Cebral palsy.pptxllllllllllllllllllllllllllllllll

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1. PREPARED BY MARRAH

2. Brain grossly differentiates into cerebrum and cerebellum during 1st Trimester of embryonic life. Neurons begin to develop in 2nd trimester. By the end of 2nd trimester all neurons are formed and any damage occurring now is irreversible. Synaptic connections occur in 3 rd trimester.

3. Cerebral palsy is a chronic neurodevelopmental disorder. never the same disease twice. Some children with CP graduate from universities and become health professionals. Some children with CP may be unable to roll or feed and may be entirely dependent for all activities of daily living.

4. First described in 1862, by William John Little, an orthopedic surgeon. Cerebral Palsy was known as Little’s Disease for decades. The term cerebral Palsy originated with William Osler and Sigmund Freud. Incidence : about 2 per 1000 live births in high resource settings.

5. Cerebral palsy (CP) describes a group of permanent disorders of movement and posture causing activity limitation, that are attributed to non progressive disturbances that occurred in the developing fetal or immature brain . The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour, by epilepsy, and by secondary musculoskeletal problems.

6. Two distinct cohorts of children present with CP. Cohort one : Infants born preterm Infants born at term experiencing a neonatal encephalopathy. Cohort two: Developmental surveillance provided through a community-based workers. Parental observation of “stiffness” or gait disturbances.

7. Prenatal (44%) First trimester : Teratogens. Chromosomal abnormalities. Genetic syndromes. Brain malformations. Second trimester : Intrauterine infections. Problems in fetal/placental functioning

8. Labor and delivery (19%) Preeclampsia. complications of labor. Perinatal (8%) PREMATURITY Sepsis/CNS infection, asphyxia. Childhood (5%) Meningitis. traumatic brain injury. toxins. Not obvious (24%)

9. Spastic : hyper tonicity with poor posture control Dyskinetic / athetoid : abnormal involuntary movement / slow wormlike writhing. Ataxic : wide-based gait. Mixed-type / dystonic : combination of spasticity and athetosis

10. Gross Motor Function Classification System(GMFCS)

11. Physical signs : poor head control after 3 months of age. stiff or rigid arms or legs. pushing away or arching back. floppy or limp body posture. cannot sit up without support by 8 months .

12. uses only one side of the body, or only the arms to crawl. clenched hands after 3 months(cortical thumb.) leg scissoring. Seizures. sensory impairment (hearing, vision). after 6 months of age, persistent tongue thrusting.

13. Extreme irritability or crying. Feeding difficulties. Little interest surrounding. Excessive sleeping.

14. Stiff or floppy posture. Excessive lethargy or irritability /high pitched cry. Poor head control. Weak suck /tongue thrust /tonic bite /feeding difficulties. Persistence of primitive infantile reflexes.

15. Intellectual impairment. Seizures. Drooling of saliva. Feeding difficulties. Orthopedic complications. Dental carries.

16. Physical Assessment. Observe LBW, preterm, and those with low Apgar scores at 5 minutes. Observe infants who have seizures, intracranial hemorrhage, metabolic disturbances. Diagnosis may not be confirmed until after 6 months of age.

17. Magnetic resonance imaging (MRI). Ultrasound. Computerised tomography (CT) scan. Electroencephalogram (EEG). Electromyogram (EMG). Additional tests: Vision impairment, Hearing impairment, Speeh impairments, Intellectual disabilities, Movement disorders

18. Medical To enhance functional abilities of CP child. Therapy is chiefly symptomatic and preventive. The broad aims of therapy are : To establish locomotion, communication and self help. To gain optimum appearance and integration of motor functions. To correct associated defects as early and effectively . To provide educational opportunities adapted to the individual child’s needs and capabilities. To promote socialization experiences with other affected, unaffected children

19. physiotherapy is directed toward good skeletal alignment for child with spasticity. Physiotherapy can help the child's strength, flexibility, balance, motor development and mobility. physiotherapy uses orthotic devices, such as braces, casting and splints to support and improved walking.

20. Using alternative strategies and adaptive equipment, occupational therapists work to promote the child's independent participation in daily activities and routines in the home, the school and the community. Adaptive equipment may include walkers, quadrupedal canes, seating systems or electric wheelchairs.

21. Speech-language therapist can help improve the child's ability to speak clearly or to communicate using sign language. RECREATION THERAPY This therapy can help improve the child's motor skills, speech and emotional well-being.

22. To reduce the effects of cerebral palsy and prevent complications: Analgesic drugs to reduce intense pain or muscle spasm. Botulinum toxin type A, used to reduce spasticity in targeted muscle of the upper and lower extremities. Dantrolene sodium, baclofen, and diazepam to improve muscle coordination and to muscle relaxation. Anticonvulsants drug, to relieve or stop seizures

23. Surgery used to correct problems with bones and joints, by lengthening any muscles and tendons that are too short and causing problems. ORTHOPEDIC SURGERY : To correct contracture or spastic deformities, to provide stability for an uncontrolled joint, to address bone malalignment, and to provide balanced muscle power. Example : tendon transfer, muscle lengthening.

24. Selective dorsal rhizotomy (SDR) is a surgical procedure that can help children with severe muscle stiffness in their legs to improve their walking.

25. To improve feedings, correct GERD and correct associated dental problems.

26. THANK YOU….