Cerebral Palsy

• What is cerebral palsy?


  Group of permanent movement disorders that appear in early childhood (non-progressive) due to damage to CNS.
• What are the possible causes of CP?


  Maternal infections

  Maternal smoking, alcohol or cocaine use

  Trauma during pregnancy

  Birth asphyxia

  Pre-term birth

  Low birth weight

  Multiple births

  Meningitis

  Severe neonatal jaundice

  Head injury
• CP can be idiopathic.
• What are the different types of CP?


  Spastic (pyramidal)

  • hypertonia & reduction function
  • from damage to UMNs

  Dyskinetic (athetoid/extrapyramidal)

  • problems controlling muscle tone (hypertonia & hypotonia) -> athetoid movements & oro-motor problems
  • from damage to basal ganglia

  Ataxic

  • problems with coordinated movement
  • from damage to cerebellum

  Mixed
• What are the possible patterns of spastic CP?


  Monoplegia - 1 limb affected

  Hemiplegia - 1 side of body affected

  Diplegia - 4 limbs affected, mainly legs

  Quadriplegia - all 4 limbs severely affected, often with seizures, speech disturbance & other impairments
• What are the signs & symptoms of CP?


  Depends on site & extent of lesion

  Signs become more evident during development

  • Failure to meet milestones
  • Increased or decreased tone, generally or in specific limbs
  • Hand preference below 18 months is a key sign to remember for exams
  • Problems with coordination, speech or walking
  • Feeding or swallowing problems
  • Learning difficulties
• What are the DDx of CP?


  Muscular dystrophies

  Metabolic disorders

  Hereditary spastic paraplegia

  Juvenile idiopathic arthritis
• What are the Inx for CP?


  Full Hx & neurological examination

  MRI

  Genetic testing -> if suspicion of underlying genetic disorder
• What may be shown in a neurological examination of a child with CP?


  Retention of primitive reflexes

  Lack of age appropriate reflexes

  Hypertonia

  Clonus

  Toe walking (hemiplegic/diplegic gait)

  Possible reduced coordination
• What are the possible complications & conditions associated with CP?


  Recurrent chest infections

  Chronic constipation & incontinence

  Visual & hearing impairment

  Epilepsy

  Behavioural & emotional difficulties

  Learning disability

  Kyphoscoliosis

  GORD
• What is the management of CP?

  Physiotherapy

  Occupational therapy

  Speech & language therapy

  Dieticians

  Charities & support groups

  Medical management

  • Baclofen -> to manage muscle spasms
  • Botox (Botulinum toxin) injections -> to help with contractures

  Surgical management

  • orthopaedic surgery (for MSK deformities, injuries or tendon release)
  • general surgery (e.g. PEG tube insertion)