Upload
maheshwaran-selva-kumaran
View
3.720
Download
1
Embed Size (px)
DESCRIPTION
Presentation by Pre-Med (2013) Students of Penang Medical College. This presentation is based on a mini research paper on Multidisciplinary Management of Cerebral Palsy. Group members consist of Nurul Najihah,Daniel Koshy & Maheshwaran
Citation preview
Nurul Najihah,Daniel Koshy,Maheshwaran
Multidisciplinary Management of Cerebral Palsy
http://www.nationwidechildrens.org/Document/Get/42099 http://www.hcocinc.com/wp-content/uploadsbigstock_Little_Boy_Sitting_Isolated_6867877.jpg
1.What is Cerebral Palsy ?
2.What causes Cerebral Palsy?
3.What are the types of Cerebral Palsy?
3.What are the signs and symptoms?
4.How many children are affected worldwide?
5.What is the role of doctor, pharmacist and physiotherapist
Questions that public would have in mind
- It refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination
- Classification of cerebral palsy
What is Cerebral Palsy?
http://nyp.org/health/pedneuro-cpalsy.html#top
Spastic
DyskineticAtaxic
Mixed
Rudolph’s Fundamentals of Pediatrics
Templates
What causes Cerebral Palsy?
1. Injuries to the infant’s brain during birth- Birth asphyxia - hypoxia > 4 mins during birth)- APGAR Score (numbered rating that reflects a newborn's physical
health). Good Score is more than 7/10
Reddihough D,Collins K,Others. The epidemiology and cause of cerebral palsy.Australian Journal of Physiotherapy. 2003;49(1);7-14
htt
p://
med
icin
a.u
fm.e
du
/ima
ge
s/3
/3c/
Ap
ga
r.jp
g
(The Etiology)
TemplatesWhat causes Cerebral Palsy?
3. Due to intake of certain toxins by mother during pregnancy (accidentally ingested)
- eg: methyl mercury
4. Infection during perinatal period-Intrauterine infections eg: TORCH Virus (Toxoplasmosis,Rubella,Cytomeglovirus,Herpes)
5. Cerebro vascular accident (CVA) - rapid loss of blood supply to the brain - due to ischemia caused by thrombosis, arterial embolism or hemorrhage
Reddihough D,Collins K,Others. The epidemiology and cause of cerebral palsy.Australian Journal of Physiotherapy. 2003;49(1);7-14
2. Metabolic disorders- Lesch-Nyhan Syndrome - Deficiency of Arginase (causes spastic diplegia)
(Etiology)
What are types of Spastic Cerebral Palsy?
Most common type of overall cerebral palsy, occurring in 90% of all cases according to the Society for Cerebral
Palsy in Europe (SCPE)
http://forkneedlepen.files.wordpress.com/2013/03/typesofcp.gif
• Delayed development milestones– Head control, roll over, sitting, crawling and walking
• Low muscle tone (hypotonia)– Problems with mobility– Poor Muscle control
• Infantile reflexes persist for long time– Sucking and startle reflex
• Failure to speak simple sentence by 24 months • Seizures
What are the signs and symptoms?
https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/signs-and-symptoms-of-cp/http://www.healthcentral.com/adhd/h/hypotonia-fatigue-adhd.html
How many children are affected?
According to an article published by American Academy of Family Physicians, It is the most common childhood physical disability and affects 2 to 2.5 children per 1,000 born in the United States.
There is insufficient statistics for cerebral palsy in Asia and Malaysia
? ? ? ??
Role Of Doctor
http://shotofprevention.com/2012/02/24/how-the-doctorparent-relationship-can-impact-immunization-decisions/
1.Doctors carry out physical examination
- complete prenatal and postnatal history of the child
2. Doctors look into the development milestones of the child - Head control,turn-over,sitting,standing
3. Carry out diagnostic tests- x-rays (spine ~ scoliosis ,hip ~ dislocation)- electroencephalogram (EEG) ~ seizures- magnetic resonance imaging (MRI) ~ brain abnormalities - feeding studies - genetic studies
https://www.unitypoint.org/filesimages/rightcallouts/doctor-with-child.jpg
http://nyp.org/health/pedneuro-cpalsy.html#top , http://cshcn.org/sites/default/files/webfm/file/CriticalElementsofCare-CerebralPalsy.pdf,
Role of Doctor(Coordinator)
http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#243683104
4. Determines the type of treatment child requires
- Conservative treatment
Physical – resistive or strength training programs (prevents contracture)
~ Special braces (orthotic devices) improve mobility and stretch spastic muscles
Occupational - help individuals address new ways to cope with day-to- day activities
Recreation - encourages participation in art and cultural programs, sports, and other events (improve child’s emotional well-being)
Speech and Language Therapy, Treatment for problems with eating and drooling
Oral Medications (eg: Baclofen)
Role of Doctor
http://soap.org/abstracts-uploads-spring-2011/1010711131105Xray_Baclofen_pump.jpg
Role of Doctor
- Invasive treatment
Botulinum Toxin (anti-spasticity management)
Selective Dorsal Rhizotomy
Insertion of intrathecal baclofen pump
~ helps in ambulation of child
5. Delegates job to physiotherapist and pharmacist for further treatment and counseling
Role Of Pharmacist
http://img.dailymail.co.uk/i/pix/2007/12_01/pharmacyREX0212_468x331.jpg
1. Educating parents about the medications given to their child
- side effects of medication- effectiveness- Purpose of medication
Role of Pharmacist
http://uspharmacist.com/content/d/featured%20articles/c/10170
