Cerebral Palsy - PowerPoint PPT Presentation

1 / 62
About This Presentation
Title:

Cerebral Palsy

Description:

A group of chronic neurological disorders that appear in the first years of life. ... http://my.webmd.com/content/article/1680.53542 ... – PowerPoint PPT presentation

Number of Views:25271
Avg rating:3.0/5.0
Slides: 63
Provided by: labs61
Category:
Tags: cerebral | palsy | webmd

less

Transcript and Presenter's Notes

Title: Cerebral Palsy


1
Cerebral Palsy
  • Course Development
  • Alissa Backus
  • Jessica Laurent

course outline, organization, and editing Paul
A. Hayden Ph.D
2
Definition of Cerebral Palsy
  • A group of chronic neurological disorders that
    appear in the first years of life.
  • These disorders involve impaired control of
    movement that generally do not worsen over time.
  • These disorders cause faulty development or
    damage to motor areas in the brain which causes
    the inability to control movement and posture.

3
A Closer Look
  • The word cerebral refers to the brain's two
    halves, or hemispheres.
  • The word palsy refers to any disorder that
    impairs control of body movement.

4
Incidences
  • 1 in 500 people in the United States have
    Cerebral Palsy.
  • United Cerebral Palsy Associations estimate that
    more than 500,000 Americans have cerebral palsy.
  • Equally occurs among males and females.

5
Etiology of Cerebral Palsy
  • Caused by dysfunctions of parts in the brain that
    control body movement and posture.
  • Dysfunction can occur when brain cells
  • Fail to or abnormally grow
  • Damage due to lack of blood, oxygen, or nutrients
  • Damage caused by infection

6
Prenatal Etiology of Cerebral Palsy
  • Genetic or Chromosomal cause
  • Parents age as related to sperm and egg
    viability
  • Exposure to toxins
  • Mother acquires infection during pregnancy
  • Infections in the birth canal or uterus

7
Natal Etiology of Cerebral Palsy
  • Prolonged labor
  • Placenta breaks down before infant is delivered
  • Infection in the birth canal
  • Poor health
  • Multiple births

8
Postnatal Etiology of Cerebral Palsy
  • Serious illness
  • Bleeding surrounding the brain (hemorrhages)
  • Anoxia due to accidents (i.e. drowning)
  • Traumatic Brain Injuries (i.e. car accidents,
    abuse, etc.)
  • Low blood sugar

9
Cramped Synchronized General Movements in
Preterm Infants as an Early Marker for Cerebral
PalsyFabrizio, F., Giovanni, C., et al (2002)
  • Purpose To determine whether specific
    abnormalities (cramped synchronized general
    movements GM) can predict cerebral palsy and
    its severity in preterm infants affected by brain
    lesions.
  • Method Traditional neurological exams were
    performed, and GMs were videotaped and blindly
    studied for 84 preterm infants with ultrasound
    abnormalities from birth to 56-60 weeks
    gestation. The developmental course of GM
    abnormalities was compared with brain ultrasound
    findings alone and with findings from the
    neurological exams. The results from these two
    tests were then compared to the patient outcome
    at age 2-3 years.

10
Cramped Synchronized General Movements in
Preterm Infants as an Early Marker for Cerebral
PalsyFabrizio, F., Giovanni, C., et al (2002)
  • Results Infants with consistent cramped
    synchronized GMs developed cerebral palsy. The
    earlier cramped synchronized character GMs, the
    most severe motor disorder, has been linked to
    the worse neurological impairment. Temporary
    cramped synchronized character GMs or normal GMs
    with poor repertoire GMs lead to mild CP or
    normal development.
  • Conclusion Consistent and predominant cramped
    synchronized GMs predict CP. The earlier this
    characteristic appears, the worse the later
    impairment.

11
Classification by Limb Involvement
  • Quadriplegia All four limbs are involved
  • Diplegia All four limbs many be involved, but
    two inferior limbs are more severely affected
    than the two superior limbs
  • Hemiplegia One side of the body is affected.
    The arm is usually more affected then the leg.
  • Triplegia Three limbs are involved, usually
    affecting both arms and one leg
  • Paraplegia Two paired limbs are involved (i.e.
    both arms).
  • Monoplegia Only one limb is involved, usually
    affecting an arm.

