Cerebral palsy. Cerebral pediatric .pptx

Cerebral palsy

1. Cerebral Palsy

2. Definition Cerebral palsy is an umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes, secondary to lesions or anomalies of the brain arising in the early stages of its development.

3. Cause low birth weight birth asphyxia (low oxygen) abnormalities during pregnancy acquired infantile spasms acquired brain injury acquired cerebral infection

4. classification based on distribution hemiplegia (one side) diplegia (lower limbs) quadriplegia (four limbs) based on predominating form spasticity dyskinesia (involuntary movement) ataxia (coordination disorders)

5. Gross Motor Function Classification System GMFCS level 1 walk at home, outdoors climb stairs without use of a railing run and jump with speed, balance limitation

6. Gross Motor Function Classification System GMFCS level 2 walk climb stairs using railing difficulty walking long distance, uneven terrain, inclines, in crowded areas

7. Gross Motor Function Classification System GMFCS level 3 walk using hand-held mobility device climb using railing with supervision wheeled mobility for long distance

8. Gross Motor Function Classification System GMFCS level 4 walk for short using physical assistance at home use wheelchair outdoor

9. Gross Motor Function Classification System GMFCS level 5 use manual cheelchair all time limited ability to maintain antigravity head and trunk postures

10. Physical examination cognetive skills bone and joints deformities joints ROM muscle power muscle tone hyper - hypo, reflexes muscles coordination - invulontary movement posture standing sitting lying balance gait analysis

11. physical examination spinal assessment (flexibility, deformity) sitting hip abduction lying hip rotation prone hip flexion supine with other hip extension hip extension prone with other hip flexed knee flexion extension dorsiflexion with knee flexed and extended

12. Muscle tone modified ashworth scale 00 hypotonia normal 1 Slight increase in tone manifested by a slight catch and release or minimal increased resistance to joint range of motion 1+ Slight increase in tone manifested by a slight catch and minimal increased resistance to joint range of motion for more than half the joint range 2 More marked increase of tone through most of the whole joint range, but the affected joint is easily moved 3 Considerable increase in muscle tone; passive movement difficult but possible 4 Affected joint is stiff and cannot be moved

13. motor assessment tone - spasticity - reflex activity mucsle weakness - fatigue - incoordination posture gait analysis

14. Muscluloskeletal Deformities neruological lesion slow the development of typical patterns of movement postural deformities from increased or decreased muscle tone positional deformities from habitual postures imbalance in muscle groups deformities of joints and bones

15. hemiplegia walk independently smaller limbs and leg shortening in affected side equinus of foot and ankle flexion of elbow wrist and fingers adducted thumb

16. spastic diplegia contractures of hip flexors and adductors and hamstring and calf muscles internal rotation of hip and femoral anteversion kyphosis or hyper-lordosis

17. quadriplegic as befor plus hip subluxation or dislocation spine kypho-scoliosis

18. pain many CP patients suffer from pain in adolcense pain usually in hip and lower back and lower limb

19. management medication (anticonculsants, antispasm, botulinum) sergery (correction of deformities) physical therapy

20. NDT handling and control given at key points to inhibit spasticity and guide movements correct posture facilitate correct movement and tone inhibite wrong movement and tone

21. conductive education conductive education are provided in structured groups led by a conductor who combines the roles of a teacher and therapist younger patient use songs and rhythm older use tasks

22. hare approach encourage child’s ability to control movement of the trunk by the use of arm and leg gaiters, below knee plaster boots, aids and adapted furniture

23. strength training exercise for weak muscles concerning spasticity

24. constraint-induced movement therapy the therapy involves constraining the use of a child’s unaffected arm and encouraging increased activity of the affected limb

25. Positioning and postural management Children with Cerebral Palsy need external postural support in different positions with the aim of enabling them to experience and develop more normal ways of moving and prevent secondary complications.

26. Goals of positioning Normalizing tone or decreasing its abnormal influence on the body Maintaining skeletal alignment Preventing or accommodating skeletal deformity Providing a stable base of support to promote function Promoting increased tolerance of the desired position Promoting comfort and relaxation Facilitating normal movement patterns or controlling abnormal movement patterns Managing pressure or preventing the development of pressure sores

27. principles of good positioning Symmetry and alignment feel comfortable. varied and changed frequently. adjusted to the specific positions useful to modify/improve the child’s pattern of posture and movement.

28. Lying position Supine lying, side lying and prone position should be alternated during the day often to prevent pressure sores and avoid body stiffness. Especially lying face down is a good position for a child to begin to develop control of the head

29. Sitting position A stable postural base-the position of the pelvis is an important factor Postural Control and Alignment Postural Head Control

30. Standing position preventing the risk of dislocation of hip and pain density of the bone Breathing and blood circulation Emptying the bladder and bowel Reduce stiffness, increased tone and uncontrolled movements

31. Standing position

32. Examples Positioning and postural management