cerebral palsy
TRANSCRIPT
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CEREBRAL PALSY
Prepared by: Mohammed Ahmed Rajab
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Introduction
◦ Historically known as static encephalopathy
◦ A group of motor impairment syndromes resulting
from disorders of early brain development.
◦ Often associated with epilepsy and abnormalities of
speech, vision and intellect.
◦ However, many children and adult with CP function
at a high educational and vocational level without
sign of cognitive dysfunction
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Epidemiology
◦ CP is the most common and costly form of chronic
motor disability
◦ Prevalence: 2/1000
◦ Prevalence of CP is increased in low birth weight
infants (<1000g)
◦ CP incidence higher in premature and twin birth
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Aetiology
•Infection- German measles
- Shingles
•Diabetes
•Toxemia of
pregnancy
•Rh incompatibility
•Asphyxia
•Birth injury
•Prematurity
Caused by developmental, genetic,
metabolic, ischemic, infections
Antenatal
factors (80%)
Intrapartum
(10%)
Postpartum
(10%)
◦ Very high fever
◦ Brain infection
◦ Head injury
◦ Lack of oxygen
◦ Poisoning
◦ Intracranial
hemorrhage or
blood clot
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Risk Factors◦ Before Pregnancy:
- History of fetal wastage
- Long menstrual cycle
- Maternal thyroid disorder
- Family history of mental retardation
◦ During Labor and Delivery:
- Premature separation of placenta
◦ During Early Postnatal Period:
- Newborn hypoxic ischemic or bilirubin (kernicterus) encephalopathy
◦ During Pregnancy:
- Low socioeconomic status
- Tx of mother with thyroid hormone, estrogen or progesterone
- Maternal seizure disorder
- Polyhydramnios
- Eclampsia
- Bleeding in 3rd trimester
- Twin gestation
- Congenital malformation
- Fetal growth retardation
- Abnormal fetal presentation
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Physiologic
identify forms of motor impairment
Spastic CP
Dyskinetic CP
Ataxic CP
Mixed CP
Distribution
identify location of musculoskeletal involvement
Spastic diplegia
Spastic quadriplegia
Spastic hemiplegia
Classification
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Spastic CP◦ The most common form of CP (70-
80%)
◦ Due to injury to upper motor neurons
of pyrimidal tract
◦ Often exhibit truncal hypotonia in 1st
year of life
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•Characterized by at least 2 of following:
-Abnormal movement pattern
-Increased tone
-Pathologic reflexes (Babinski, hyper-reflexia)
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Dyskinetic CP◦ 10-15%
◦ Result of injury to basal ganglia (associated with kernicterus)
◦ Characterized by variable tonal abnormalities & involuntary
movement (athetosis, chorea)
◦ Fewer seizures & >normal cognitive function
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Ataxic CP◦ <5% of CP cases – rare
◦ Results from cerebellar injury
◦ Abnormalities of voluntary movement and balance
◦ Wide-based, unsteady gait, abnormal muscle tone
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Mixed CP◦ 10-15% of all cases
◦ > 1 type of motor pattern is present
& when 1 pattern does not clearly
dominate another
◦ Associated with > complications:
sensory deficits, seizures, cognitive-
perceptual impairments
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Dystonic CP
◦ Uncommon
◦ Characterized by reduced activity and stiff movement
(hypokinesia) and hypotonia
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Choreoathetotic CP
◦ Rare
◦ Caused by excess hyperbilirubinemia
◦ Dominated by increased and stormy movement (hyperkinesia)
and hypotonia
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Clinical Manifestations
◦ Spectrum of developmental abnormalities
◦ Mental retardation
◦ Epilepsy
◦ Motor handicap
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•Visual, hearing, speech, cognitive &
behavioral abnormalities
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Diagnosis◦ History and PE should preclude
progressive disorder of CNS,
degenerative disease, metabolic
disorders, spinal cord tumor,
muscular dystrophy
◦ MRI scan of brain or spinal cord
◦ Test of hearing and visual function
◦ Genetic evaluation
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Management◦ CP cannot be cured
◦ Family support – educate parents
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◦ Adjunctive therapy:
- Physiotherapy
- Occupational therapy
- Speech therapy
◦ Surgery
◦ Psychologist or psychiatrist
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Nursing Manegment
◦ Early Intervention
◦ • The earlier disabled children are given
rehabilitation and education, the better they are
able to realize their full potential later in life.
◦ - Early intervention can have a really positive
impact on a child’s life.
◦ Physiotherapy
◦ - Physiotherapy is extremely beneficial and the
children love the interaction
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◦ Feeding
◦ • Three finger jaw control helps in swallowing
◦ • Speech therapy helps in better swallowing
◦ - Care and dignity when feeding a disabled child
improve trust and ensure a healthy, happy child.
◦ Children with learning disabilities
◦ - Encourage appropriate use of the curriculum and
teacher’s guide for mentally disabled children.
◦ - A teacher using teaching materials she has made
herself and adapted to the individual needs of this
child.
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◦ Children with hearing and visual impairments
◦ - Special technical skills and training are to be
provided to help deaf or blind children.
◦ - Teaching self help skills through play for blind
children.
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◦Drugs:
- Oral Dantrolene sodium, benzodiazepines, baclofen
– treat spasticity
- Botulinum toxin
- Levodopa
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Thank you!!