C HAPTER 26: C EREBRAL P ALSY P AGES Melissa Ewerth Adapted Physical Education West Chester University ure=youtu.be

O BJECTIVES Define Cerebral Palsy Identify the causes of cerebral palsy Understand the diagnosis for cerebral palsy Explain ways to help children with cerebral palsy Identify useful strategies for teachers

W HAT IS C EREBRAL P ALSY ? Cerebral palsy is a movement and posture disorder that is caused by a non- progressive abnormality of the immature brain. Cerebral palsy is a developmental disability that is associated with signs of neurological dysfunction.

C AUSES OF C EREBRAL P ALSY Cerebral palsy is most often caused by a brain injury. In some cases, cerebral palsy is caused by genetic problems with brain development. Birth asphyxia is only the cause of cerebral palsy in a minority of cases.

C AUSES OF C EREBRAL P ALSY : P REMATURITY -R ELATED Premature infants are at increased risk for cerebral palsy. The increased risk comes from the weakness in the white matter of the brain. Two common causes of white matter injury at this stage of life are periventricularleukomalacia (PVL) and intraventricular hemmorage (IVH) Both of these conditions can result from immature brain development.

C AUSES OF C EREBRAL P ALSY : F ULL -T ERM I NFANTS Full-term infants with cerebral palsy are often smaller than average at the time of their birth or have deformities of the central nervous system (CNS) or other body systems. Birth asphyxia can be a cause of cerebral palsy in a full term infant as it can cause severe brain damage at the time of birth.

C AUSES OF C EREBRAL P ALSY : I NFECTION Infections are also a known cause of cerebral palsy in both premature and full-term infants. Fetal viruses and other agents of infections such as parasites are an uncommon cause of cerebral palsy. Chorioamnionitis is an intrauterine infection of the mother and is known to be linked with the Cerebral Palsy.

D IAGNOSIS Cerebral palsy is diagnosed based on delays in motor development paired with dysfunction in the central nervous system. Cerebral palsy cannot be diagnosed at birth. Severe cerebral palsy is usually diagnosed by age one. Mild cases of cerebral palsy are usually diagnosed by two years of age

D IAGNOSIS : D ELAYED M OTOR D EVELOPMENT The most common cause of motor delay in children is not cerebral palsy. Individuals with motor delays that are related to cerebral palsy tend to have more severe motor delays that are related to signs of upper motor neuron dysfunction.

U PPER M OTOR N EURON S YSTEM Two Primary Components Pyramidal Tract/Corticospinal Pathways Extrapyramidal System Upper Motor Neuron dysfunction is often characterized by positive and negative signs.

P ERSISTENT P RIMITIVE R EFLEXES Primitive reflexes are reflexes that are present early in life. Suckling reflex, hand-grasp reflex These reflexes are controlled by the primitive regions of the nervous system Spinal cord, lower brain areas, brain stem For children with cerebral palsy, it is common for primitive reflexes to continue on past infancy. The asymmetrical tonic neck reflex and the tonic labyrinthine response are primitive reflexes that that are helpful in the diagnosis of cerebral palsy.

P ERSISTENT P RIMITIVE R EFLEXES C ONTINUED

I NVOLUNTARY M OVEMENTS & A TAXIA Dyskinesias- atypical, involuntary movements Chorea- rapid, random, jerky movements Athetosis- slow, writhing movements Dystonia- rigid posturing that is centered in the trunk and neck Ataxia- abnormal voluntary movement when it comes to balance and the spacial position of the limbs and trunk.

W ALKING AND C EREBRAL P ALSY Walking Maintain upright posture Move forward smoothly with coordination Protective safety responses Even those with the mildest forms of cerebral palsy have trouble walking. Scissoring: Increased muscle tone/internal hip rotation. Toe Walking: Tightness of calf muscles and Achilles Quick Fact: Children with better motor skills at a younger age have a better prognosis for walking than those with more underdeveloped skills.

S UBTYPES OF C EREBRAL P ALSY Spastic Cerebral Palsy Spastic hemiplegia Spastic diplegia Spastic quadriplegia Dyskinetic cerebral palsy Athetoid cerebral palsy Dystonic cerebral palsy Ataxic cerebral palsy Mixed cerebral palsy

I MPAIRMENTS ASSOCIATED WITH C EREBRAL P ALSY Intellectual Disability Visual Impairments Hearing Impairments Speech and Language Disorders Seizures Feeding and Growth Abnormalities Behavior and Emotional Disorders

G ROSS M OTOR F UNCTION C LASSIFICATION There are 5 levels of function classification. Each level is broken into age classification. Compare and contrast levels 1 and 5.

H ELPING C HILDREN WITH C EREBRAL P ALSY Habilitation Therapy Neurodevelopmental Therapy (NDT) Hippotherapy Aquatic Therapy Bracing and splinting Orthotic Devices Positioning Devices Adaptive Equipment Crutch, walker, cane Wheelchairs Cushions Car seats

U SEFUL I NFORMATION FOR T EACHERS Know your students! Physical exercise is important and can be modified. Swimming, dancing, horseback riding Be creative in adaptations! Work with the family and additional resources to best meet the needs of the student as an individual.

D ID Y OU KNOW ? Most children with CP will live into adulthood, although life expectancy is shorter than the general population. The ability to successful function in society is based more on the cognitive ability than physical ability. Young Adults Study 30% lived with parents 12.5% lived with a partner 32.5% lived alone 53% had secondary education 36.3% had paid employment

S UMMARY Cerebral palsy is a disorder resulting from brain damage or dysfunction of the developing brain. There are different types of cerebral palsy that must be taken into account when treating and teaching individuals with the disorder. Physical activity is beneficial in a variety of ways for individuals with cerebral palsy.

C ONTACT I NFORMATION Melissa Presentation Link: &feature=youtu.be