CEREBRAL PALSY
CEREBRAL PALSYChronic disability of central nervous system origin characterised by aberrant control of movement of posture, appearing early in life and not the result of progressive neurological disease.
Spastic: Upper motor neurone lesion. Hemiplegia: UMNL of one side of body. Diplegia: UMNL of all four limbs but legs more than arms. May be symmetric or asymmetric. Quadriplegia: Equal involvement of arms and legs.
Rigidity:↑ tone throughout range of movement.Dyskinesia:Involuntary movements and changes in muscle tone. Damage to basal ganglia and extraphyomides pathways.Athetosis:Slow writhing movements of limbs. Extension and fanning of fingers and extension of wrist.Chorea:Quick jerky movements of trunk and prox, limb muscles.
Paraplegia: Legs involved only. Double Hemiplegia: Bilateral UMNL. Arms and legs. Also pseudobulbar palsy. Monoplegia: One Limb.
Cerebral Palsy Rates
Multiple births 7.5 / 1000 live births Singletons 2.1 / 1000 live births 1500gr or less 80 / 1000Types of Cerebral Palsy
Spastic Hemiplegia Diplegia Quadriplegia Ataxic Dyskinetic Dystonic Hypokinesia Hypertonia Chored-Athetoid Hyperkinesia HypotoniaCEREBRAL PALSY
Hemiplegia. Double Hemiplegia. Diplegia (hypotonic, dystonic, spasticity, ataxic). Ataxia. Dysequilibrium Syndrome. Dyskinetic. Mixed.Early Signs of Cerebral Palsy
Birth History Prematurity. Seizures. Low apgars. Intracranial haemorrhage. Periventricular leucomalacia. Delayed Milestones Abnormal Motor Performance Handedness. Reptilian crawl. Toe waking.Early Signs of Cerebral Palsy
Altered Tone. Persistence of primitive reflexes. Abnormal posturing.Prenatal Associations with Cerebral Palsy
Placental insufficiency. Brain malformation. Congenital infection. Chromosomal defects. Exposure to toxins. Abnormality of neuronal migration.ANTENATAL
Maternal infection & cerebral palsyMaternal fever> 38oc + Chorioamnionitis associated with ↑ risk of cerebral palsy.↑ Inflammatory markers in children with cerebral palsy.Cerebral Palsy
Fall in incidence of Cerebral Palsy in low birth weight babies.⇧ in incidence in babies 2.5-4kg (2/3 of cases).Excess boys (C58%).⇩in incidence of dyskinetic cerebral palsy.⇧in lowest socio-economic groups.Maternal age and parity.U shaped curve < 20 years - > 34 years.4 children or >.Breach delivery.Cerebral Palsy Associated Disabilities
Mental retardation 1/3 N. 1/2 I.Q. < 55. Epilepsy 20-50% > generalised. Speech disorders 50% delay/dysarthria. Vision and hearing 25%. Behaviour abnormalities. Learning difficulties.