12
Classification by Movement Disorder Location of
brain injury determines how movement is affected
  • Spastic Cerebral Palsy Upper Motor Neuron
  • Athetoid Palsy Basal Ganglion
  • Ataxic Palsy - Cerebellar
  • Mixed-Type Cerebral Palsy Any Combination

13
Spastic Cerebral Palsy
  • Most common type - accounts for about 80 of the
    cases
  • Due to damage of the motor cortex
  • Movement is limited due to spastic muscles (tight
    and stiff)
  • Spasticity may range from very mild (affecting
    only a few muscles) to very severe (affecting the
    whole body)
  • Spasticity can vary from day to day basis

14
Athetoid Cerebral Palsy
  • Accounts for 10 of the cases
  • Due to damage of the basal ganglia
  • Difficultly in controlling and coordinating
    movements (i.e. speech, reaching and grasping
    objects, etc.)
  • Some movements may be involuntary

15
Ataxic Palsy
  • Rarest type - accounts for only 5-10 of the
    cases
  • Due to damage of the cerebellum
  • Low muscle tone and poor coordination of
    movements
  • Affects balance and depth perception

16
Mixed-Type Cerebral Palsy
  • Accounts for about 10 of the cases
  • Due to damage of the brain affecting both muscle
    tone and voluntary movement
  • Spasticity is more apparent in the beginning
  • Involuntary movement increase throughout the
    childs development

17
Associated Problems Accompanying Cerebral Palsy
  • Visual Difficulties
  • Hearing Problems
  • Seizures
  • Social/Emotional

18
Visual Difficulties
  • Cerebral palsy frequently affects the visual
    system
  • Categories of Visual Impairments
  • Refractive errors
  • Strabismus
  • Amblyopia
  • Cataracts
  • Cortical Blindness

19
Refractive Errors
  • Most prevalent visual impairments
  • Hyperopia (farsightedness)
  • Myopia (nearsightedness)
  • http//my.webmd.com/content/article/1680.53542
  • Astigmatism (blurry vision) due to abnormal
    curvature of the cornea
  • Treatment
  • Glasses or contact lenses can help improve vision

20
Strabismus
  • Crossed eyes
  • Affects half of all children with cerebral palsy
  • Treatment
  • Placing a patch over the stronger eye, which
    forces the muscle of the weaker eye into proper
    alignment
  • Corrective glasses
  • Surgery to assure development of good muscle
    coordination

21
Amblyopia
  • Lazy eye
  • The brain purposely suppresses the weaker eye
    preventing the child from having blurred or
    double vision
  • Caused by other underlying problems strabismus,
    impaired acuity, and cataracts
  • Treatment
  • If detected early the problem can be reversed

22
Cataracts
  • Clouding of the Lenses
  • Causes
  • Congenital
  • Genetic
  • Rubella
  • Toxoplasmosis
  • CMV
  • Other infections in utero
  • Treatment
  • Surgery in early months of life to remove
    cataracts

23
Cortical Blindness
  • Injury to visual centers in the cerebral cortex
  • Brain cannot interpret and process information
    correctly
  • Total cortical blindness is rare, usually occurs
    with extensive brain injury (severe quadriplegia)
  • Treatment
  • Seek medical and educational treatment
  • Enhance use of other senses

24
Hearing Problems
  • 5 to 15 of children with cerebral palsy have
    hearing impairments.
  • Two types of hearing losses
  • Sensorineural hearing loss
  • Conductive hearing loss
  • Most common hearing loss
  • Due to middle ear infections, anatomic
    abnormalities (cleft lip and palate), or
    malformed ears.

25
Sensorineural Hearing Loss
  • 1 of children with cerebral palsy have this type
    of loss.
  • Due to congenital or acquired factors
    (meningitis, high fever or medication).
  • Treatment
  • Hearing aids to amplify sounds

26
Conductive Hearing Loss
  • Most common type of hearing loss.
  • Due to middle ear infections, anatomic
    abnormalities (cleft lip or palate, or malformed
    ears).
  • Treatment
  • Antibiotics
  • Decongestants
  • Myringotomy with P.E. tubes

27
Acoustic-Phonetic Contrasts and Intelligibility
in the Dysarthria Associated with Mixed Cerebral
PalsyJournal of Speech and Hearing Research
(1992)
  • Purpose The purpose of this study was to
    examine the relationship between several acoustic
    measures of speech features and perceptual
    judgments of word intelligibility of people with
    mixed cerebral palsy who possess dysarthric
    characteristics.
  • Subjects SLPs from two large United Cerebral
    Palsy Association Centers were asked to select
    those male individuals with a diagnosis of mixed
    cerebral palsy who used verbal communication as
    their sole means of communication, and who in the
    opinion of the staff had some degree of
    intelligibility deficit. These subjects had IQ
    scores of at least 70, normal hearing, and a
    normal oral-peripheral structure. A sample of 16
    subjects ranging from 21 to 41 years with varying
    degrees of intelligibility deficit was used.

