Cerebral Palsy for nurses and midwives ptx pead III.pdf

Cerebral Palsy for nurses and midwives ptx pead III.pdf

1. Disorders of Central Nervous System
Cerebral Palsy
Prepared by:
Kakooza Abdul Wahabu
BNS,PGDME

2. Cerebral Palsy (CP)
Cerebral palsy is a term used to describe a range of non-specific clinical
symptoms characterized by abnormal motor pattern and postures caused
by non-progressive abnormal brain function.
Cerebral palsy is the dysfunction of the portion of the brain that controls
motor function resulting in partial paralysis and uncontrolled movement.
Cerebral palsy is the most common movement disorder of childhood; it is
a lifelong condition and one of the most common causes of physical
disability in children.

3. Incidence
The word “cerebral” means having to do with the brain. The word “palsy” means
weakness or problems with body movement.
CP is the most common cause of motor disabilities in childhood.
According to the Centers for Disease Control and Prevention (CDC), it affects at
least 1.5 to 4 out of every 1,000 children worldwide.
The crude cerebral palsy was 2.7 per 1000 children and prevalence increased to
2.9 per 1000 children after adjustment for attribution. The prevalence is lower in
older than young children

4. Causes of CP
Prenatal
Congenital malformation of brain structure,
Hypoxia .e.g. from maternal bleeding and preeclampsia
Maternal infections like TORCHES especially rubella
Exposure to radiation
Environmental toxins
Metabolic disorders

5. Cont’n
Intrauterine growth restriction
Nutritional deficits
Preeclampsia
Abdominal insults
Perinatal
Asphyxia
Hypoxia
Sepsis or central nervous system infection

6. Cont’n
Placental complications
Electrolyte disturbance
Cerebral hemorrhage
Chorioamnionitis (infection of the placental tissues and amniotic fluid)
Postnatal
Kernicterus (a type of brain damage that may result from neonatal
hyperbilirubinemia)
Asphyxia

7. Cont’n
Head trauma (e.g., motor vehicle accidents, abuse)
Seizures
Viral or bacterial infection of the central nervous system (e.g., meningitis)
Cerebral infarcts
Intraventricular hemorrhage

8. Risk Factors
Certain factors put babies at an increased risk for CP. These include:
Premature birth
Low birth weight
Being a twin or triplet
A low Apgar score, which is used to assess the physical health of Babies at birth
Rh incompatibility, which occurs when a mother’s blood Rh type is incompatible
with her baby’s blood Rh type maternal
Exposure to toxic substances, such as methylmercury, while pregnant

9. Pathophysiology
Cerebral palsy is a disorder caused by abnormal development of, or damage to,
the motor areas of the brain, resulting into a neurologic lesion that causes a
disruption in the brain's ability to control movement and posture.
The lesion itself does not change over time, thus, the disorder is considered non-
progressive since the brain injury does not progress.
However, the clinical manifestations of the lesion change as the child grows.
Some children may improve, but many either plateau in their attainment of motor
skills or demonstrate worsening of motor abilities because it is difficult to maintain
the ability to move over time.

11. Types of CP
Spastic (most common): The cortex is affected resulting in the child having a
scissor-like gait where one foot crosses in front of the other foot. Spastic CP is the
most common type of CP, affecting approximately 80 percent of people with CP. It
causes stiff muscles and exaggerated reflexes, making it difficult to walk.
Athetoid/ Dyskinetic cerebral palsy: The basal ganglia are affected resulting in
uncoordinated involuntary motion.People with dyskinetic CP have trouble
controlling their body movements. The disorder causes involuntary,sit, swallow, or
talk, abnormal movements in the arms, legs, and hands. In some cases, the face
and tongue are also affected. The movements can be slow and writhing or rapid
and jerky. They can make it difficult for the affected person to walk,

12. Cont’n
Ataxic: The cerebellum is affected resulting in poor balance and difficulty with
muscle coordination. Ataxic CP is the least common type of CP. Ataxic CP is
characterized by voluntary muscle movements that often appear disorganized,
clumsy, or jerky. People with this form of CP usually have problems with balance
and coordination.
They may have difficulty walking and performing fine motor functions, such as
grasping objects and writing.

