cerebral palsy

• Cerebral palsy


  Any of several neurologic disorders that appear in infancy or early childhood
• Cerebral palsy is the leading cause of childhood disabilities that affect motor function and development
• Cerebral palsy


  Permanently affects body movement and muscle coordination but does not worsen over time
• Cerebral palsy is usually present at birth but sometimes takes months or even years to be detected
• Cerebral palsy is usually evident by age 2 years
• Cerebral palsy prognosis


  • Mild forms can mean a life expectancy similar to the unaffected population
  • Severe forms can result in a significantly reduced life span
• Classifications/types of cerebral palsy


  • Spastic
  • Hemiplegia
  • Diplegia
  • Quadriplegia
  • Dyskinetic or extrapyramidal
  • Athetoid
  • Choreoathetoid
  • Dystonic
  • Ataxic
  • Telangiectasia
  • Mixed
• Spastic cerebral palsy


  Muscle tightness as dominant impairment (most common)
• Hemiplegia


  Spasticity affecting one side of the body
• Diplegia


  Spasticity affecting symmetric parts of the body (usually the legs)
• Quadriplegia


  Involvement of all four extremities
• Dyskinetic or extrapyramidal cerebral palsy


  Caused by damage to the basal ganglia (second most common)
• Athetoid cerebral palsy


  Inability to control muscle tone
• Choreoathetoid cerebral palsy


  Uncontrollable, writhing movements of arms, legs, or both
• Dystonic cerebral palsy


  Usually occurring in combination with other symptoms
• Ataxic cerebral palsy


  Caused by damage to the cerebellum; affects coordination of movement
• Telangiectasia


  Neurodegenerative, autorecessive disease
• Mixed cerebral palsy


  Combination of at least two of the other types
• Cerebral palsy produces such secondary effects as seizures, speech disorders, and mental retardation
• Pathophysiology of cerebral palsy


  • Nonprogressive brain lesions are caused by hemorrhage in the periventricular region of the brain
  • The periventricular area is extremely sensitive to changes in blood pressure, partial pressure of carbon dioxide, pH, and acidosis
  • Hemorrhage eventually results in periventricular leukomalacia, leading to motor impairment
• Conditions that result in cerebral palsy


  • Any condition resulting in cerebral thrombus or embolus
  • Any condition resulting in intracranial hemorrhage
  • Head trauma
  • Infections, such as meningitis and encephalitis
  • Poisoning
  • Near-drowning
  • In utero intracerebral hemorrhage or periventricular leukomalacia
• Risk factors for cerebral palsy


  • Infection during pregnancy (especially varicella, rubella, cytomegalovirus, toxoplasmosis, or syphilis)
  • Exposure to toxins (such as mercury) during pregnancy
  • Other conditions during pregnancy (such as seizures and thyroid disease)
  • Premature birth
  • Low birth weight
  • Breech delivery
  • Multiple fetus delivery
  • Birth asphyxia
  • Intracranial hemorrhage
  • Infant illness (such as bacterial meningitis, untreated severe jaundice, viral encephalitis, or hypoxia-ischemia)
  • Maternal infection
• Incidence of cerebral palsy


  • CP occurs in 1 to 4 per 1,000 live births globally
  • Approximately 1 in 345 children (3 per 1,000 8-year-old children) in the United States have CP
  • The prevalence of CP is greater in children born prematurely or born with a low birth weight
• Complications of cerebral palsy


  • Abnormal gait
  • Seizure disorders
  • Speech, vision, and hearing impairments
  • Language and perceptual deficits
  • Mental retardation (in up to 50% of children)
  • Attention deficit hyperactivity disorder
  • Learning disabilities
  • Dental problems
  • Respiratory difficulties, such as frequent respiratory tract infections
  • Poor swallowing and gag reflexes, which increase the risk of aspiration
  • Spasticity
  • Contractures
  • Skin alterations and pressure injuries
  • Difficulty feeding, resulting in the need for tube feeding
  • Failure to thrive
• Assessment of cerebral palsy


  • Gross motor developmental delay
  • Prematurity
• Physical findings in cerebral palsy


  • Retarded growth and development
  • Difficulty chewing and swallowing
  • Abnormal muscle tone (most commonly hypertonic)
  • Asymmetric crawling or failure to crawl
  • Hyperreflexia
  • Underdevelopment or absence of postural or protective reflexes
• Spastic cerebral palsy physical findings


