CEREBRAL PALSY.pptx

CEREBRAL PALSY

1. CEREBRAL PALSY Syed masood

2. DEFINITION DISORDER OF MOVEMENT AND POSTURE DUE TO DEFECTIVE OR NON-PROGRESSIVE LESION OF IMMATURE BRAIN.

3. EPIDEMOLOGY 1-3/1000 LIVE BIRTHS MALES AND FEMALES ARE EQUALLY AFFECTED

4. THE PRETERM INFANT Prof. Dr. R Harihara Prakash, MPT (Paed. Neuro) Definition by GESTATIONAL AGE BIRTH WEIGHT WHO definition: Less than 37 weeks gestation LBW : < 2500 gms VLBW: < 1500 gms ELBW : < 1000 gms Infant born before: 37 completed gestational weeks – preterm 32 completed gestational weeks – very preterm 28 completed gestational weeks – extremely preterm Lower the gestational age, more immature is the infant .

5. ETIOLOGY 1. PEMATURITY: TRAUMA AT DELIVERY AFTER BIRTH DUE TO IMMATURE RESPIRATORY AND CVS 2. ASPHYXIA: ACCIDENTS AT BIRTH KNOTTED UMBLICAL CORD CORD AROUND NECK PROLAPSED CORD

6. ETIOLOGY CONTD. 3. BIRTH TRAUMA: DISPROPORTION FORCEP DELIVERY BREECH DELIVERY 4. SEVERE JAUNDICE: UNCONJUGATE BILIRUBIN IN BLOOD DEMAGES BASAL GANGLIA.

7. ETIOLOGY CONTD. 5. HYPOGLYCEMIA: CAUSES SEVERE BRAIN DEMAGE. 6. INTRA-UTERINE VIRUS INFECTION: RUBELLA VIRUS INFECTION AND CYTOMEGALOVIRUS INFECTION. 7. NEONATAL MENINGITIS

8. ETIOLOGY CONTD. 8. GENETIC CAUSES 9. VASCULAR CAUSES 10. CHOREOAMNIONITIS

9. CLASSIFICATION

10. CLASSIFICATION CONTD.

11. HEMIPLEGIA Hemiplegic children become independent walkers by age 3. Sensory deficits and learning disability add to movement problem. Children adopt compensatory pattern. Difficulty in having midline orientation .

12. DIPLEGIA Requires walking aids. Can usually walk by the age of 4 to 7. Hand dexterity is impaired. Children have difficult writing and other tasks requiring fine motor control. Surgery may be required for contractures and deformities.

13. QUADRIPLEGIA Mobility is major problem. All four limbs are affected. Poor muscle endurance. Difficulty maintaining static and dynamic posture

14. SPASTIC DISORDER OF TONE CAUSED BY DEMAGE TO UMN OR ALONG PATHWAYS INCREASED DTR AND EXTENSOR PLANTER RESPONSES

15. DIFFERENCES BETWEEN SPASTICITY AND DYSTONIA Spasticity Dystonia Examination You feel You see Tendon reflexes Increased Generally normal Clonus Present Absent Pathological reflexes Present Rare

16. ATAXIC CAUSED BY DEMAGE TO CEREBELLUM OR ITS PATHWAYS. SIGNS: HYPOTONIA DISTURBANCE OF BALANCE INCORDINATION INTENTION TREMORS DYSARTHRIA NYSTAGMUS

17. ATHETOID DEMAGE CENTERED ON BASAL GANGLIA IRREPRESSIBLE SLOW WRITHING MOVEMENTS.

18. EXTRAPYRAMIDAL CLINICAL MENIFESTATION: DYSKINESIA DYSTONIA TREMORS RIGIDITY ARMS, LEGS, NECK AND TRUNK INVOLVED 30% OF PATIENTS MR AND HEARING DEFICITS MAY BE PRESENT.

19. COMMON SITES FOR CONTRACTURES Upper extremity Lower extremity Pronator Hip adductor – flexor Wrist and finger flexor Knee flexor Thumb adductor Ankle plantar flexor

20. COMMON SITES OF DEFORMITY Place Deformity Spine Scoliosis, kyphosis Hip Subluxation , dislocation Femur and tibia Internal or external torsion Foot Equinus , valgus , varus

21. SPINAL DEFORMITIES SPINAL DEFORMITY OCCURS IN Scoliosis Total body involved spastic and dystonia Kyphosis ( thoracolumbar ) Patients with no sitting balance Kyphosis (lumbar) Patients with hamstring contracture Hyperlordosis (lumbar) Ambulatory patients with hip flexion contractures

22. SPINAL DEFORMITIES

23. SPINAL DEFORMITIES Long C shaped hyperkyphosis in the child with weak spinal extensor muscles . Hamstring spasticity causes posterior pelvic tilt and sactal sitting resulting in lumbar kyphosis .

24. ASSOCIATED FEATURES

25. ASSOCIATED FEATURES

26. CP IS LIKELY IF THERE IS NO HEAD CONTROL AT 3 MONTHS SITTING AT 6 MONTHS ROLLING OVER AT 6 MONTHS WALKING AT 18 MONTHS

27. QUERIES