Cerebral Palsy

Question 1

What is Cerebral Palsy

Answer 1

A non progressive neurological disorder as a result of insult to the developing brain which may be due to birth asphyxia, trauma, infection or prematurity in the antenatal, perinatal or postnatal period.

Question 2

What are the causes of CP?

Answer 2

●	Antenatal
    ○	Maternal infections
    ○	Trauma during pregnancy 
●	Perinatal
    ○	Birth asphyxia
    ○	Pre-term birth
●	Postnatal
    ○	Meningitis
    ○	Severe neonatal jaundice
    ○	Head injury

Question 3

How can CP be classified

Answer 3

Spastic, Dyskinetic, Ataxic, Mixed.

Spastic subtypes - mono, hemi, di, quadriplegia

Question 4

How might it present?

Answer 4

Developmental delay e.g. gross motor, hand dominance before x months, delayed speech
Failure to thrive
If co-existing epilepsy - seizures

Question 5

What is the association between CP and epilepsy?

Answer 5

Co-existence of the disorders in up to 50% of children with CP.
Mean age of onset of seizures is approx 18 months.
Generalised seizures are the most common.
Children with CP are more likely to have a refractory epilepsy and can be difficult to manage.

Question 6

Who should be involved in the care of a child with CP?

Answer 6

Children with CP require MDT management including;
physiotherapy, occupational therapy, SALT, Dietician, Social worker, physchologist, General paediatrician and specialist paediatricians as required e.g. orthopaedic surgery.

Question 7

What are some of the reasons for pain and discomfort in a child with CP?

Answer 7

Pressure sores
Scoliosis
Fracture / hip subluxation 
Constipation
UTIs
Dental pain

Question 8

What is the role of orthopaedic surgery in the management of a child with cerebral palsy?

Answer 8

Children with CP may develop contractures and require orthopaedic intervention to correct deformities and improve the efficiency and appearance of walking, or the comfort for sitting and transfers.
Surgery undertaken may involve the hip - non walkers are at risk of hip subluxation and dislocation.
Flexion contractures at the knee may require hamstring surgery.
Equinus deformity of the ankle is common in CP. for younger children - manage conservatively with orthoses, inhibitory casts and Bot toxin A. older may benefit from surgery.
May need surgery to correct scoliosis.

Question 9

What is meant by spasticity?

Answer 9

Inappropriate involuntary muscle activity associated with UMN paralysis.
Causes problems with ADLs - gait, feeding, washing, toileting, dressing.
Can cause muscle pain, poor seating position, difficulty with transfers.

Question 10

What options are available to manage spasticity in CP?

Answer 10

Oral meds - diazepam, baclofen, dantrolene sodium.
Inhibitory casts
Botilinum toxin A to reduce localised spasticity
Intrathecal baclofen in some severe cases for enhanced QOL.
Available in UK and US is selective dorsal rhizotomy - sectioning of anterior spinal roots