CEREBRAL PALSY

Presentation prepared by:Presentation prepared by:

Jawen CaguioaJawen CaguioaEDSP 202EDSP 202

Historical BackgroundHistorical Background WILLIAM LITTLEWILLIAM LITTLE

– 1919THTH CENTURY CENTURY Senior physician at the London HospitalSenior physician at the London Hospital Founder of the Royal Orthopedic HospitalFounder of the Royal Orthopedic Hospital

– 18531853– 1862 1862 (Obstetrical Society of London)(Obstetrical Society of London)

Paper entitled “The Influence of Abnormal Parturition, Paper entitled “The Influence of Abnormal Parturition, Difficult Labor, Premature Birth and Asphyxia in Difficult Labor, Premature Birth and Asphyxia in Relation to Deformities”Relation to Deformities”

Little’s DiseaseLittle’s Disease Approx 200 cases Approx 200 cases

studiedstudied Outline of Outline of

characteristics and characteristics and traitstraits

CausesCauses Fundamental approach Fundamental approach

to treatment and mgtto treatment and mgt

In the US in Early 1940’s :In the US in Early 1940’s :

Cerebral PalsyCerebral Palsy

Definition (history of)Definition (history of)

PERLSTEIN (1949)PERLSTEIN (1949)– CP is a condition characterized by paralysis, CP is a condition characterized by paralysis,

weakness, incoordination or any other weakness, incoordination or any other aberration of motor function due to pathology of aberration of motor function due to pathology of the motor centers of the brain.the motor centers of the brain.

DENHOFF (1951)DENHOFF (1951)– CP is a condition in which interferences with the CP is a condition in which interferences with the

control of the motor system arise as a result of control of the motor system arise as a result of lesions occurring from birth trauma.lesions occurring from birth trauma.

SWARTZ (1951)SWARTZ (1951)– CP is an aggregate of handicaps: emotional, CP is an aggregate of handicaps: emotional,

neuromuscular, sensory caused by damage or neuromuscular, sensory caused by damage or absent brain structures.absent brain structures.

CROTHERS and PAINE (1959)CROTHERS and PAINE (1959)– A term which covers individuals who are A term which covers individuals who are

handicapped by motor disorders which are due handicapped by motor disorders which are due to non-progressive abnormalities of the brain. to non-progressive abnormalities of the brain.

CEREBRAL PALSYCEREBRAL PALSY

A disorder in the movement and posture caused A disorder in the movement and posture caused by an injury to the immature brain.by an injury to the immature brain.

MovementMovement

PosturePosture

Immature brainImmature brain

Causes/EtiologyCauses/Etiology

Prenatal causes (before birth)Prenatal causes (before birth)– Maternal characteristicsMaternal characteristics

Perinatal causes (at the time of birth to 1mo)Perinatal causes (at the time of birth to 1mo)

Postnatal causes (in the first 5 mos of life)Postnatal causes (in the first 5 mos of life)

Prenatal causesPrenatal causes

Hemorrhage/bleedingHemorrhage/bleeding InfectionsInfections Environmental factorsEnvironmental factors

Maternal CharacteristicsMaternal Characteristics

AgeAge Difficulty in conceiving or holding a baby to termDifficulty in conceiving or holding a baby to term Multiple birthsMultiple births History of fetal deaths/miscarriagesHistory of fetal deaths/miscarriages Cigarette smoking Cigarette smoking >30 sticks per day>30 sticks per day

Maternal alcoholism and drug addictionMaternal alcoholism and drug addiction Social status; mother with MRSocial status; mother with MR Mother’s medical conditionMother’s medical condition

Perinatal CausesPerinatal Causes

High or low BPHigh or low BP Umbilical cord coilUmbilical cord coil Breech deliveryBreech delivery Oversedation of drugsOversedation of drugs Trauma i.e. forceps or vacuum deliveryTrauma i.e. forceps or vacuum delivery *** complications of birth*** complications of birth

Postnatal CausesPostnatal Causes

Trauma, head injuryTrauma, head injury InfectionsInfections Lack of oxygenLack of oxygen Stroke in the youngStroke in the young Tumor, cystTumor, cyst

Types of CPTypes of CP

** CP depends on the ** CP depends on the

1. extent of the brain damage1. extent of the brain damage

2. which part of the brain is damaged2. which part of the brain is damaged

Types of CPTypes of CP

Spastic CPSpastic CP– stiffnessstiffness

Flaccid SPFlaccid SP– floppyfloppy

Athetoid CPAthetoid CP– Fluctuating toneFluctuating tone

Ataxic CPAtaxic CP– Unsteady; incoordinatedUnsteady; incoordinated

Mixed CPMixed CP– Most common is spastic athetoidMost common is spastic athetoid

Classification of CPClassification of CP

Topographical Classification Topographical Classification (based on the location of the motor disability)(based on the location of the motor disability)

– 1. quadriplegia1. quadriplegia– 2. diplegia2. diplegia– 3. paraplegia3. paraplegia– 4. triplegia4. triplegia– 5. hemiplegia5. hemiplegia– 6. hemiplegia6. hemiplegia– 7. monoplegia7. monoplegia– 8. double hemiplegia8. double hemiplegia

Perlstein 1949, 1952Perlstein 1949, 1952

Degree of SeverityDegree of Severity– 1. Mild CP1. Mild CP– 2. Moderate CP2. Moderate CP– 3. Severe CP3. Severe CP

5 CLINICAL SIGNS OF CP5 CLINICAL SIGNS OF CP

1. Abnormal tone1. Abnormal tone 2. abnormal posture2. abnormal posture 3. presence of primitive reflexes3. presence of primitive reflexes 4. delays in motor skills4. delays in motor skills 5. difficulty in executing movement5. difficulty in executing movement

Associated Clinical ConditionsAssociated Clinical Conditions

Mental retardationMental retardation SeizuresSeizures HI, VIHI, VI Sensory integration problemsSensory integration problems Feeding problemsFeeding problems Behavioral/emotional difficultiesBehavioral/emotional difficulties

Diagnostic Procedures Diagnostic Procedures

MRIMRI CT ScanCT Scan EEGEEG Laboratory and radiologic work upLaboratory and radiologic work up Physical evaluation Physical evaluation InterviewInterview Assessment tools i.e. Peabody Assessment tools i.e. Peabody

Development Motor Skills, BruininxDevelopment Motor Skills, Bruininx

Treatment strategies and Treatment strategies and interventionsinterventions

Physical, occupational, speech therapyPhysical, occupational, speech therapy Special educationSpecial education Feeding managementFeeding management OrthosisOrthosis SurgerySurgery Pharmacologic i.e botox injection, anti spasticity Pharmacologic i.e botox injection, anti spasticity

drugsdrugs Family and patient counseling programFamily and patient counseling program Vocational and functional training programVocational and functional training program Others: acupuncture, hyperbaric thx, thera suitOthers: acupuncture, hyperbaric thx, thera suit

prognosisprognosis

““A disabled child has the right to enjoy A disabled child has the right to enjoy a full and decent life, in conditions which a full and decent life, in conditions which ensure dignity, promote self-reliance and ensure dignity, promote self-reliance and facilitate the child’s active participation in the facilitate the child’s active participation in the community.”community.”

--UN Convention on the Rights UN Convention on the Rights ofof

the Child. 1989.the Child. 1989.