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Title: Cerebral%20Palsy


1
Cerebral Palsy
  • Victor Politi, M.D., FACP
  • Medical Director, SVCMC, School of Allied Health
    Professions, Physician Assistant Program

2
Cerebral Palsy
  • "Cerebral" refers to the brain and "palsy" to a
    disorder of movement or posture.
  • It is neither progressive nor communicable

3
Overview
  • Cerebral palsy is a general term that describes a
    group of disorders that appear in the first few
    years of life and affect a child's ability to
    coordinate body movements.
  • This results in difficulties in movement and
    posture.
  • Cerebral palsy has different causes, and affects
    each person differently, therefore people with
    cerebral palsy have varying individual needs.

4
Overview
  • Cerebral palsy is the most common physical
    disability in childhood.
  • It is estimated 2 to 3 people out of every 1000
    will have cerebral palsy.
  • This condition is not hereditary and there is no
    cure.
  • Many causes of cerebral palsy are still not known
    or understood.
  • Injury or changes to the developing brain are
    associated with cerebral palsy.

5
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6
Overview
  • The muscles of speech, swallowing and breathing
    may be involved.
  • Intellectual disabilities (mental retardation)
    and seizures can also occur, but these problems
    are not always present.

7
  • There are about 500,000 persons who have cerebral
    palsy in the United States

8
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9
Overview
  • In the early months of life it is sometimes
    difficult to determine if a child has cerebral
    palsy.
  • The condition may only be identified when a child
    experiences delays with the movement and postural
    development needed for sitting and standing.

10
Overview
  • Cerebral palsy is characterized by an inability
    to fully control motor function.
  • Depending on which part of the brain has been
    damaged and the degree of involvement of the
    central nervous system, one or more of the
    following may occur ---

11
Overview
  • spasms
  • tonal problems
  • involuntary movement
  • disturbance in gait and mobility
  • Seizures
  • abnormal sensation and perception
  • impairment of sight, hearing or speech
  • mental retardation

12
Overview
  • 1. The cortex
  • controls thought, movement and sensation.
  • An abnormality in the movement area of the cortex
    can result in spastic cerebral palsy
  • 2. The basal ganglia
  • helps movement become organized, graceful and
    economical.
  • An abnormality can result in athetoid

    cerebral palsy
  • 3. The cerebellum
  • coordinates movement, posture and balance.
  • An abnormality can result in ataxic
    cerebral palsy

13
What part of the body is affected?
  • Hemiplegia - the leg and arm on one side of the
    body are affected.
  • Diplegia - both legs and both arms are affected
    but the legs are significantly more affected than
    the arms. Children with diplegia usually have
    some clumsiness with their hand movements.
  • Quadriplegia - both arms and legs are affected.
    The muscles of the trunk, face and mouth can also
    be affected.

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15
Types of cerebral palsy
  • There are three major types of cerebral palsy
  • Spastic cerebral palsy
  • Athetotic cerebral palsy
  • Ataxic cerebral palsy

16
Types of Cerebral Palsy
  • Some children have signs and symptoms of more
    than one type of cerebral palsy, which may be
    referred to as a mixed form of the condition.

17

Spastic cerebral palsy
  • Most children with cerebral palsy have spastic
    cerebral palsy.
  • This form of the condition causes muscles to
    stiffen, which makes movement difficult.

18
Spastic cerebral palsy
  • It can affect both legs (spastic diplegia), or it
    can affect one side of the body (spastic
    hemiplegia).
  • In the most severe cases, all four limbs and the
    trunk are affected (spastic quadriplegia).

19
Athetotic cerebral palsy
  • 10 to 20 percent of people with cerebral palsy
    have this form, which is also referred to as
    extrapyramidal cerebral palsy.

20
Athetotic cerebral palsy
  • It affects the entire body and often causes
    uncontrolled, slow movements.
  • children with athetoid cerebral palsy often have
    very weak muscles or feel floppy when they are
    carried.

21
Ataxic cerebral palsy
  • This is the least common of the major types of
    cerebral palsy.
  • It affects balance and coordination.
  • characterised by unsteady, shaky movements or
    tremor.

22
Ataxic cerebral palsy
  • People with ataxic cerebral palsy have difficulty
    using muscles to achieve balance and coordinated
    movement.

