cerebral palsy: what every early intervention provider should know joshua j. alexander, md director...
TRANSCRIPT
Cerebral Palsy:What Every Early
Intervention ProviderShould KnowJoshua J. Alexander, MD
Director of Pediatric Rehabilitation
UNC School of Medicine
Objectives Understand the definition of cerebral palsy Be able to identify common types and
distributions of cerebral palsy Understand functional classification system
ratings for children with cerebral palsy Know common secondary conditions
associated with CP Be able to develop an approach to care of
the child and their family Be familiar with resources for children with
CP and their families
Overview
Our Children Expectations and Goals Challenges to
Overcome Your Responsibilities Resources Questions
Our Children
Our Children
Brain-Related Lack of Muscle Control
CEREBRAL PALSY
“ A persistent though not unchanging disorder of movement and posture,appearing early in life and due to a non-progressive lesion of the developing
brain” - Little
Our Children
“A disorder of movement and posture due to a defect or lesion of the immature brain”
- Bax
Our Children
“A static, non-progressive (though not unchanging) condition characterized
by abnormalities in movement, posture,balance, and /or tone
(and lots of other things, too)”
- Alexander
Our Children are Unique Age Type Distribution Associated Challenges Personal Strengths Family Environment
AgeAge
Birth Preschool Grade School Middle School High School College/ Adulthood
TypeType
Distribution
Monoplegia Hemiplegia Diplegia Quadriplegia
Functional LevelFunctional Level
Gross Motor Functional Classification System GMFCS - E&R (2007)
Level 1 – Walks without limitations Level 2 – Walks with limitations Level 3 – Walks using hand-held mobility device Level 4 – Self-Mobility with limitations/ May use
Powered Mobility Level 5 – Transported in a Manual Wheelchair
Functional LevelFunctional Level Manual Ability Classification System
(MACS) – (2005)
Our Children
GOALS: stay healthy and happy maximize communication and mobility achieve independence in self-care
activities pursue higher education satisfying personal and professional life Take care of us in our old age
Challenges
Seizures
Hemiplegia = 67%
Quadriplegia = 56%
Diplegia = 31 %
Dyskinesia = 27%(increased in presence of mental retardation)
Overall, risk is ~ 33%
Seizures
14 % will become seizure free for 2+ years on AEDs
If seizure-free for 2+ years, try stopping AEDs
40% will have relapses/ 60% won’t
Delgado, et al. Pediatrics 97(2) February, 1996
Cognitive/Behavioral Challenges
mental retardation learning disability ADD ADHD “Acting out” Memory difficulties
Hearing Loss
Prevalence = <10%
Most common type = sensori-neural
Feeding Challenges
BPD----SOB---Decreased endurance High arched palate Oral Motor Dysfunction Hypersensitivity GER--- food avoidance Parent-Infant Bonding
Feeding Challenges
Children with cerebral palsy can take up to 18 times longer than non-disabled
children
to eat a mouthful of food.
(especially those without speech)
Gisell & Patrick. Lancet, 1985
Obesity
Decreased caloric expenditure Food = love Food = quiet g-tube feeds bypass satiety cues
Obesity
Problems:outgrow equipmentincreased skin pressurestransfer difficulties
- stress on the heartStress on the bones and ligaments
Drooling
Dysarthria
Dentitia
MusculoskeletalHip Dislocation
Scoliosis
Pelvic Obliquity
Contractures
Fractures
SpasticityA velocity-dependent increase in muscle tone
(and another lecture)
Sensory Disorders
two-point discrimination
stereognosis
Incontinence
cognitive impairment decreased communication skills decreased mobility neurogenic bladder
Your Responsibilities
Help Make the Diagnosis Identify Challenges Prevent the Preventable Determine and Encourage Child’s
Abilities Refer & Coordinate Services/Supports Educate & Advocate
Diagnosis
CAUTION !
Not all “CP” is really Cerebral Palsy
Make the Diagnosis
Why it’s important:
Prediction for the future is different
siblings/relatives may be at risk
therapies for some disorders
Make the Diagnosis
RED FLAGS Is there a similar illness in other family
members? Is there a progression of symptoms? Has the child lost abilities?
Identify Challenges
Prevent the Preventable
Immunizations Dental care Injury prevention Abuse prevention Divorce prevention Sibling issues
Referrals
MDs - Neurology,Ortho, NS, Genetics, GI
Therapists - OT, PT, ST, other(?), RD’s Nursing- Home and Preschool Financial Resources (SSI, Medicaid,
CAP, CSHS, Healthchoice) Child Service Coordinators Family Support Groups
Coordination
Medical services Therapy services Home Health services Letters of Necessity School Services Managed Care Transportation
Resources
The Real ExpertsThe Real Experts
Questions?