Cerebral palsy

CEREBRAL PALSY

1. INTRODUCTION Cerebral palsy is actually an umbrella term for several different types of physical disabilities . The term ‘‘ cerebral’’ refers to the area of the brain that is affected by the disease. The disease often includes other connections in the brain involving the cortex and parts of the cerebellum as well. The term ‘palsy’ refers to the disorder of movement .

2. DEFINITION A condition marked by impaired muscle coordination and/or other disabilities, typically caused by damage to the brain before or at birth.

3. INCIDENCE Prevalence rate is about 4% per 1000 live birth 10% of infants born 1000gm or less at birth 5%-10% incidence in preterm Birth asphyxia as a cause only in 3-21%

4. Types/classification BASED ON MOTOR DEFICIT (MOVEMENT DISORDER) A. SPASTIC CEREBRAL PALSY The most common form of cerebral palsy 65-70-% of all people with the condition are affected by this type Have stiff and awkward movement

5. Depending upon the involvement of spasticity

6. B. EXTRAPYRAMIDAL CEREBRAL PALSY (DYSKINETIC CP) It is found in about 30 percent of patients of all cerebral palsy. Uncontrolled interfere with speaking, feeding, grabbing, reaching and others skills that require motor skills. Caused by cerebral damage due to kernicterus.

7. C. ATONIC CEREBRAL PALSY Found in about 5% of all cerebral palsy patient Poor balance and lack of coordination Results in stumbles and falls Ataxia and tremors appears by the age of 2 years D. MIXED FORM Spastic muscle tone and involuntary movement Have damage to the motor cortex and cerebellum

8. ACCORDING TO SEVERITY A. MILD CEREBRAL PALSY (20%) Patients are ambulatory, fine movement are impaired only. B. MODERATE CP (50%) These children achieve ambulation by self-help. There is impaired gross motor, fine motor and speech development. C. SEVERE CP (30%) The children present with multiple defects and unable to perform usual activities of daily living.

9. CLINICAL MANIFESTATIONS EARLY SIGNS OF CP Asymmetric movement Restlessness Irritability Feeding or swallowing or poor sucking Poor head control Tongue thrust Excessive high pitch cry Slow weight gain

10. LATE SIGNS OF CP Delayed gross motor development Persistent infantile reflexes Weakness Abnormal postures Drooling Recurrent infections Malocclusion of teeth Constipation Caries teeth Delayed or defective speech Evidence of mental retardation

11. management

12. Medical management Correction or alleviation of specific neuro-motor deficits or associated disabilities. Symptomatic management is done. Pharmacotherapy Diazepam - for spasticity Strychnine - for hypotonic Levodopa - for athetosis Carbamazepine - for dystonia Anticonvulsants - for epilepsy Tranquilizers - for behavioral problems Muscle relaxants- to improve muscular functions

13. Physiotherapy. Development enrichment experiences. Development of vocational and socialization. Emotional behavioral and social adjustment.

14. SURGICAL MANAGEMENT Orthopedic correction of: Scoliosis Contractures Dislocations Rhizotomy is an attempt to decrease spasticity.

15. bibliography Dutta P . pediatric nursing. 2 nd ed. New Delhi: Jaypee brothers, 2009. P. 374-76 Jacob A. Pediatric Nursing. 1 st ed. Indore: NR Brothers; 1997.P . 358-65 Marlow DR, Redding BA . Text book of pediatric nursing. 6 th ed. New Delhi: Elsevier. 2011; P.947-56 5. Ghai P.O, Paul K.V, Bagg . A essential pediatrics. 7 th ed. New Delhi: CBS publishers; 2010.P. 559-91