1. CEREBRAL PALSY

2. CEREBRAL PALSY
None progressive, static disorder of the tone, posture or movement, due to lesion in developing brain. But symptoms may change

3. Cerebral Palsy Rates Multiple births 7.5 / 1000 live births
Singletons / 1000 live births
1500gr or less 80 / 1000

4. RISK FACTORS ASSOCIATED WITH CEREBRAL PALSY
GENERAL
Gestational age < 32 weeks
Birth weight <2500 g
MATERNAL HISTORY
Mental retardation
Seizure disorder
Two or more prior fetal deaths
Sibling with motor deficits
DURING GESTATION
Twin gestation Chorionitis
Fetal growth retardation
Third-trimester bleeding Low placental weight
Premature placental separation
FETAL FACTORS
Abnormal fetal presentation
Fetal malformations
Fetal bradycardia
Neonatal seizures

5. CP: ETIOLOGY Majority is idiopathic (thought to present prenatally)
PRENATAL PERIOD- wherein most causes of CP occur.
The most common currently understood causes are related to brain injury occurring in children born prematurely.

6. Prenatal Associations with Cerebral Palsy
Placental insufficiency.
Brain malformation.
Congenital infection.
Chromosomal defects.
Genetic malformations

7. Types of Cerebral Palsy
Spastic Hemiplegic
Diplegic
Quadriplegic
Ataxic
Dyskinetic Dystonic Hypokinesia
Hypertonia
Chored-Athetoid Hyperkinesia
Hypotonia
Mixed

8. Spastic:
Hemiplegia:
UMNL one side of body.
Diplegia:
UMNL of legs more than arms.
Quadriplegia:
Equal involvement of arms and legs.

9. Diplegic CP : The most common type 30%
Speech / cognitive function : normal .
no Epilepsy.
UL : gross motor (Normal)
LL : spastic
Infant ( commando crawl by hand), Delay sitting.
O/E Scissoring position, hyper-reflexia knee & ankle, Bilateral Babinski sign.
Child, Delay walking, walk on tiptoe
O/E disuse atrophy
hip: flexion, adduction, int. rotation
knee: flexor / extensor spasticity /or equal
ankle: equinovarous.
foot: pes valgus
Most walk independently by 4 years

11. Hemiplegic CP : 25 % of all CP
One side affection, upper > lower extremity
25 % mentally retarded
33 % seizures
Infant: Hand preference
Child: Circumductive
gait, hyper-reflexia
Cause :Thromboembolism

12. All four limbs involved – and trunk- UMNL Often with MR & seizures
Spastic Quadriplegia (Most severe)20%
All four limbs involved – and trunk- UMNL
Often with MR & seizures
Most ( 80 % ) non walkers
Swallowing difficulty &
Aspiration pneumonia due to
Pseudo-bulbar palsy
.Speech &visual abn.
Flexion contracture of knee
& elbow, scissoring posture.
Hypertonia, hyper-reflexia.

14. Dyskinetic CP Less common than spastic CP.15%.
Infant is hypotonic, head lag then rigidity& dystonia(mov. Disorder that persons muscle contract uncontrollably, repetitive mov.).
Feeding and speech are typically affected.
Cause : birth asphyxia., kernicterus, metabolic disease that effect basal ganglia.

15. Diagnosis of CP Birth History Delayed Milestones
Prematurity.
Seizures.
Low apgars.
Intracranial haemorrhage.
Periventricular leucomalacia.
Delayed Milestones
Abnormal Motor Performance
Handedness.
Reptilian crawl. (abdomen) like snake
Toe waking.

16. Early Signs of Cerebral Palsy
Altered Tone.
Persistence of primitive reflexes.
Abnormal posturing.
Inv.:
MRI of brain,
Test for vision & hearing
Genetic evaluation

17. Cerebral Palsy Associated Disabilities
Mental retardation 1/3 N. 1/2 I.Q. < 55.
Epilepsy 25% > generalised.
Speech disorders 50% delay/dysarthria.
Vision and hearing 25%.
Behaviour abnormalities.
Learning difficulties.

18. Common Management Problems in Cerebral Palsy
Feeding Problems:
Failure to suck.
Tongue trusting, gagging and choking.
Vomiting and regurgitation.
Dribbling.
Constipation.
Crying, screaming and sleep disturbances.
Growth.

19. Treatment of Cerebral Palsy
Parent guidance.
Physiotherapy
Orthopaedic: scoliosis, contractures, deformities.
Speech and Occupational Therapy.
Medical.
Psychiatric.

20. Management of Spasticity in Cerebral Palsy
Oral Medicines: Baclofen, Diazepam, Dantrolene
Intrathecal Baclofen.
Botulinum Toxin.(to affected muscle)
Selective dorsal Rhizotomy on spinal n. for severe spasticity.(cutting some of sens. N. fibers come from muscles &enter spinal cord)
Tenotomy of Achilles tendon(cutting a tendon called tendon release, lengthening)used to lengthen m. become shortened & resistant to stretch
Rigidity, dystonia Levodopa-carbidopa (Sinemet)
Dystonia : carbamazepine.