1. Cerebral Palsy
= Brain Paralysis

2. Complications of Neurodevelopmental Mental Disorders
Cognitive
Dysfunction
Motor Dysfunction
Seizures
Behavior Dysfunction

3. Definition
Cerebral palsy is a symptom complex, (not a disease) that has multiple etiologies.
CP is a disorder of tone, posture or movement due to a lesion in the developing brain.
Lesion results in paralysis, weakness, incoordination or abnormal movement
Not contagious, no cure.
It is static, but it symptoms may change with maturation

4. Cerebral Palsy Brain damage Occurs during developmental period
Motor dysfunction
Not Curable
Non-progressive (static)
Any regression or deterioration of motor or intellectual skills should prompt a search for a degenerative disease
Therapy can help improve function

5. Cerebral Palsy
There are 2 major types of CP, depending on location of lesions:
Pyramidal (Spastic)
Extrapyramidal
There is overlap of both symptoms and anatomic lesions.

6. Epidemiology
The overall prevalence of cerebral palsy ranges from 1.5 to 2.5 per 1000 live births.
The overall prevalence of CP has remained stable since the 1960’s.
Likewise the expected decrease in CP as a result of
C-section and fetal monitoring has not happened.

7. Epidemiology
Due to the increased survival of very low birth weight preemies, the incidence of spastic diplegia has increased.
Choreoathetoid CP, due to kernicterus, has decreased.
Multiple gestation carries an increased risk of CP.

8. Distribution of the Types of CP
Cerebral Palsy
Frequency of Distribution
Nonspastic
(extrapyramidal and mixed types)
23%
Spastic CP (total)
77%
Spastic Diplegia
21%
Spastic Hemiplegia
Spastic Quadriplegia

9. The severity
Cerebral Palsy can be classified by how severe it’s effects on movement and muscle tone are
Severe : 혼자 독립적으로 일상생활을 할 수 없으며 항상 보조기와 보 호자가 필요
Moderate : 약간의 도움으로 일상생활을 수행할 수 있고 완전한 활동 을 위해 보조기의 착용이 필요
Mild : 독립적으로 일상생활을 수행할 수 있고 보조기 착용없이 보행가 능
All three areas (movement, body part and severity) are then joined together to classify or describe the type of Cerebral Palsy eg: Severe spastic hemiplegia.

10. Cerebral Palsy : Etiologic
Prenatal (70%) Infection, anoxia, toxic, vascular, Rh disease, genetic, congenital malformation of brain
Natal (5-10%) : 난산 Anoxia, traumatic delivery, metabolic(jaundice etc)
Post natal Trauma, infection, toxic

11. Natal
전치태반
(Placenta previa)

12. Natal
둔위분만(Breech delivery)

13. Natal
겸자분만
(forceps delivery)

14. Post natal
meningitis

15. Post natal
hydrocephalus

16. Cerebral Palsy: Classification
Various classifications of Cerebral Palsy
Physiologic
Topographic
Etiologic

17. Cerebral Palsy: Physiologic
Athetoid
Ataxic
Rigid-Spastic
Atonic
Mixed

18. Cerebral Palsy: Topographic
Monoplegic
Paraplegic
Hemiplegic
Triplegic
Quadraplegic
Diplegic

19. Cerebral Palsy : Clinical Presentation
Remember that motor developmental progression is from…. Head to Toe

20. Types of Cerebral Palsy
Pyramidal (Spastic)
Quadriplegia- all 4 extremities
Hemiplegia- one side of the body
Diplegia- legs worse than arms
Paraplegia- legs only
Monoplegia- one extremity

21. According to Pattern of involvement
Monoplegia : one limb / rare
Diplegia : both LL >> UL / good intelligence / prematurity
Hemiplegia : unilateral usually UL > LL / 33 % seizures
50 % mentally retarded
Triplegia : rare / usually both LL + one UL
Quadriplegia : total body / often mentally retarded /
with seizures / severe hypoxia
Double hemiplegia : bilateral UL > LL