  • Underdevelopment of affected limbs
  • Characteristic scissors gait
  • Walking on toes
  • Crossing one foot in front of the other during ambulation
  • Hyperactive deep tendon reflexes
  • Increased stretch reflexes
  • Rapid alternating muscle contraction and relaxation (clonus)
  • Muscle weakness
  • Impaired fine and gross motor skills
  • Contractures in response to muscle manipulation
• Dyskinetic cerebral palsy physical findings


  • Involuntary movements
  • Grimacing
  • Worm-like writhing
  • Dystonia
  • Sharp jerks that impair voluntary movement
  • Involuntary facial movements (causing speech difficulty)
  • Drooling
• Ataxic cerebral palsy physical findings


  • Wide gait
  • Disturbed balance
  • Incoordination (especially of the arms)
  • Hypoactive reflexes
  • Nystagmus
  • Muscle weakness
  • Tremors
• Mixed cerebral palsy


  • Includes symptoms from more than one type
  • Most common mix is spastic-dyskinetic
• Diagnostic tests for cerebral palsy


  • Cranial ultrasonography
  • Computed tomography scanning (brain)
  • Electroencephalography
  • Magnetic resonance imaging
• Cranial ultrasonography


  May show evidence of hemorrhage or hypoxic-ischemic injury
• Computed tomography scanning (brain)


  Helps to identify or rule out congenital malformations as the cause of symptoms
• Electroencephalography


  May show evidence of seizure activity
• Magnetic resonance imaging


  Defines structural and other abnormalities of the brain more clearly than other methods and, therefore, is the neuroimaging study of choice
• Treatment for cerebral palsy


  • Braces or splints
  • Special appliances, such as adaptive eating utensils and a low toilet seat with arms
  • Range-of-motion exercises
  • Wheelchair or rolling walker
  • Physical, occupational, and speech therapy, as indicated
  • Communication aids, such as computers with voice synthesizers or storyboards
• Diet for cerebral palsy


  • Possibly, pureed, soft, or thickened liquids (depending on the level of oromotor and swallowing deficits)
  • Gastrostomy feedings, jejunostomy feedings, or both, if the risk of aspiration is too great or if the child is unable to maintain a healthy caloric intake
• Medications for cerebral palsy


  • Baclofen (via oral route, feeding tube, or intrathecal administration)
  • DiazePAM
  • OnabotulinumtoxinA
  • Dantrolene sodium
  • TiZANidine hydrochloride
  • Gabapentin
  • Anticholinergic agents
  • Dopamine agonists
  • Trihexyphenidyl hydrochloride
  • Glycopyrrolate
  • DiazePAM
  • Valproic acid
• Surgical treatments for cerebral palsy


  • Orthopedic surgery for tendon lengthening and scoliosis management
  • Neurosurgery (dorsal root rhizotomy) to treat velocity-dependent spasticity
  • Stereotactic basal ganglia surgery to lessen rigidity, choreoathetosis, and tremors
  • Intrathecal baclofen pump insertion to treat spasticity and dystonia
• Nursing interventions for cerebral palsy


  • Speak slowly and distinctly, making sure to face the child and maintain eye contact
  • Allow enough time to carefully attend to the needs of the child and family
  • Provide support to the child and family
  • Encourage the child and family to ask questions and ensure their understanding of the disease process
  • Actively listen and answer questions honestly
  • Encourage the child's and family's participation in the child's care and decision making
  • Encourage the family to stay with the child
  • Collaborate with a nutritionist to ensure adequate calorie intake
  • Collaborate with a speech therapist to assist with communication
  • Collaborate with an occupational therapist to assist with swallowing and feeding deficit care
  • Collaborate with a physical therapist to assist with exercises to maintain muscle tone and reduce the risk of contractures
  • Administer prescribed medications and monitor their effect
  • Provide frequent mouth and dental care
  • Assist with the application of braces and splints or the use of assistive devices, as necessary
  • Provide meticulous skin care and scheduled repositioning, especially to pressure-prone areas, such as under braces and splints
  • Prepare the child and family for possible surgery and provide all necessary teaching
  • Provide a safe physical environment
  • Complete a pediatric fall risk assessment using an approved screening tool, and implement necessary precautions
  • Initiate seizure precautions per facility policy
  • Collaborate with the multidisciplinary team to assure that all specialty areas agree with the plan of care
  • Consult with care management to ensure that all home-going needs are met prior to discharge
  • Consult with a child life specialist to provide age-appropriate distractions and support
  • Consult with social services to provide counseling, community resources, and support