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CP.ppt
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.
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.
11.
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
13.
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
The etiology of CP is very diverse and multifactorial. The causes are congenital, genetic, inflammatory, infectious,anoxic, traumatic and metabolic.
Cerebral dygenesis
Genetics[edit]
About 2% of all CP cases are inherited, with glutamate decarboxylase-1 being one of the possible enzymes involved.[3] Most inherited cases are autosomal recessive,[3] meaning both parents must be carriers for the disorder in order to have a child with the disorder.
Intrauterine growth restriction (IUGR) refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb. Delayed growth puts the baby at risk of certain health problems during pregnancy, delivery, and after birth. They include: Low birth weight.
Shaken baby syndrome
Pb poisoning
Chorioamnionitis also known as intra-amniotic infection (IAI) is an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection. It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor.
Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
Cerebral palsy risk increases with the number of babies sharing the uterus. If one or more of the babies die, the chance that the survivors may have cerebral palsy increases.
Premature birth. A normal pregnancy lasts 40 weeks. Babies born fewer than 37 weeks into the pregnancy are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
Dental carries
Improper dental hygiene
congenital enamel defects (hyperplasia of primary teeth)
high carbohydrate intake and retention
Dietary balance with poor nutritional intake
Inadequate fluoride
Difficulty in mouth closure and drooling
Spastic or clonic movements cause gagging or biting on toothbrush
CP is classified by the types of motor impairment of the limbs or organs, and by restrictions to the activities an affected person may perform
In newborn infants, high bilirubin levels in the blood, if left untreated, can lead to brain damage in the basal ganglia (kernicterus), which can lead to dyskinetic cerebral palsy
In those at risk of an early delivery, magnesium sulphate appears to decrease the risk of cerebral palsy.[41][42] It is unclear if it helps those who are born at term.[43]
Cooling high-risk full-term babies shortly after birth may reduce disability
poor head control after 3 months
stiff or rigid arms/legs, arching back, floppy or limp posture
Cannot sit up without support by 8 months
Uses only one side of the body or only the arms to crawl
Failure to smile by 3 months
After 6 months of age, tongue pushes soft food out of the mouth.
Local nerve blocks to motor points of a muscle with a neurolytic agent (phenol solution) may relieve spasticity.
