palsy
1. Spastic CP
• The most common type, 70%
• Tight muscles in some parts of the body that are unable to relax.
• Affected joints become stiff and hard to move.
• Hypertonic upper motor neuron lesion in the brain as well as the corticospinal
tract or the motor cortex. This damage impairs the ability of some nerve receptors
in the spine to receive gamma-Aminobutyric acid properly, leading to hypertonia in
the muscles signaled by those damaged nerves.
• Clonus of the affected limb(s) may sometimes result, as well as muscle
spasms resulting from the pain and/or stress of the tightness experienced.
2. Ataxic CP
• It occurs in 5% and 10% of all cases.
• Ataxic CP causes problems with Balance and Precise movements.
• Incoordination. A person with ataxic CP may walk with the feet unusually far apart.
• Hand control. Often only one hand is able to reach for an object; the other hand
may shake with attempts to move it (intention tremor). The person may not be
able to button clothes, write, or use scissors.

12. 3. Athetoid/Dyskinetic CP
• It is mixed muscle tone — hypertonia and hypotonia mixed with
involuntary motions.
• In some cases, rapid and jerky or uncontrolled slow continuous
movements occur involuntarily. These movements most often affect the
face and neck, hands, feet, arms, legs, and sometimes the torso.
• Athetoid (hyperkinetic) CP characteristics include relaxed and limp
muscles during sleep, with some involuntary jerking (chorea) or writhing
(athetosis). If the face and mouth muscles are affected, problems may
develop related to unusual facial expressions, drooling, speaking, and
choking when sucking, drinking, and eating.
• With dystonic CP, the body and neck are held in a stiff position.
4. Mixed CP
• Mixed cerebral palsy has symptoms of athetoid, ataxic and spastic CP
appearing simultaneously, each to varying degrees, and both with and
without symptoms of each. Mixed CP is the most difficult to treat as it is
extremely heterogeneous and sometimes unpredictable in its symptoms
and development over the lifespan.
• For example, spastic legs (symptoms of spastic diplegic CP) and
problems with facial muscle control (symptoms of dyskinetic CP) may
both develop

14. Prevention
1.Antenatal and Neonatal care.
2.Early detection and advice.
3.Drugs.
4.Immunization and screening.
5.Genetic counselling.
6.Health education.
7.Rh factor test
8.Neonatal resuscitation
9.Magnesium Sulphate

15. Diagnosis
• Person's history and physical examination.
• A general movements assessment, which involves measuring
movements that occur spontaneously among those less than
four months of age, appears to be most accurate. Symptoms
and diagnosis typically occur by the age of 2.
• Observe LBW, preterm, and those with low Apgar scores at 5
minutes.
• When abnormal, the neuroimaging study(MRI,Cranial
U.S,EEG) can suggest the timing of the initial damage.
• Laboratory tests

16. Managment
• Orthopedic Surgery
• Occupational Therapy
• Orthotics
• Intrathecal Baclofen
• Botox Injections
• Selective Dorsal Rhizotomy
• Speech Therapy
• Special Education
• Physical Therapy