28
Acoustic-Phonetic Contrasts and Intelligibility
in the Dysarthria Associated with Mixed Cerebral
PalsyJournal of Speech and Hearing Research
(1992)
  • Study 1
  • Method for Acoustic and Perceptual Analysis
    Speech material included monosyllabic CVC real
    word pairs. Stimulus words concentrated on seven
    phonemic contrasts syllable-initial voicing
    (back-pack), syllable-final voicing (cab-cap),
    stop-nasal (bad-mad), fricative-affricate
    (ship-chip), front-back vowel (bat-bought), high
    low vowel (hat-heat), and tense-lax vowel
    (feet-fit).
  • Six minimal word pairs were constructed for each
    phonemic contrast.
  • Each subject read a total of 112 stimulus words
    one time from printed cards.
  • Word productions were tape-recorded and later
    digitalized at a sampling rate of 20 kHz for
    preparation of listener tapes.

29
Acoustic-Phonetic Contrasts and Intelligibility
in the Dysarthria Associated with Mixed Cerebral
PalsyJournal of Speech and Hearing Research
(1992)
  • Method for Speech Intelligibility Twelve
    potential listeners, who had varying degrees of
    familiarity with the speakers with dysarthria,
    were administered a training tape transcription
    task. Eight of these listeners who reached 73
    agreement were retained as listeners, thus
    increasing interjudge reliability.
  • Each judge was seated in a quiet room with a
    quality headset for delivery of speech material.
    Words were presented at a rate of 1 every 5 sec.
    Listeners were asked to provide orthographic
    transcriptions of each stimulus word, and then
    indicate the degree of ease or difficulty they
    had recognizing the word heard on a 7-point
    scale.
  • 3 ways transcriptions were scored
  • Whether the entire word was transcribed correctly
  • Whether the target phonemic segment was
    transcribed correctly
  • If the contrast was incorrect, the transcribed
    error was coded to signify if the opposite
    contrast pair had been transcribed

30
Acoustic-Phonetic Contrasts and Intelligibility
in the Dysarthria Associated with Mixed Cerebral
PalsyJournal of Speech and Hearing Research
(1992)
  • Study 2
  • Method The subjects and acoustic and perceptual
    data analyzed in this study consisted of the same
    data in Study1.
  • Analysis All acoustic measures were included in
    a multiple regression framework to determine
    which acoustic measures or combination of
    measures accounted the most for the variance in
    the perceptual intelligibility measures. The
    potential predictor (independent) variables were
    the 7 acoustic measures (voice onset time, vowel
    duration). The predicted (dependent) variables
    were the intelligibility percentages.

31
Acoustic-Phonetic Contrasts and Intelligibility
in the Dysarthria Associated with Mixed Cerebral
PalsyJournal of Speech and Hearing Research
(1992)
  • Summary of Study 1 and Study 2 A large multiple
    correlation between speech intelligibility and
    four acoustic aspects of speech
    fricative-affricate, front-back vowel contrast,
    high-low vowel contrast, and tense-lax vowel
    contrast indicated that these 4 factors strongly
    influence intelligibility. A general conclusion
    of this research is that the vowel parameters of
    duration and F1 and F2 formant locations, and the
    fricative-affricative durational parameters are
    major predictors of the scored intelligibility.
  • Clinical Implications The ability to explain
    intelligibility deficits in the way of specific
    acoustic correlates has definite clinical
    implications such as to use diagnostic tools to
    document deficits, to focus treatment, and to
    validate improvements in speech proficiency.

32
Seizures
  • Involuntary movements or changes in consciousness
    or behavior resulting from abnormal bursts of
    electrical activity in the brain.
  • 1 out of 2 children with cerebral palsy develop
    seizures.
  • Higher risks due to brain damage and scaring
    which can trigger abnormal brain activity.
  • Classified by type and location of abnormal brain
    activity.

33
Types of Seizures
  • Partial Seizures
  • Abnormal brain activity in one area of the brain.
  • Generalized Seizures
  • Abnormal brain activity is present in both sides
    of the brain.

