PEDIATRICS

• Cerebral palsy (CP)


  A group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction
• Affected children also may have speech or ocular difficulties, seizures, cognitive challenges, or hyperactivity
• CP is the most common motor disability of childhood, more common among males than females and more common among Black children than White children
• Cause of CP


  Abnormal brain development or damage to the developing brain, leading to cell destruction of the motor tracts. Nutritional deficiencies, drug use, maternal infections, direct birth injury may also contribute.
• CP occurs in approximately one in 323 children, most frequently in very-low-birth-weight infants and those who are small for gestational age
• Head injury such as from child maltreatment or automobile accidents, and infections such as meningitis or encephalitis can also lead to CP symptoms
• Congenital CP


  Exact cause is unknown
• Acquired CP


  Occurs within the first 28 days of life, often caused by an infection, head trauma, or conditions causing cerebrovascular bleeding
• Types of CP


  • Spastic
  • Dyskinetic or Athetoid
  • Ataxic
  • Mixed
• Spastic CP


  • Hypertonic muscles, abnormal clonus, exaggeration of deep tendon reflexes, abnormal reflexes, continuation of neonatal reflexes
• Spastic involvement


  • May affect both extremities on one side (hemiplegia), all four extremities (quadriplegia), or primarily the lower extremities (diplegia or paraplegia)
• Athetoid CP


  • Involves abnormal involuntary movement, child appears limp and flaccid early on, later makes slow, writhing motions, poor tongue and swallowing movements, drooling, difficult speech
• Ataxic CP


  • Awkward, wide-based gait, unable to perform fine coordinated motions, finger-to-nose test, or rapid, repetitive movements
• Mixed CP


  • Symptoms of both spasticity and athetoid or ataxic and athetoid movements, resulting in severe physical impairment
• The diagnosis of CP is based on history and physical assessment
• Children with CP may have sensory alterations, speech disorders, attention deficit, autism, cognitive challenges, and recurrent seizures
• CP is not always diagnosed early, so parents may not learn of the chronic disorder until 2-4 years later
• Symptoms may seem to grow worse as fine motor skill is needed
• The severity of cognitive deficits

  Does not necessarily parallel the severity of physical deficits
• CP is not caused by childhood vaccine reactions