23
Signs and Symptoms
  • In general, children with cerebral palsy exhibit
    a wide variety of signs and symptoms, ranging
    from mild to severe.

24
Signs and Symptoms
  • These signs and symptoms don't worsen with age.
    They may include
  • Ataxia (a lack of muscle coordination when
    performing voluntary movements)
  • Spasticity (stiff muscles and exaggerated
    reflexes)
  • Asymmetrical walking gait, with one foot or leg
    dragging
  • Variations in muscle tone, from too stiff to too
    floppy
  • Excessive drooling or difficulties swallowing,
    sucking or speaking
  • Tremors
  • Difficulty with precise motions, such as writing
    or buttoning a shirt

25
Signs and Symptoms
  • Some children with cerebral palsy have severe
    mental retardation, but others are extremely
    bright.
  • Many need a wheelchair and extensive, lifelong
    care, but some require little or no special
    assistance.

26
Causes
  • Cerebral palsy results from an abnormality in or
    injury to the cerebrum the largest area of the
    brain, which controls sensation and voluntary
    motor function.

27
Causes
  • Although cerebral palsy affects movement, the
    underlying problem originates in the brain, not
    in the muscles themselves.

28
Causes
  • A small number of children with cerebral palsy
    acquire the disorder after birth.
  • In these cases, sometimes a specific reason for
    the neurological problem can be pinpointed.
  • For example, cerebral palsy can develop following
    an illness during early infancy, such as
    bacterial meningitis. It can also be the result
    of a head injury.

29
Causes
  • The cause of most cases of congenital cerebral
    palsy are not understood.
  • For many years, it was believed that cerebral
    palsy was caused by a lack of oxygen during
    birth. However, it is now believed that only a
    small number of cases are caused by problems
    during labor and delivery.

30
Causes
  • Identifiable causes of congenital cerebral palsy
    include
  • Maternal infection during pregnancy, such as
    rubella or other viral infections
  • Severe jaundice in newborns, which may be caused
    by infection, severe bruising or problems with
    red blood cells due to ABO or Rh incompatibility
  • Abnormal brain development before birth,
    resulting from genetic causes or metabolic
    disorders
  • Disturbance to brain circulation before birth,
    caused by an artery spasm or blood clot, similar
    to a stroke in adults

31
Risk Factors for Developing Cerebral Palsy
  • Infection of mother during pregnancy
  • including rubella (German measles) and other
    infections in the womb
  • Premature delivery or low birth weight
  • premature babies have immature brain tissue that
    is susceptible to injury
  • Inadequate oxygen or blood flow to the brain in
    the mother's womb or during delivery
  • Rh disease

32
Risk Factors for Developing Cerebral Palsy
  • Congenital (birth) defects
  • Head trauma
  • (including shaken baby syndrome)
  • Jaundice in the newborn baby
  • Or it may occur early in life as a result of an
    accident, lead poisoning, viral infection, child
    abuse, or other factors

33
Risk Factors for Developing Cerebral Palsy
  • A less common type is acquired cerebral palsy
  • head injury is the most frequent cause, usually
    the result of motor vehicle accidents, falls, or
    child abuse.

34
Screening and diagnosis
  • Early signs of cerebral palsy may be present from
    birth, but it's often difficult to make a
    definite diagnosis during the first six months.
  • Cerebral palsy is generally diagnosed by age 1 or
    2.

35
Screening and diagnosis
  • A physician will generally observe the child and
    discuss their physical and behavioral
    development. Reflexes, muscle tone and movements
    will be checked
  • Additional tests may rule out other disorders
    that can cause movement problems.
  • CT
  • MRi
  • Genetic and/or metabolic blood work-up

36
Screening and diagnosis
  • Referrals
  • pediatric neurologist
  • developmental pediatrician
  • physiatrist

37
Complications
  • Besides difficulty with movement and posture,
    cerebral palsy may result in these health
    problems
  • Development of joint deformities or dislocation,
    if there's considerable spasticity
  • Nutrition problems, if there are swallowing or
    feeding difficulties

38
Complications
  • Some children with cerebral palsy will have
    multiple handicaps and may require long-term
    care. Some of the associated problems may
    include
  • Difficulty with vision, hearing and speech
  • Dental problems
  • Mental retardation
  • Seizures
  • Abnormal sensation or perception
  • Incontinence

39
Treatment
  • The brain abnormality or damage that underlies
    cerebral palsy doesn't worsen with time, but
    children with cerebral palsy often require
    long-term care.
  • The type and amount of treatment depend on how
    many problems the child has and how severe they
    are.