22. Cerebral palsy Spastic Diplegia
The most common type
Speech / intellect: normal – slightly impaired
UL(gross motor well done)
minor incoordination of fine motor skills
LL (spastic)
hip : flexion, adduction, int. rotation
knee : flexor / extensor spasticity /or equal
ankle : equinus
foot : pes valgus
Most walk independently by 4 years

23. Cerebral palsy Spastic Hemiplegia
30 % of all CP
One side affection
upper > lower extremity
50 % mentally retarded
33 % seizures

24. Cerebral palsy Spastic Quadriplegia
All four limbs involved – and trunk
Often mentally retarded
With seizures
Most ( 80 % ) non walkers

25. Cerebral palsy Clinical Assessment : Upper Limb
Elbow flexion
Forearm pronation
Wrist flexion
Finger flexion
Thumb in palm

26. Cerebral palsy Clinical Assessment : Upper Limb
Wrist palmar-flexed
Wrist dorsi-flexed

27. Extrapyramidal ; Divided into Dyskinetic and Ataxic types
Athetosis- slow writhing, wormlike
Chorea- quick, jerky movements
Choreoathetosis- mixed
Hypotonia- floppy, low muscle tone, little movement
Ataxic CP
Results from damage to the cerebellum
Ataxia- tremor & drunken- like gait

28. Anatomy
Pyramidal
Lesion is usually in the motor cortex, internal capsule and/or cortical spinal tracts.
Extrapyramidal
Lesion is usually in the basal ganglia, Thalamus, Subthalamic nucleus and/or cerebellum.

29. Comparison of Symptoms
Pyramidal
Extrapyramidal
Tone
increased
alternating
Type of tone
spastic
rigid
DTR’s
normal to increased
Clonus
Present
occ. present
Contractures
early
late
Primitive Reflexes
delayed
persistent
Involuntary movements
rare
frequent

31. Cerebral Palsy: Complications
Spasticity
Weakness
Increase reflexes
Clonus
Seizures
Articulation & Swallowing difficulty
Visual compromise
Deformation
Hip dislocation
Kyphoscoliosis
Constipation
Urinary tract infection

32. Associated Problems Mental Retardation Communication Disorders
Neurobehavioral
Seizures
Vision Disorders
Hearing loss
Somatosensation (skin sensation, body awareness)
Temperature instability
Nutrition
Drooling
Dentition problems
Neurogenic bladder
Neurogenic bowel
Gastroesophageal reflux
Dysphagia
Autonomic dysfunction

33. Cerebral Palsy: Management
Neurologic and Physiatric
OT and PT
Speech
Adaptive equipment
Surgical
Rhizotomy, Baclofen pumps, Botoxin

34. Medical Management Growth
Persons with CP often have struggle to gain or maintain weight.
Failure to Thrive is a common problem.
Before diagnosing Failure to thrive, an accurate Body Mass Index must be obtained, but an accurate height is difficult to obtain in a person with severe contractures.
In such cases, arm span calculations may be used and a growth chart is available to determine percentiles standardized to age and gender.

35. Medical Management Orthopedic Problems Scoliosis Hip Dislocations
Contractures
Osteoporosis

36. Medical Management Oromotor Dysfunction
Especially common in persons with Extrapyramidal CP and Spastic quadriplegia
Language delay/Speech delays
Drooling
Dysphagia
Aspiration

37. Gastrointestinal Dysmotility
Medical Management
Gastrointestinal Dysmotility
Delayed gastric emptying
Gastroesophageal reflux
Pain
Chronic aspiration
Constipation
These disorders are interrelated and compound one another.

38. Spasticity Management
Medical Management
Spasticity Management
Management of spasticity does not fix the underlying pathology of CP, but it may decreased the sequelae of increased tone.
Over time, the spasticity leads to:
musculoskeletal deformity
scoliosis
hip dislocation
contractures
Pain
Hygiene problems

39. Treatment of Spasticity
Medications
Valium
Dantrium
Baclofen
Clonidine
Clonazepam
BOTOX

40. Cerebral Palsy What is substantially disabling Cerebral Palsy?
Mobility
Communication
Learning
Self Care
Self Direction
Independent Living
Economic Sufficiency

41. Good luck on your finals!
Thank You!
Good luck on your finals!