Download - 2013- 2014 Cerebral Palsy Jan 2014 -
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Dr. Sahar Hassanein
Prof. of Pediatrics
School of MedicineAin Shams University
Cerebralplasy
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Objectives
To be able to identify and manage :
Abnormal Motor Development.
Cerebral palsy.
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Abnormal Motor Development
Delayed Motor Development ?
Regression ?
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What is Cerebral Palsy? Cerebral Palsy-Definition
Astaticnonprogressivemovementandposture
disorder asaresultofbraininjuryor
malformationthat
occurs
early
in
development
upto3yearsofage.
Itisnotanetiologicdiagnosisbutaclinical
syndrome(a
manifestation
of
static
encephalopathy)
thatrefersonlytoMotordysfunction.
Anyregression
or
deterioration
of
motor
or
intellectualskillslookforadegenerativedisease.
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Whataresomeetiologicfactors? Prenatal?(list4):
Geneticfactors,toxins,placentalfactors,and
infection(TORCH).
Perinatal?(list2):
Prematurityand
its
sequelae,
asphyxia
Postnatal?(list3):
Infection(Meningitis),trauma,andasphyxia
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1. Systemorpathophysiologic?
2. TopographicClassification orAnatomical
distribution?
3. Severitylevel
or
functional
classification?
Whatarethe3classificationsofCPandtheircharacteristics?
CerebralPalsy
Classification:
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1. System or pathophysiologic?
There are 2 major types of CP, depending onlocation of lesions:
Pyramidal (Spastic). The pyramidal system carriesthe signal for muscle contraction. 77%
Extrapyramidal. The extrapyramidal systemprovides regulatory influences on that contraction.Non-spastic (extrapyramidal and mixed types) 23%
There is overlap of both symptoms and anatomiclesions.
CerebralPalsy
Classification:
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2. Topographic Classification
Quadriplegia - all 4 extremities
Hemiplegia - one side of the body (arm) Diplegia - legs worse than arms
Paraplegia - legs only
Monoplegia - one extremity
CerebralPalsy
Classification:
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3. By degree or severity
Mild impairment of only fine precision movement
Moderate gross and fine movement
- speech problems
Severe inability to perform ADL
CerebralPalsyClassification:
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A. Pyramidal
Lesion is usually in the motor cortex, internalcapsule and/or cortical spinal tracts.
Clasped knife spasticity.
The spasticity can be worse when the person is
anxious or ill. The spasticity does not go away when the person
is asleep.
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A. Pyramidal : Spastic CP (total) 77%
Quadriplegia (23%) - all 4 extremities
Hemiplegia (21%) - one side of the body (arm)
Diplegia (21%) -legs worse than arms
Paraplegia - legs only Monoplegia - one extremity
CerebralPalsy
Classification:
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B. Extrapyramidal
Lesion is usually in the basal ganglia, Thalamus,
Subthalamic nucleus and/or cerebellum.
Ataxia Hypotonia Dystonia Rigidity
The tone may increase with volitional
movement, or when the person is anxious During sleep the person is actually hypotonic
CerebralPalsyTypes
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B. Extrapyramidal: Divided into Dyskinetic and Ataxic types
1. Dyskinetic
Athetosis- slow writhing, wormlike
Chorea- quick, jerky movements Choreoathetosis- mixed
2. Ataxic CP
Results from damage to the cerebellum
Ataxia- tremor & drunken- like gait
CerebralPalsyTypes
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How is the diagnosis made?
Clinical history and physical examination.
Laboratory and imaging tests are often needed to:
confirm suspected brain injury (e.g., porencephalic cyst),
to rule out a progressive or degenerative neurologicprocess (e.g., metachromatic leukodystrophy), or to
define etiology (e.g., chromosome analysis).
CerebralPalsyDiagnosis
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Whataresomeassociateddisabilities? Mentalretardation,seizures,hearing.
Visual
impairments.
Attentiondeficits,learningdisabilities.
Dysphagia,malnutrition,poorgrowth.
Gastroesophageal
reflux,
constipation.
Jointcontracturesandscoliosis.
CerebralPalsyDiagnosis
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Formulatethediagnosis
Postanoxic,spasticquadriplegiccerebral
palsywith
microcephaly,
MR,
squint,
pseudobulbarpalsyandGTCTTTwithAED.
ORequinesdeformity?
Marasmus
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What is the treatment?
Treatment is supportive.
Directed toward maximizing functional abilities,
Managing concurrent medical problems,
Physical and occupational therapy, special education,psychology, audiology, and orthotics).
Cerebral Palsy Management
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The EndFor any [email protected]