34
Social/Emotional Needs of Parents
  • Accepting the disability
  • Adjusting to the situation
  • Overcoming shame, embarrassment, and social
    isolation
  • Asking and accepting help
  • Maintaining a positive relationship with the child

35
Social/Emotional Needs of the Child
  • Instill high self-esteem
  • Sense of belonging
  • Support and reassurance
  • Prepare for social situations

36
Physical Therapy Considerations
  • Goal To recognize and treat problems involving
    movement and posture.
  • Crucial that physical therapy (PT) begin at an
    early age because the central nervous system is
    more receptive to changes in the first five year
    of life.

37
Areas that Require Physical Therapy
  • Posture
  • Difficulty with holding head, trunk, arms, or
    legs in proper alignment in the following
    positions
  • Sitting
  • Side-lying
  • Kneeling
  • Standing
  • All need to be mastered in order to acquire
    gross motor skills

38
Areas of Physical Therapy
  • Transitional Movements
  • Connects one posture to another (Roll from back
    to front)
  • Persistent Primitive Reflexes
  • Present at birth and fades away before 6 mo.
  • Balance
  • Ability to keep body upright
  • Sensory Impairments
  • Over or under responsive to senses
  • Joint Mobility
  • Movement and flexibility of joints

39
Physical Therapy
40
Occupational Therapy Considerations
  • Goal Help people function as effectively as
    possible in their daily activities.
  • Occupational Therapists (OT) assist with helping
    people overcome sensory, motor and perceptual
    problems that affect their learning and daily
    living skills.

41
Areas of Occupational Therapy
  • Fine Motor Skills
  • Hand-eye Coordination
  • Daily Living Skills
  • Perceptional Skills
  • Sensory Processing and Integration
  • Basic Non-Verbal Communication Skills

42
Occupational Therapy
43
Recreational Therapy
  • A health care and human service discipline that
    delivers treatment services designed to restore,
    remediate and/or rehabilitate functional
    capabilities for persons with injuries, chronic
    illnesses and all types of disabling conditions
    (ATRA).
  • Goal Increase motivation and ease the feelings
    of idleness, loneliness, and depression, which
    can prevent progress in the healing process.

44
Music Therapy
  • Goal Use therapeutic music in rehabilitation,
    special education, and community settings.
  • Music therapists assess emotional well-being,
    physical health, social functioning,
    communication abilities, and cognitive skills
    through musical responses.

45
Medical Considerations
  • Surgery Not always necessary, but may be
    recommended to improve muscle development and
    reduce spasticity in the legs. 
  • Medication Your child's doctor may prescribe
    medication to prevent or control seizures
    associated with cerebral palsy. 

46
Major Speech Problems Associated with Cerebral
Palsy
  • Articulation
  • Dysarthrias
  • Voice Problems
  • Dysphagia

47
Articulation
  • Moderate to profound vocal communication
    disorders (70-80). The muscles that control
    speech are often affected. Poor speech can
    complicate cognitive assessment.
  • Considerations 
  • Early intervention.
  • Consult with a speech-language pathologist.
  • Investigate augmented communication and assistive
    technology.

48
Dysarthrias
  • Most common
  • Difficulty controlling muscles to coordinate
    speech movement.
  • Hypernasal
  • Hyponasal
  • Speech may sound slow and slurred.

49
Voice Problems
  • Spastic Palsy Harsh vocal quality, increased
    intensity, and high pitch
  • Athetoid Palsy Hoarse vocal quality,
    fluctuating intensity, and variable pitch
  • Ataxic Palsy Hoarse vocal quality, fluctuating
    intensity, and variable pitch

50
Dysphagia
  • Related to muscular speech mechanism
  • Due to muscles beginning spastic, athetosis,
    ataxic or flaccid
  • People with cerebral palsy may cough, gag, or
    choke when eating.

51
Language Delay
  • Expressive language delay due to limits in speech
    production imposed by dysarthria
  • Inability to express their level of language
    comprehension
  • They are subjected to the same language disorders
    as children without CP

52
Speech Therapy Considerations
  • Goal Improve childs speech and language skills.
  • Evaluate speech and language skills. Based upon
    results, develop therapy plan that helps child
    communicate more effectively.

