CEREBRAL PALSY

for pediatrics UG teaching

1. Dr M.Sanjeevappa
M.D.(paeds)
Asst.Professor
Dept. of Paediatrics
GMC ,Ananthapuramu

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 orthopedicsurgeon.
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 posturecausing activity
limitation, that are attributed tonon progressive
disturbancesthat 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

11. Gross Motor Function Classification System(GMFCS)

13. 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.

14. 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.

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

16. 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.

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

18. 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.

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

20. 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

21. 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.

23. 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.

25. 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.

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

27. 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.

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

30. To improve feedings, correct GERD and correct
associated dental problems.

32. THANK YOU….