CEREBRAL PALSY

By: Ida Sherri L. CorveraBy: Ida Sherri L. Corvera

BSN III - NMBSN III - NM

• In 1860s, known as

"Cerebral Paralysis” or

“Little’s Disease”

• After an English surgeon

wrote the 1st medical

descriptions

William William John John LittleLittle

(1810-(1810-1894)1894)

CEREBRAL PALSY (CP)

• Cerebral“- Latin Cerebrum;

– Affected part of brain

• “Palsy " -Gr. para- beyond,

lysis –

loosening

– Lack of muscle control

CEREBRAL PALSY

• A motor function disorder – caused by permanent, non-progressive brain lesion – present at birth or shortly thereafter. (Mosby, 2006)

• Non-curable, life-long condition• Damage doesn’t worsen• May be congenital or acquired

A Heterogenous Group

of Movement Disorders

CEREBRAL PALSY

– An umbrella term

– Not a single diagnosis

CP AffectsMuscle

StrengthMovements

Balance

Coordination Posture

CAUSESOF CEREBRAL PALSY

An insult or injury to the brain

– Fixed, static lesion(s)

– In single or multiple areas of the motor centers of the brain

– Early in CNS dev’t

• Development Malformations– The brain fails to develop correctly.

• Neurological damage – Can occur before, during or after delivery – Rh incompatibility, illness, severe lack of oxygen

* Unknown in many instances

CAUSES

Severe deprivation of oxygen or

blood flow to the brain

–Hypoxic-ischemic encephalopathy

or intrapartal asphyxia

CHIEF CAUSE

TYPESOF CEREBRAL PALSY

1. Accdg. to Neurologic Deficits

• Based on the - extent of the damage

- area of brain damage

• Each type involves the way a person moves

3 MAIN TYPES

1. PYRAMIDAL - originates from the motor areas of the cerebral cortex

2. EXTAPYRAMIDAL

- basal ganglia and cerebellum

3. MIXED

2. Accdg. to Type of Movement

Photo from: Saunders, Elsvier.

4 MAIN TYPES

PYRAMIDAL 1. Spastic CP

EXTAPYRAMIDAL 2. Athethoid CP

3. Ataxic CP

MIXED 4. Spastic & Athethoid CP

ATHETOID-Fluctuating

Tone

ATAXIC-Unsteady,

uncoordinated

SPASTIC -Stiffness

ATHETOID-Uncontrolled

Movements

ATAXIC-Unsteady,

uncoordinated

TYPES

Types of Spastic CP

According to affected limbs:* plegia or paresis - meaning paralyzed or weak:

• Paraplegia • Diplegia • Hemiplegia • Quadriplegia• Monoplegia –one limb (extremely rare)• Triplegia –three limbs (extremely rare)

DEGREE OF SEVERITY

1. Mild CP- 20% of cases

2. Moderate CP- 50%

- require self help for assisting their impaired ambulation capacity.

3. Severe CP- 30%;

-totally incapacited and bedridden and they always need care from others.

Signs and Symptoms

OF CEREBRAL PALSY

a.

b.

c.

d.e.

f.

g.

h.

Early Signs

• Stiff or floppy posture

• Weak suck/ tongue thrust/ tonic bite/ feeding difficulties

• Poor head control

• Excessive lethargy or irritability/ High pitched cry

Infancy (0-3 Months)

• Abnormal or prolonged primitive reflexes

Moro’s reflexAsymmetric tonic neck reflex

Placing reflexLandau reflex

Early Signs

CHILD with CP

Slow to re

ach

developmental

milesto

nes

Behavioral Symptoms

• Poor ability to concentrate,

• unusual tenseness,

• Irritability

ASSOCIATED PROBLEMSOF CEREBRAL PALSY

• Hearing and visual problems

• Sensory integration problems

• Failure-to-thrive, Feeding problems

• Behavioral/emotional difficulties,

• Communication disorders

• Bladder and bowel control problems, digestive problems

(gastroesophageal reflux)• Skeletal deformities,

dental problems• Mental retardation and

learning disabilities in some

• Seizures/ epilepsy

DiagnosisOF CEREBRAL PALSY

DIAGNOSIS

• Physical evaluation, Interview

• MRI, CT Scan EEG

• Laboratory and radiologic work up

• Assessment tools – i.e. Peabody Development Motor Skills,

Denver Test II

ASSESSMENT

1. SUBJECTIVE

- INTERVIEW

a. History Taking

–Include all that may predispose an infant to brain damage or CP

•Risk factors

•Psychosocial factors

•Family adaptation

b. Child’s Health History

• Often admitted to hospitals for corrective surgeries and other complications.

– Respiratory status – Motor function– Presence of fever– Feeding and weight loss – Any changes in physical state – Medical regimen

2. OBJECTIVE

- Physical Examination

CRITERIAP osturing / Poor muscle control and strength

O ropharyngeal problems

S trabismus/ Squint

T one (hyper-, hypotonia)

E volutional maldevelopment

R eflexes (e.g. increaseddeep tendon)

*Abnormalities 4/6 strongly point to CP

PO S

TER

TreatmentOF CEREBRAL PALSY

- No treatment to cure cerebral palsy.

- Brain damage cannot be corrected.

• Crucial for children with CP:

–Early Identification;

–Multidisciplinary Care; and

–Support

“The earlier we start, the more improvement can be made”

-Health worker

I. Nonphysical Therapy

A. General management - Proper nutrition and personal care

B. Pharmacologic

Botox, Intrathecal, Baclofen

- control muscle spasms and seizures, Glycopyrrolate -control drooling

Pamidronate -may help with osteoporosis.

C. Surgery

-To loosen joints,

-Relieve muscle tightness,

- Straightening of different twists or unusual curvatures of leg muscles

- Improve the ability to sit, stand, and walk.

Selective posterior rhizotomy In some cases nerves need to be severed to decrease

muscle tension of inappropriate contractions.

D. Physical Aids • Orthosis, braces and splints• Positioning devices• Walkers, special scooters, wheelchairs

E. Special Education

F. Rehabilitation Services- Speech and occupational therapies

G. Family Services -Professional support

H. Other Treatment

- Therapeutic electrical stimulation,- Acupuncture,- Hyperbaric therapy - Massage Therapy might help

 

'The ultimate long-term goal is realistic independence. To get there we have to have some short-term goals.

Those being a working communication system, education to his potential,

computer skills and, above all, friends'. - Parent of boy with CP

II. Physical Therapy

A.Sitting

- Vertical head control and control of head and trunk.

B. Standing and walking

- Establish an equal distribution of weight on each foot, train to use steps or inclines

C. Prone Development

D. Supine Development

o Head control on supine and positions

NURSING RESPONSIBILITIES

NURSING RESPONSIBILITIES

A. Functioning as a member of the health team

B. Providing counseling and education for the parents and promote optimal family functioning

C. Promoting physical and psychological health

D. Assisting with feeding management and toilet training

E. Assisting with rehabilitation therapies (physical, occupational and speech)

F. Providing counseling for educational and vocational pursuits

G. Preventing child abuse

H. Providing care during hospitalization

I. Prevent physical injury

J. Prevent physical deformity

K. Promote a positive self-image

"Time and gravity are enemies of very aging body, especially mine." - Adult with CP