53
Areas of Speech Therapy
  • Oral-Motor Skills
  • Language Skills
  • Augmentative Communication (AAC)

54
Oral-Motor Skills
  • Feeding
  • A child with CP may have difficulty with sucking,
    chewing, or swallowing due to muscle tone or
    sensory integration.
  • The SLP exercises the facial muscles and
    recommends certain foods (textures and amounts).
  • Speech
  • The SLP will teach the child to use their lips
    and tongue to produce sounds.
  • The SLP will teach appropriate breathing postures
    and techniques required for speech production.
  • Drooling
  • Sensory Deficit SLP will massage childs face
    with a variety of textures to increase
    sensitivity.
  • Motor Deficit SLP will position the child so
    muscle tone is as normal as possible.

55
Language Skills
  • Concepts
  • The SLP will use real objects and pictures to
    teach concepts.
  • Auditory Processing
  • The SLP will begin by presenting instructions at
    the length and complexity at which the child can
    barely understand.
  • Grammar/Syntax
  • The SLP will work on each grammatical error. The
    SLP will begin with isolation and end with
    carry-over activities.
  • Pragmatics
  • The SLP will explain the importance of allowing
    the child to communicate on their own.

56
Augmentative Communication
  • The SLP will choose an appropriate AAC device for
    the child.
  • The SLP will explain the importance of using the
    AAC in everyday activities.
  • The SLP will facilitate the use of the AAC
    device.
  • http//www.abilityhub.com/aac/aac-devices.htm

57
Phonatory Control in Adults with Cerebral Palsy
and Severe DysarthriaAAC Augmentative and
Alternative Communication (March 2002)
  • Purpose AAC users with severe dysarthria may
    benefit from using residual vocalizations to
    enhance their communication efficiency and
    naturalness.
  • Hypothesis Despite severe degradation of
    segmental speech sounds, speakers signal
    information through the control of phonatory
    features such as pitch and duration.
  • Participants Eight individuals with severe
    dysarthria caused by cerebral palsy and unable to
    communicate using only speech.

58
Phonatory Control in Adults with Cerebral Palsy
and Severe DysarthriaAAC Augmentative and
Alternative Communication (March 2002)
  • Method
  • Each participant was asked to produce 20
    vocalizations at three different levels for both
    pitch and duration.
  • Pitch High, Medium, and Low
  • Duration Long, Medium, and Short
  • The Praat System was used to visualize and
    calculate the average pitch and duration for each
    vocalization.
  • The duration was measured in seconds.
  • The pitch was calculated by the average
    fundamental frequency of each vocalization.

59
Phonatory Control in Adults with Cerebral Palsy
and Severe DysarthriaAAC Augmentative and
Alternative Communication (March 2002)
  • Results
  • There was separate analysis done for each
    subject.
  • All eight were able to produce at least three
    distinctive durations.
  • The subjects were more varied in their production
    of pitches. However, at the vary least they were
    able to produce two distinct pitches.
  • Conclusion
  • Using distinct durations and pitches, the speaker
    with severe dysarthria due to CP will be able to
    vocalize information using their voice helping to
    improve communication efficiency and naturalness.

60
Work Cited
  • Books
  • Finnie, N. (1974). Handling the Young Cerebral
    Palsied Child at Home. New York Dutton-Sunrise.
  • Gerialis, E. (1991). Children with Cerebral
    Palsy A Parents Guide. Bethesda, MD Woodbine
    House.
  • Shames, G., Wiig, E., Secord, W. (1998). Human
    Communication Disorders An introduction, Fifth
    Edition. Needham Heights, MA Allyn and Bacon

61
Work Cited
  • Journals
  • Acoustic-Phonetic Contrasts and Intelligibility
    in the Dysarthria Associated with Mixed Cerebral
    Palsy. (1992). Journal of Speech and Hearing
    Research, 04(01).
  • Ferrari, F., Cioni, G., Einspileler, C., Roversi,
    F., et. al. (2002). Cramped Syncronized General
    Movements in Preterm Infants as an Early Marker
    for Cerebral Palsy. Pediatrics and Adolescent
    Medicine, 156(5), 460-471.
  • Patel, Rupal. (March 2002). Phonatory Control in
    Adults with Cerebral Palsy and Servere
    Dysarthria. AAC Augmentative and Alternative
    Communication, 18(1), 2-11.

62
Work Cited
  • Web sites
  • www.about-cerebral-palsy.org
  • www.webmd.com
  • http//epilepsyontario.org
  • http//www.abilitiescenter.com
Write a Comment
User Comments (0)
About PowerShow.com