Cerebral Palsy

UNDER SUPERVISION OF SHEELU KACHHAP

PRESENTED BYSHARADA PRASAD SINGHB.Ed.-SPECIAL (H.I.)BANARAS HINDU UNIVERSITY

William John Little(1810-1894)

* Formerly known as "Cerebral Paralysis,“

* First identified by English surgeon William Little in 1860. (Little’s disease)* Believed that asphyxia during birth is chief cause

Historical Background

• In 1897, Sigmund Freud, suggested that difficult birth was not the cause but only a symptom of other effects on fetal development.

• National Institute of Neurological Disorders & Stroke (NINDS) in 1980s suggested that only a small number of cases of CP are caused by lack of oxygen during birth

Definition• Cerebral“- Latin Cerebrum;

Affected part of brain

• “Palsy " -Gr. Para- beyond, lysis – loosening

Lack of muscle control

Cerebral Palsy-a condition caused by injury to the parts of the brain that control our ability to use our muscles and bodiesCerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood.

Prenatal (70%)Peri-natal (5-10%)Post natal

In about 70 % of cases, CP results from events occurring before birth that can disrupt normal development of the brain.Commonly thought to be due to birth asphyxia; now known to be due to existing prenatal brain abnormalities.

Premature delivery is the single most important determinant of CP.In 24% of cases, no cause is found.

Causes of CP

• Maternal infections E.g. rubella, herpes simplex • Inflammation of placenta (chorion amnionitis)• Rh incompatibility • Diabetes during pregnancy • Genetic causes • Exposure to radiations • Maternal jaundice• Teratogens

Prenatal

• Prematurity- immature respiratory & cardiac function

• Asphyxia• Maconeum aspiration • Birth trauma • Disproportion • Breech delivery • Rapid delivery • Low birth weight• Coagulopathy

Peri- natal

• Brain damage secondary to cerebral hemorrhage, trauma, infection or anoxia

• Motor vehicle accidents • Shaken baby syndrome • Drowning • Lead exposure • Meningitis • Encephalitis

Post natal

• A) Classification by number of limbs involved:– 1) Quadriplegia- all 4 limbs– 2) Diplegia- all 4 limbs, legs more severely affected

than arms– 3) Hemiplegia- one side of the body; arm is usually

more involved than the leg– 4) Triplegia- three limbs are involved, usually both

arms and a leg– 5) Monoplegia- only one limb is affected, usually

an arm

Types of Cerebral Palsy

Monoplegia Diplegia

Hemiplegia

Quadriplegia

Total Body

Types of Cerebral

Palsy

• B) Classification by movement disorder:– 1) Spastic CP- too much muscle tone or tightness.

Movements are stiff, especially in the legs, arms, and/or back.

– 2) Athetoid CP (dyskinetic CP)- affect movements of the entire body. Involves slow, uncontrolled body movements and low muscle tone; hard for person to sit straight and walk.

– 3) Ataxic CP- least common. Disturbed sense of balance and depth perception. Poor muscle tone, a staggering walk and unsteady hands. Results from damage of the cerebellum.

– 4) Combined classifications- both movement and number of limbs involved are combined.

Types of CP (cont.)

Signs and Symptoms

• OF CEREBRAL PALSY

a.

b.

c.

d.e.

f.

g.h.

ASSOCIATED PROBLEMSOF CEREBRAL PALSY

• Hearing and visual problems

• Sensory integration problems

• Failure-to-thrive, Feeding problems

• Behavioral/emotional difficulties,

• Communication disorders

• Bladder and bowel control problems, digestive problems

(gastroesophageal reflux)• Skeletal deformities,

dental problems• Mental retardation and

learning disabilities in some

• Seizures/ epilepsy

TreatmentOF CEREBRAL PALSY

No

-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

A. General management - Proper nutrition and personal care

B. Pharmacologic Botox, Intrathecal, Baclofen

- control muscle spasms and seizures, Glycopyrrolate -control drooling

Pamidronate -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 • Orthotics, braces and splints• Positioning devices• Walkers, special scooters, wheelchairs

E. Special Education

F.Rehabilitation Services- Speech and occupational therapies

G. Family Services -Professional support

H. 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

A.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

“A disabled child has the right to enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the child’s active participation in the community.”

-UN Convention on the Rights of the Child. 1989.

Summary

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