CEREBRAL PALSY (CP) فلج مغزی

CEREBRAL PALSY Definition Cerebral palsy is the result of a brain lesion The brain lesion must be fixed and nonpr gressive. The abnormality of the brain results in motor impairment

Epidemiology In recent reports the incidence has been estimated to be between 2.4 and 2.7 per 100O Live births. (low birth weight tiny neonates) The risk for cerebral palsy in a child born full-term is approximately 1 in 2000.

Epidemiology Cerebral palsy was diagnosed in 12.3% of infants born at between 24 and 33 weeks of gestation. Approximately 50% of children with cerebral palsy have low birth weight, and 28% weight less than 1500 g at birth.

Epidemiology The incidence of cerebral palsy in recent studies of multiple births is 9 to 12 per 1000 in twins 31 to 45 per 1000 in triplets 111 per 1000 in quadruplets.

Etiology PRENATAL The TORCHES group of infections (toxoplasmosis, rubella, cytomegalovirus, herpes, and syphilis) Cocaine, heroin, and marijuana Congenital malformations Rhesus blood group incompatibility resulting in kernicterus as a cause of cerebral palsy

Etiology PRENATAL Prenatal chorioamnionitis and maternal infection have been associated with an increased risk for premature onset of labor and cerebral palsy in the infant. placental abnormalities Fetal biophysical profile scores are prenatal noninvasive tests used to monitor the health of the developing fetus.

Etiology PERINATAL Anoxia as a result of perinatal complications (A tight nuchal Cord or placental abruption) Premature delivery Sepsis in the neonatal period Extracorporeal membrane oxygenation (ECMO Heart surgery before the age of 1 month resulted in cerebral palsy in 25% of infants.

Etiology POSTNATAL Infections such as meningitis in early childhood can lead to cerebral palsy Cardiopulmonary arrest Suffocation Motor vehicle accidents Severe falls, and child abuse

Classification PHYSIOLOGIC The most common movement abnormality is Spasticity. Hypotonia Dystonia Athetosis Patients with cerebral palsy frequently have a mixed form of movement disorder

classification GEOGRAPHIC what part of the body is affected by cerebral palsy. Hemiplegia Diplegia Triplegia Quadriplegia total body involvement,

PHYSICAL EXAMINATION Muscle Tone Reflexes Deep tendon reflexes (hyperreflexia & clonus) Infantile reflexes (3-6 mouth.) - startle reflex, or Moro's reflex - tonic neck reflex - parachute reflex (5 month. Appears)

Physical examination Balance, Sitting, and Gait Gait Analysis Cadence. (number of steps per minute), Scissor gait crouch gait Knee flexion contracture and Genu recurvatum equinus contractures. toe-walking

Treatment NONSURGICAL TREATMENT Physical Therapy Casting Orthoses (AFOs) dynamic equinus, foot drop,

Treatment MEDICAL TREATMENT OF SPASTICITY Oral Medication diazepam and baclofen Intrathecal Baclofen Botulinum Toxin(Botox) Clostridium botulinum and works by blocking the release of acetylcholine at the neuromuscular junction.

Treatment Surgical treatment Tenotomies Adductor muscle tendon Hamstring muscle tendon Achill tendon Tendon transfer Osteotomies