CEREBRAL PALSY By: Ida Sherri L. Corvera BSN III - NM William John Little(1810-1894)

In 1860s, known as "Cerebral Paralysis or Littles Disease After an English surgeon wrote the 1st medical descriptions CEREBRAL PALSY (CP) Cerebral- Latin Cerebrum; Affected part of brain

Palsy " -Gr. para- beyond, lysis loosening Lack of muscle control CEREBRAL PALSY

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 doesnt worsen May be congenital or acquired CEREBRAL PALSYA Heterogenous Group of Movement Disorders CP AffectsMuscle Strength CAUSES OF CEREBRAL PALSYAn insult or injury to the brain 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 CHIEF CAUSESevere deprivation of oxygen or blood flow to the brain TYPES OF CEREBRAL PALSY Accdg. to Neurologic Deficits Based on the - extent of the damage- area of brain damage

Each type involves the way a person moves 3 MAIN TYPES PYRAMIDAL - originates from the motor areas of the cerebral cortex2. EXTAPYRAMIDAL - basal ganglia and cerebellum

3. MIXED

2. Accdg. to Type of Movement 4 MAIN TYPESPYRAMIDAL1. Spastic CP

EXTAPYRAMIDAL 2. Athethoid CP 3. Ataxic CP

MIXED4. Spastic & Athethoid CP 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) DEGREE OF SEVERITY1. Mild CP- 20% of cases

Moderate CP- 50% - require self help for assisting their impaired ambulation capacity.

Severe CP- 30%; -totally incapacited and bedridden and they always need care from others. Signs and Symptoms OF CEREBRAL PALSY Early Signs Early Signs

Abnormal or prolonged primitive reflexes

Moros reflexAsymmetric tonic neck reflexPlacing reflexLandau reflex CHILD with CP Behavioral Symptoms Poor ability to concentrate, unusual tenseness, Irritability ASSOCIATED PROBLEMS OF CEREBRAL PALSY

Hearing and visual problems Sensory integration problems Failure-to-thrive, Feeding problems Behavioral/emotional difficulties, Communication disorders Diagnosis OF CEREBRAL PALSY DIAGNOSIS Physical evaluation, Interview MRI, CT Scan EEG Laboratory and radiologic work up Assessment tools i.e. Peabody Development Motor Skills, Denver Test II

ASSESSMENT 1. SUBJECTIVE - INTERVIEW a. History Taking Include all that may predispose an infant to brain damage or CP

Risk factors Psychosocial factors Family adaptation b. Childs Health History Often admitted to hospitals for corrective surgeries and other complications.

Respiratory status Motor function Presence of fever Feeding and weight loss Any changes in physical state Medical regimen 2. OBJECTIVE - Physical Examination CRITERIAP osturing / Poor muscle control and strength O ropharyngeal problemsS trabismus/ SquintT one (hyper-, hypotonia)E volutional maldevelopment R eflexes (e.g. increaseddeep tendon) *Abnormalities 4/6 strongly point to CP Treatment OF CEREBRAL PALSY No treatment to cure cerebral palsy. Brain damage cannot be corrected. Crucial for children with CP: Early Identification; Multidisciplinary Care; and Support

The earlier we start, the more improvement can be made-Health worker I. Nonphysical Therapy General management - Proper nutrition and personal care

B. Pharmacologic Botox, Intrathecal, Baclofen- control muscle spasms and seizures, Glycopyrrolate -control droolingPamidronate -may help with osteoporosis.

C. Surgery

-To loosen joints, -Relieve muscle tightness, - Straightening of different twists or unusual curvatures of leg muscles - Improve the ability to sit, stand, and walk.

Selective posterior rhizotomy In some cases nerves need to be severed to decrease muscle tension of inappropriate contractions.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 supportH. Other Treatment

Therapeutic electrical stimulation, Acupuncture, Hyperbaric therapy Massage Therapy might help '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

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

C. Prone DevelopmentD. Supine Development

o Head control on supine and positions

NURSING RESPONSIBILITIES

NURSING RESPONSIBILITIES

Functioning as a member of the health team Providing counseling and education for the parents and promote optimal family functioningC. Promoting physical and psychological health

D. Assisting with feeding management and toilet training

E. Assisting with rehabilitation therapies (physical, occupational and speech)

F. Providing counseling for educational and vocational pursuits

G. Preventing child abuse

H. Providing care during hospitalization Prevent physical injury

Prevent physical deformity

K. Promote a positive self-image