40
Treatment
  • The goal of treatment is to help the child reach
    his or her maximum potential.
  • Reaching this goal typically requires a
    multidisciplinary team working together to
    address issues of social and emotional
    development, communication, education, nutrition
    and mobility.

41
Treatment
  • Physical therapy
  • Muscle training and exercises may help improve
    strength, balance and mobility and lead to
    greater independence.
  • Braces, splints or casts may be used to improve
    hand and leg function and prevent contractures
    a condition in which muscles become fixed in a
    rigid, abnormal position.

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43
Treatment
  • Occupational therapy-
  • Focuses on helping the child learn skills for
    daily living.
  • May involve hand skills and self-care skills such
    as feeding and dressing

44
Treatment
  • Speech therapy
  • A speech therapist may be able not only to help
    the child speak better, but also to improve
    eating skills.

45
Treatment
  • Vision and hearing aids
  • eyeglasses or surgery to correct a condition such
    as cross-eye or other inability of the eyes to
    focus together properly (strabismus).
  • Hearing aids may help correct any hearing
    problems.

46
Treatment
  • Medications
  • These may include muscle relaxants to ease muscle
    stiffness and anticonvulsants to reduce seizures.
  • Injections of botulinum toxin (Botox) directly
    into spastic muscles also may be helpful

47
Treatment
  • Surgery
  • severe contractures may require surgery on
    muscles, tendons, nerves or joints to place arms
    and legs in their correct positions. This can
    make it easier to use a walker, braces or
    crutches.

48
Treatment
  • Children with severe spasticity who haven't
    responded to oral medications may also benefit
    from surgical procedures.
  • Dorsal rhizotomy - a procedure in which surgeons
    identify and cut a portion of the spinal sensory
    roots that control the leg muscles.
  • .

49
Treatment
  • Intrathecal baclofen an intraspinal infusion
    catheter is placed and connected to a reservoir
    placed under the skin. This mechanism
    continuously pumps small amounts of an
    antispasticity medication called baclofen into
    the fluid around the spinal cord.

50
Treatment
  • These surgeries require careful screening and an
    expert team of health professionals, including
    pediatric neurosurgeons, orthopedic surgeons,
    pediatric neurologists, pediatric physiatrists
    and physical therapists

51
Treatment
  • Assistive technology
  • Assistive technology includes such small things
    as rails, grab bars, magnifiers, and Velcro grips
    attached to forks and pens to make them easier to
    grasp.
  • It also includes high-tech tools, such as
    customized wheelchairs, voice communication
    devices, computer software programs, and
    positioning equipment that puts a child in the
    correct posture to sit or stand with other kids
    or family members.

52
Prevention
  • For more than a century, doctors have hoped that
    by somehow improving labor and birth practices,
    they could reduce the incidence of cerebral
    palsy.

53
Prevention
  • But these rates have remained fairly constant,
    despite increased prenatal care, electronic fetal
    monitoring, prenatal ultrasound and increased use
    of Caesarean section delivery over the past 25
    years.

54
Prevention
  • Fewer babies now develop cerebral palsy as a
    consequence of birth injury.
  • However, larger numbers of extremely premature
    babies survive, and some will develop cerebral
    palsy

55
Prevention
  • Most cases of cerebral palsy can't be prevented,
    despite the best efforts of parents and doctors.

56
Long Term Goals
  • Although it is not "curable" through education,
    therapy, and applied technology people with
    cerebral palsy can lead productive lives.

57
Long Term Goals
  • Cerebral palsy cannot be cured. However, quality
    of life can be improved for most children if they
    receive support and coordinated care, which may
    include a variety of experts.

58
Long Term Goals
  • Different kinds of therapy (physical therapy,
    occupational therapy, speech therapy) help
    children to maximize their potential activities
    at various stages of development.

59
Long Term Goals
  • Coordinated treatment of disorders such as
    seizures and spasticity are crucial in helping
    children with cerebral palsy lead a healthier
    life.

60
Long Term Goals
  • Medical research is working toward improving
    diagnosis, treatment, and prevention of cerebral
    palsy.

61
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