Cerebral palsy

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1. CEREBRAL
PALSY
by dr M Saleem
Laghari
MBBS,MCPS,FCPS(GOLD
MEDALIST)
Assistant
professor
Paediatrics

2. DEFINITION
1. Disorder of Movement and posture
2. Damage to immature brain
3. Permanent
4. Non progressive (static encephalopathy)
5. Non hereditary
6.Onset before or at birth or during early months
of life.

3. INCIDENCE / PREVALENCEINCIDENCE / PREVALENCE
• In the industrialized world, the incidence
of cerebral palsy is about 2 per 1000 live
births while in developing world is 7/1000
live births.

4. ETIOLOGYETIOLOGY
Intrauterine
•Bleeding
•Infections such as rubella and
toxoplasmosis.
•Thromboembolic phenomena
•Congenital malformations:
Disorders of neuronal migration
•Massive irradiation

5. Peri natal and postnatal
•Birth trauma
•Intracerebral hemorrhage, cerebral
infarction.
•Birth asphyxia, hypoxic ischemic
encephalopathy.
•Hypoglycemia
•Kernicterus
•Acidosis

6. Infancy
•Meningitis,
•Encephalitis,
•Hypoglycemia
•Trauma
•Vascular accidents

7. Pathology
•Extent of pathological lesion variable
•Wide spread cerebral atrophy
•Atrophy of basal ganglia.
•Atrophy and gliosis of one or both cerebral
hemispheres

8. Clinical Types of cerebral palsyClinical Types of cerebral palsy
•Spastic C. Palsy 75 %
•Extra pyramidal C.Palsy 9 to 22%
(Choreoathetosis, dystonia)
•Mixed cerebral palsy
•Atonic cerebral palsy
Atonic Diplegia
Cong.Cerebellar Ataxia

9. TOPOGRAPHIC CLASSIFICATIONTOPOGRAPHIC CLASSIFICATION
•Monoplegia
•Paraplegia
•Hemiplegia
•Triplegia
•Quadriplegia
•Diplegia

10. FUCTIONAL CLASSIFICAITONFUCTIONAL CLASSIFICAITON
•CLASS 1 No limitation of actitivity
•CLASS ii Slight to moderate limitation
•CLASS III Moderate to great limitation
•CLASS IV No useful physical activity

11. Different forms of cerebral palsyDifferent forms of cerebral palsy
•Spastic diplegia (10 – 33%)
•Spastic quadriplegia (9-43%)
•Spastic hemiplegia (25-40%)
•Extrapyramidal CP (9-22%)
•Atonic CP
•Mixed CP (9-22%)

12. Clinical featuresClinical features
•Manifestation may not be apparent before
one year of age.
•Reflex hyperactivity
•Pseudobulbar palsy when spasticity is
bilateral.
•Excessive drooling.
•Microcephaly

13. Clinical featuresClinical features
•Delayed motor
milestones
•Decreased power
•Abnormality of tone
•Abnormal
Persistence of
primitive reflexes
Moro reflex

14. •Paucity of movements and facial
expression
•Arching back
•Scissoring of legs and gait
•Clenching of hands with adducted
thumb
•Sustained Ankle Clonus

15. •Spastic gait
•Clasp knife type spasticity
•Exaggerated deep tendon
reflexes
•Delayed / slurred speech
•Choreo athetosis
•Ataxia
•Babinski sign positive after
the age of two years.

20. COMPLICATIONS AND COMPLICATIONS AND
ASSOCIATED DEFICITSASSOCIATED DEFICITS
•Seizure disorders50%
•Mental retardation 50%
•Visual defects 50%
•Microcephaly 25%
•Hearing defects 15%
•Speech Disorders 15%
•Psychological problems

21. •Learning problems
•Behavior problems
•Psychiatric
problems
•Secondary
contracture and
deformities
•Constipation

22. •Oro dental infections
•Recurrent SOM
•Recurrent aspiration
•Recurrent UTI
•Bed sores

23. Differential DiagnosisDifferential Diagnosis
•Leukodystrophy
•Hydrocephalus / subdural effusion
•Brain tumor
•Spinal cord lesions
•Muscular dystrophy
•Werdnig hoffmann and benign congenital
hypotonia
•Progressive CNS disorder

24. INVESTIGATIONSINVESTIGATIONS
•C.T. Scan Brain
•M.R.I.Brain
•EEG
•IQ testing
•Audiometry
•Visual assessment
•Investigations for
complications

25. MANAGEMENTMANAGEMENT
 The disease is
incurable.
 AIM is to make child
more functional and
independent.

26.  Multi disciplinary approach.

27. PHYSIOTHERAPYPHYSIOTHERAPY
•Passive
movements to all
the limbs.

28. •Prone position
•Keep legs apart
with pillow in
between while
sleeping.
•Stretching
exercises to
prevent
contractures.

29. •Help the baby to learn
and maintain sitting
posture
•Teach the baby to hold
his head and balance it
•Teach baby to use
hands by grasping and
relaxing, use soft ball or
rubber toy.
•Turn him frequently
from supine to prone
and vice versa

30. •Teach him to crawl.
•Help him to stand
and walk
•Use walking aids
when necessary.
•Correct application
of splints and
braces
•Protection from
injuries and
infections.

31. Teach necessary skills
for daily life; feeding,
dressing, toilet training,
speech, writing etc.
Provide recreational
facilities like games,
cycling,swimming etc.

32. •Take care of the
child's education
and find out the
appropriate
institution and
occupation

33. Vision and hearing
i)Perform careful assessment of vision
and hearing
ii)Seek help of ophthalmologist for squints
and errors of refraction
iii)Refer for audiometry and guidance for
hearing aids.

34. Speech and feeding
1.Give feeding and speech advise
2.Advise more frequent and small feeds, to
prevent malnutrition.
3.Give more time for chewing and
swallowing
4.Provide constant stimulation of hearing
to help the development of speech

35. Orthopedic advise
1.Advice for boots and shoes
2.Surgical help for elongation of tendo
calcaneus.
3.Surgical procedure for reduction of
adduction spasm
4.Tendon transfer procedures to help
supination and pronation.
5.Division of spinal nerves for severe
spasticity.

36. PSYCHIATRIC HELP
For behavior disturbance
EPILEPSY
Anticonvulsants
SPASTICITY
Diazepam, baclofen, benzhexol and
Inj. of botulin toxin into posterior nerve
roots

37. PreventionPrevention
•Pre natal care.
•Natal care.
•Post natal care.

38. Prognosis Prognosis
•Depends on presence and severity of
associated motor and intellectual
handicap.