cerebral palsy.pptx for nursing students.ppt

Nursing College .

2. Outline
Definition of Cerebral palsy
Incidence and etiology
Causes of cerebral palsy
Types of cerebral palsy
Pathophysioloy
Clinical Classification of cerebral palsy
Diagnosis
Prevention
Treatment

3. Definition
Cerebralpalsy(CP)isachronicnon
progressivemotordysfunctioncausedby
damagetothemotorareasofthebrainduring
antepartal,intrapartal,orneonatalperiods.Itis
associatedwithepilepsyandabnormalspeech,
anddefectofthedevelopingbrain.

4. Incidence and Etiology
Theincidence,estimatedtobe7per1,000livebirths
peryear,mayinfactbeincreasingbecausemanyvery
lowbirthweightinfantsarenowsurviving.Lowbirth
weightnewbornsnowaccountforhalfofallcasesof
CP.
Theetiology,clinicalfeatures,andcourseare
variableandarecharacterizedbynormalmuscletone
andcoordination.

5. Pathophysiology
Congenitalmalformationoforinjurytothebrain,or
anoxiaofthebrain,atanytimebefore,during,orafter
birthmaycontributetothedevelopmentofCP.
Prognosisforinfantsandchildrendiagnosedwith
CPdependsonthelevelofphysicalinvolvementas
wellasconcurrentmedicalproblems.

7. Manychildrenwithhemiplegiaandataxiashow
improvementwiththerapyandareeventuallyableto
ambulateindependently.
However,ifatoddlerdoesnotsitindependentlyby2
yearsofage,thereisalmostnochanceofwalking,even
withintensetherapyandtheuseofbraces,crutches,
orawalker.

8. Clinical classification of CP
Spasticmayinvolveoneorbothsides.
Hypertonicitywithpoorcontrolofposture,balance
,andcoordinatedmotion.
Impairmentoffineandgrossmotorskills
Activeattemptsatmotionincreaseabnormalpostures
andoverflowofmovementtootherpartsofthebody

9. Dyskinetic/athetoid–abnormalinvoluntary
movement.
Athetosis,characterizedbyslow,wormlike,writhing
movementthatusuallyinvolvetheextremities,trunk,
neck,facialmuscle,andtongueinvolvementofthe
pharyngeal,laryngealandoralmusclescauses
droolinganddysarthria(impelfeelspeech
articulation)

10. Conte,
Involuntarymovementsmaytakechoreoid(
involuntary,irregular,jerkingmovements)and
dystonic(disorderedmuscletone)

11. Types of cerebral palsy (CP)
Types
CP
Spastic CP
Mixed
types
Ataxic CP
Extra
pyramidal
CP

13. Conte,
Spastic cerebral palsy
Spastic heiplagia
Spastic diplegia
Spastic quadriplegia
Spastic monoplagia and
paraplegia

14. Spastic cerebral palsy

16. Athetoidor atonicCP Ataxic CP

17. Diagnosis
Diagnosisisbasedonclinicalfindings.
However,adefinitivediagnosismaynotbe
possibleuntilthechildisbetween18months
and2yearsofageasmanyinfantsdisplaying
delayeddevelopmentmayimprovewith
maturation.

18. Infantsandchildrensuspectedofhavingcerebralpalsy
mustbecarefullyandcontinuallyevaluatedto
determineifandwhenspecificmotormilestonesare
met,suchasholdingontoanobjectorsittingwithout
support.

19. Diagnosis
Throughhistoryandphysicalexaminationshouldbe
performedtoeliminateprogressivedisordersofthe
CNS.
Abaselineelectroencephalogram(EEG)andCTscan
Testsofhearingandvisualfunctionshouldbe
performed

20. Prevention
prevention of cerebral palsy is the ideal approach of
this problem and is accomplished through:-
Prevention of maternal irradiation and unnecessary
drug intake
Antenatal monitoring to prevent intrapartum asphyxia
Prevention of birth trauma and prenatal asphyxia
Prevention of hypoglycemia
Prevention of low birth weight
Proper management of neonatal jaundice

21. Treatment
Physiotherapy:preventsgrosscontractures,
serialplasteringandsplintingarerequiredto
treatpositionaldeformity.
Many toddlers and children are fitted with
technical aids such as braces and walkers,
enabling them to ambulate independently.

22. Surgicalproceduretoimprovethemobilty
Speechtherapyandhearingaidsmaybeuseful
ifthereisdeafness
Toreducemusclespasmsorimprove
muscletone,aselectivedorsalroot
rhizotomy,aprocedurewheresurgeons
locateandseveroveractivatednervesthat
controllegmuscles,maybeperformed

23. Medicationadministrationisusuallyreservedforthe
olderchildoradolescent.Musclerelaxersmaybeusedto
decreasecontracturesandcanbegivenorally
intravenously,orintrathecally.Antianxietydrugsmay
reducetheexcessivemotionsassociatedwithathetosis.

24. Nursing management
Thenurseshouldensuretheinfant’sorchild’sbody
isinthebestpossiblealignment,usingpillowsand
bolstersassupports.
Specialcareshouldbetakentoprotectbony
prominencesastheyarepronetobreakdown.

25. Caregiversaswellastherapistsmayassistthenursein
determiningthebestwaytohandleandmovethese
children.Feedingmayprovechallengingaschewing
andswallowingproblemsarecommon.Techniques
suchasstrokingthethroatmayhelp;however,the
nurseshouldturnagaintothefamilyforguidance.

26. Iftheinfantorchildishospitalized,theat-home
regimeshouldbefollowedasmuchaspossible,and
physical,occupational,andspeechtherapy
departmentsshouldbecontactedsotherapysessions
canbescheduled.
Therefore,respectanddignityneedtobeintegrated
intoallinterventions.

27. FAMILY TEACHING
Nursesmustworkwiththefamilies,providingthem
withsupportandresourcestomeettheirchild’sneeds.
Assoonasadiagnosisisconfirmed,caregiversshould
bereferredtoadevelopmentalclinicorcenter.These
agencieswilloftenhavepeersupportgroupsforfamily
membersincludingsiblings,aswellasfinancial
advisors.

28. Becausethechildwillneedawiderangeof
therapeuticservices,familymemberswillhavetolearn
howtodotheexercisesandfollowthetechniquesused
bytherehabilitationspecialistssotheirchildreceives
consistenttherapyathome.
Supportandeducationprovidedbyearlyintervention
programshelpfamiliesadjusttotheirlifestylechanges.