13. Cont’n
Hypotonic cerebral palsy: Hypotonic CP causes diminished muscle tone and
overly relaxed muscles. The arms and legs move very easily and appear floppy,
like a Babies with this type of CP have little control over their head and may have
trouble breathing. As they grow older, they may struggle to sit up straight as a
result of their weakened muscles. They can also have difficulty speaking, poor
reflexes, and walking abnormalities.
Mixed cerebral palsy: Some people have a combination of symptoms from the
different types of CP. This is called mixed CP. In most cases of mixed CP, people
experience a mix of spastic and dyskinetic CP.

14. Progression of cerebral palsy
Level 1 cerebral palsy: It is characterized by being able to walk without
limitations.
Level 2 cerebral palsy: A person with level 2 CP can walk long distances without
limitations, but they can’t run or jump. They may need assistive devices, such as
leg and arm braces, when first learning to walk. They also may need to use a
wheelchair to get around outside of their home.

15. Level 3 cerebral palsy: A person with level 3 CP can sit with little support and
stand without any support. They need handheld assistive devices, such as a
walker or cane, while walking indoors. They also need a wheelchair to get around
outside of the home. They’re able to move independently in a wheelchair, and
they need some support when they’re sitting.

16. cont’n
Level 4 cerebral palsy; there is self mobility with use of powered mobility
assistance. Usually supported when sitting and likely to be transported in the
manual wheelchair.
Level 5 cerebral palsy: A person with level 5 CP needs support to maintain their
head and neck position.
They need support to sit and stand, and they may be able to control a motorized
wheelchair.
NOTE: The patient has normal intelligence regardless of the patient’s
uncontrollable movements

17. Assessment
History taking about
Physical examination
Investigations
EEG: Identifies the site in the brain that is causing seizures
CT scan: Identifies the site of the disorder in the brain

18. Cont’n
MRI: Identifies the site of the disorder in the brain
Screening for metabolic defects and genetic testing may be performed to help
determine the cause of cerebral palsy.
Delayed developmental milestones

19. Management
The goal of treatment is to improve limitations and prevent complications.
Treatment may include assistive aids, medications, and surgery.
Treatment is mainly preventative, symptomatic, and supportive. The use of
therapeutic modalities such as physical therapy, occupational therapy, and speech
therapy will be essential in promoting mobility and development in the child with
cerebral palsy.
Nursing management focuses on promoting growth and development by
promoting mobility and maintaining optimal nutritional intake. Providing support
and education to the child and family is also an important nursing function

20. Medical Management
Skeletal muscle relaxant (baclofen) to relax skeletal muscles and reduce spasticity.
Anticonvulsants (phenytoin, Phenobarbital to control seizures.
Anticholinergics to children with athetoid cerebral palsy to help decrease abnormal
movements
Surgical management It is often required to correct contractures related to
spasticity that are severe enough to cause movement limitations.
.

21. Common orthopedic procedures include tendon lengthening procedures,
correction of hip and adductor muscle spasticity, and fusion of unstable joints to
help improve locomotion, correct bony deformities, decrease painful spasticity,
and maintain, restore, or stabilize a spinal deformity

22. Nursing Management
Perform range-of-motion exercises to prevent contractures.
Use special appliances to help the child perform activities of daily living.
Provide protective head gear and bed pads to prevent injury.
Provide a high-calorie diet because the child will have a high metabolism rate due
to high motor function.
Explain the disorder and treatment to the family and that efforts should be made to
ensure that the child reaches the optimal developmental level possible..

23. NOTE:
Management of cerebral palsy involves multiple disciplines, including a primary
physician, specialty physicians such as a neurologist and an orthopedic surgeon,
nurses, physical therapists, occupational therapists, speech therapists, dietitians,
psychologists, counselors, teachers, and parents. There is no standard treatment
for all children.
The overall focus of management will be to assist the child to gain optimal
development and function within the limits of the disease. Spasticity management
will be a primary concern and will be determined by clinical findings

24. References
Wong, Donna L. (2009).Wong’s essentials of pediatric nursing. (8
th
ed.).
St. Louis: Mosby.
Ball, B. Cowen, (2010).Partnering with children and families. (2
nd
ed.).
New Jersey: Pearson Education 24=
Kyle, T.(2008).Essentials of paediatric nursing. Lippincott: Williams&
Wilkins
Ball, Bindler and Cowen (2010).Child Health Nursing: Parenting with
Children and families. New Jerseyson: Pear Education