2. Advise and collaborate with doctors on the suitable medication and dosage needed for cerebral palsy patients
- suitable dosage, not to overdose or under dose patient
Role of Pharmacist
http://www.everydayhealtenh.com/drugs/baclofen
3. Support the doctor by providing the adverse effects that occur to the patients because of the medication
Role of Pharmacist
http://uspharmacist.com/content/d/featured%20articles/c/10170
http://www.pharmacynews.com.au/news/latest-news/new-prescribing-initiatives-to-be-investigated
- Information reaches the pharmacist about the adverse effects of medication
which is then passed on to the doctor
4. Obtain past medical records containing medications taken by the patient and interpret for the doctor
- complications - determine whether to change dosage - effectiveness of the medicines - toxicity
Role of Pharmacist
http://uspharmacist.com/content/d/featured%20articles/c/10170
http://www.jacksongeneral.com/for-visitors---medical-records.php
Role Of Physiotherapist
http://www.pretoria-south-africa.com/elarduspark-faerie-glen-physiotherapist.html
TemplatesRole of Physiotherapist
1.Rehabilitation of physical impairments (Conservative Treatment)
- second line of treatment - main intervention for spasticity and dystonia - maximize functional control of the body - increase motor function - improve posture of cerebral palsy patients
http://www.csp.org.uk/your-health/conditions/cerebral-palsy http://www.tasputraperkim.org.my/images/serv_physio.jpg
2. Give advice regarding walking aids and equipment with the help of occupational therapist
- improve the patient’s co-ordination and body balance
- to allow children to go to school - preform daily activities - To enhance the ability of self-care
Role of Physiotherapist
http://www.tasputraperkim.org.my/images/serv_physio.jpg
3. Teaching parents physical therapy that have to be carried out at home on daily basis - to maintain effectiveness of Botulinum Toxin A injection
- encorage normal postures and movement (legs, arms,head control)
Role of Physiotherapist
http://www.childbirthinjuries.com/Cerebral-Palsy/Treatment/Physiotherapy http://www.ctn-simcoeyork.ca/aboutctn/newsandupdates.php?article=80
Summary
Cerebral Palsy is a neurological disorder
No Known Cure
Mobility of child can be greatly enhanced with correct diagnosis and treatment
Doctors advise on available treatment (conservative and invasive)
Physiotherapist offer physical treatment
Pharmacist advise on medications
Summary
Doctor
Pharmacist Physiotherapist
“Treatment of children with cerebral palsy is a multidisciplinary approach that is highly dependant upon a team of medical professionals”
TemplatesReference List
1) Bejing Puhua International Hospital. Bejing Puhua International Hospital. [Online] [Viewed 5 Dec 2013]. Available from: http://www.puhuahospital.com/?gclid=CJux66LqorsCFUcB4godUUQASQ#!cerebral-palsy/c1tc6 2) Cerebralpalsy.org.au. Signs and Symptoms of Cerebral Palsy | Cerebral Palsy Alliance. [Article], [Viewed 5 Dec 2013]. Available from: https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/signs-and-symptoms-of-cp/. 3) Csp.org.uk. What is physiotherapy? | The Chartered Society of Physiotherapy. [Article], [Viewed 5 Dec 2013]. Available from: http://www.csp.org.uk/your-health/what-physiotherapy 4) Csp.org.uk. Cerebral palsy | The Chartered Society of Physiotherapy. [Article], [Viewed 4 Dec 2013]. Available from: http://www.csp.org.uk/your-health/conditions/cerebral-palsy 5) Drugs.com. Baclofen Side Effects in Detail - Drugs.com. [Website], [Viewed 6 Dec 2013]. Available from: http://www.drugs.com/sfx/baclofen-side-effects.html 6) Minciu I. CEREBRAL PALSY MANAGEMENT. [Online Journal] Therapeutics, Pharmacology & Clinical Toxicology.; 2011 , [Viewed 3 Dec 2013] 7) Nhs.uk. Cerebral palsy - Treatment - NHS Choices. [Online]. [Viewed 4 Dec 2013]. Available from: http://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Treatment.aspx
8) Ninds.nih.gov. Cerebral Palsy Information Page: National Institute of Neurological Disorders and Stroke (NINDS). [Online], [Viewed 4 Dec 2013]. Available from: http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm
TemplatesReference List
9) Nyp.org. Cerebral Palsy - New York Presbyterian Hospital. [Article], [Viewed 3 Dec 2013]. Available from: http://nyp.org/health/pedneuro-cpalsy.html#top , 10) Placzek R, Siebold D, F. Funk J. Development of Treatment Concepts for the Use of Botulinum Toxin A in Children with Cerebral Palsy. [Online Journal], Toxins.; 2010, [Viewed 4 Dec 2013]. 11) Reddihough D, Collins K, Others. The epidemiology and causes of cerebral palsy. Australian Journal of physiotherapy. 2003; 49 (1): 7--14. 12) Tang KL. Interviewed by: Koshy DI. 5 Dec 2013 13) The Centre For Children with Special Need. Cerebral Palsy CRITICAL ELEMENTS OF CARE. [Article] [Accessed 4 Dec 2013]. Available from:http://cshcn.org/sites/default/files/webfm/file/CriticalElementsofCare-CerebralPalsy.pdf 14) Uspharmacist.com. USPharmacist.com > Cerebral Palsy: Pharmacologic Treatment of Spasticity. [Online], [Viewed 6 Dec 2013]. Available from: http://uspharmacist.com/content/d/featured%20articles/c/10170/ 15) Zimbio.com. Untitled. [Online], [Accessed 8 Dec 2013]. Available from: http://www.zimbio.com/Cerebral+palsy/articles/H6K4PmzsnyM/Role+physiotherapy+Cerebral+palsy
Q & A
THANK YOU