[25] Cerebral Palsy

• • Cerebral: brain
  • Palsy: Muscle weakness or paralysis
• Cerebral Palsy is characterized by impaired involuntary movement due to damage in brain from pre, peri, post natal malformation
• Cerebral palsy manifest before the age of 2
• Cerebral palsy is a non-progressive condition
• CP Etiology

  • damaged or abnormal development from the brain that controls movement
  • Cerebellum
  • Basal Ganglia
  • Primary Cortices
• Prenatal

  • Chromosomal abnormalities
  • intraurine stroke and infections
  • congenital abnormalities
• Perinatal

  • Hypokinetic-ischemic (Low O2)
  • CNS Infection
  • Strokes
  • Kernicterus (Severe Jaundice)
• Postnatal

  • accidental or non-accidental head injuries
  • stroke
  • CNS Infection
  • Anoxic Results
• Risk Factors

  • Maternal Substance Abuse
  • Low Birth Weight and Prematurity
  • Multiple Pregnancies
• Risk Factors

  • Infertility treatments
  • Birth Complications
  • Infections
• Prevalence

  • Worldwide
  • common disability in childhood
  • 1.5 to 2.5 per 1000 live births
• Prevalence (PH)

  • 2012: 21.7% of 1387 pediatric patients
  • among the three most common referred conditions
• 3-6 months

  • head falls when picked up from lying
  • overextends neck and back
  • floppy or stiff arms (Hypo and Hypertonia)
  • legs stiffen or cross
• 6-10 months

  • cannot roll over in either directions
  • cannot bring hands together
  • cannot put hands into mouth
  • reach out with one hand and one fisted
• 10 months older

  • commando crawl, loopsided
  • scoot around on buttocks or hop on knees but do not crawl on fours
  • cannot stand even with given support
• 3 early signs

  • Developmental Delays
  • Abnormal Muscle tone
  • Unusual Posture
• Spastic: form of hypertonia that causes resistance to movement

  • most common (80%)
  • upper motor neuron
  • stiff muscles, exaggerated reflex
• Dyskinetic: athetoid

  • second most common type (15%)
  • involuntary movement, Basal Ganglia
• Dyskinetic

  • Dystonia: twist repetitive
  • Athetosis: slow, writhing
  • Chorea: Jerky
• Ataxic: unsteadiness/incoordination

  • least common
  • cerebellum
  • poor balance
  • wide - based gait
  • Difficulty with rapid or fine movement
• Mixed: 2 or 3 types, usually spastic and dyskinetic
• Paresis: weakened

  Plegia: Paralyzed
• Mono: one limb

  Hemi: one side

  diplegia: symmetrical, two limbs (legs>arms)

  quad: all four
• • Level 1: without limitation
  • Level 2: with limitation
  • Level 3: hand-held mobility device
  • Level 4: self-power mobility device
  • Level 5: manual wheelchair
• Prognosis depends on

  • Motor Severity
  • Presence of Comorbidities
  • Environmental Factors
• Secondary Conditions

  • Drooling, Swallowing, Feeding
  • GERD, constipation
  • Speech Impairment
• Associative Conditions

  • ID, LD
  • Visual, Hearing
  • Epilepsy
• Speech

  • Dysarthria
  • Articulation
  • Childhood Apraxia of Speech
  • Mixed
• Language

  
  

  Receptive: vocabulary, poor comprehension

  Expressive: grammar
• Cognitive Impairment

  • short declarative memory
  • executive functions
• Swallowing

  • Dysphagia
  • Reduced Lip Closure
  • Tongue Thrust and Function
  • Drooling
  • Tactile Hypersensitivity
  • Reduced pharyngeal motility
  • Exaggerated Bite Reflex
  • Swallow initiation