cerebral palsy

CEREBRAL PALSY

CEREBRAL PALSY
None progressive, static disorder of the tone, posture or movement, due to lesion in developing brain. But symptoms may change

Cerebral Palsy Rates

Multiple births 7.5 / 1000 live births Singletons 2.1 / 1000 live births 1500gr or less 80 / 1000

RISK FACTORS ASSOCIATED WITH CEREBRAL PALSY

GENERAL Gestational age < 32 weeks Birth weight <2500 g
MATERNAL HISTORY Mental retardation Seizure disorder Two or more prior fetal deaths Sibling with motor deficits
DURING GESTATION Twin gestation Chorionitis Fetal growth retardation Third-trimester bleeding Low placental weight Premature placental separation
FETAL FACTORS Abnormal fetal presentation Fetal malformations Fetal bradycardia Neonatal seizures

CP: ETIOLOGY

Majority is idiopathic (thought to present prenatally) PRENATAL PERIOD- wherein most causes of CP occur. The most common currently understood causes are related to brain injury occurring in children born prematurely.


Prenatal Associations with Cerebral Palsy
Placental insufficiency. Brain malformation. Congenital infection. Chromosomal defects. Genetic malformations

Types of Cerebral Palsy

Spastic Hemiplegic Diplegic Quadriplegic Ataxic Dyskinetic Dystonic Hypokinesia Hypertonia Chored-Athetoid Hyperkinesia Hypotonia Mixed

Spastic: Hemiplegia: UMNL one side of body. Diplegia: UMNL of legs more than arms. Quadriplegia: Equal involvement of arms and legs.


Diplegic CP : The most common type 30% Speech / cognitive function : normal . no Epilepsy. UL : gross motor (Normal) LL : spastic Infant ( commando crawl by hand), Delay sitting. O/E Scissoring position, hyper-reflexia knee & ankle, Bilateral Babinski sign. Child, Delay walking, walk on tiptoe O/E disuse atrophy hip: flexion, adduction, int. rotation knee: flexor / extensor spasticity /or equal ankle: equinovarous. foot: pes valgus Most walk independently by 4 years

Hemiplegic CP : 25 % of all CP One side affection, upper > lower extremity 25 % mentally retarded 33 % seizures Infant: Hand preference Child: Circumductive gait, hyper-reflexia Cause :Thromboembolism

Spastic Quadriplegia (Most severe)20%All four limbs involved – and trunk- UMNLOften with MR & seizuresMost ( 80 % ) non walkersSwallowing difficulty & Aspiration pneumonia due toPseudo-bulbar palsy.Speech &visual abn.Flexion contracture of knee& elbow, scissoring posture.Hypertonia, hyper-reflexia.

Dyskinetic CP

Less common than spastic CP.15%. Infant is hypotonic, head lag then rigidity& dystonia(mov. Disorder that persons muscle contract uncontrollably, repetitive mov.). Feeding and speech are typically affected. Cause : birth asphyxia., kernicterus, metabolic disease that effect basal ganglia.

Diagnosis of CP

Birth History Prematurity. Seizures. Low apgars. Intracranial haemorrhage. Periventricular leucomalacia. Delayed Milestones Abnormal Motor Performance Handedness. Reptilian crawl. (abdomen) like snake Toe waking.

Early Signs of Cerebral Palsy

Altered Tone. Persistence of primitive reflexes. Abnormal posturing. Inv.: MRI of brain, Test for vision & hearing Genetic evaluation

Cerebral Palsy Associated Disabilities

Mental retardation 1/3 N. 1/2 I.Q. < 55. Epilepsy 25% > generalised. Speech disorders 50% delay/dysarthria. Vision and hearing 25%. Behaviour abnormalities. Learning difficulties.

Common Management Problems in Cerebral Palsy

Feeding Problems: Failure to suck. Tongue trusting, gagging and choking. Vomiting and regurgitation. Dribbling. Constipation. Crying, screaming and sleep disturbances. Growth.

Treatment of Cerebral Palsy

Parent guidance. Physiotherapy Orthopaedic: scoliosis, contractures, deformities. Speech and Occupational Therapy. Medical. Psychiatric.

Management of Spasticity in Cerebral Palsy

Oral Medicines: Baclofen, Diazepam, Dantrolene Intrathecal Baclofen. Botulinum Toxin.(to affected muscle) Selective dorsal Rhizotomy on spinal n. for severe spasticity.(cutting some of sens. N. fibers come from muscles &enter spinal cord) Tenotomy of Achilles tendon(cutting a tendon called tendon release, lengthening)used to lengthen m. become shortened & resistant to stretch Rigidity, dystonia Levodopa-carbidopa (Sinemet) Dystonia : carbamazepine.