cerebral palsy Flashcards
Cerebral Palsy
- A group of non-progressive, irreversible motor disorders caused by brain damage to an immature brain
- This brain damage may occur in utero (from 2nd half of pregnancy onwards), during the birth process, or in early childhood (usually the first 3 years of life).
Etiology
Think hypoxia and ischemia
CP is usually due to hypoxia, which may occur via:
- A very premature birth
- Intrauterine virus (TORCH) or other infection/toxicity or source of brain damage
- Ischemic insults
Hypoxia and ischemia – in utero causes
○ kink in the umbilical cord or the cord wrapping around the fetus’s neck
○ maldevelopment of the placenta
○ shock in the mother from an accident.
Postpartum hypoxia or ischemia
○ suppression of the respiratory centres b/c of overmedication of the mother;
or pneumonia, a collapsed lung or drowning of the infant
what causes Trauma to, or rupture of cerebral blood vessels
○ separation of the placenta
○ difficult or prolonged delivery
○ postpartum head injury from an accident or abuse
● The brain of a premature baby is particularly susceptible to hemorrhage.
● Strokes can occur as a result of dehydration.
Presentation
There is a very wide spectrum of presentations in CP
Some are very mild and would be noticed only by HCPs
Others are very profound and include significant disability
4 types of cerebral palsy
- Spastic
- Athetoid
- Ataxic
- Mixed
Spastic
increased tone; accounts for 75% of all cases (most common)
a. Monoplegia: 1 arm or leg
b. Diplegic: usually both legs, M/C of spastic form, fully ambulatory scissor gait
c. Hemiplegic: 1 side of body, usually most ambulatory
d. Quadriplegic: all 4 limbs
Athetoid
uncontrolled movement, slow & writhing, increase with intention & stops with sleep, has trouble holding themselves upright
Ataxic
poor coordination, least common, due to damage to cerebellum
Mixed
usually spastic & athetoid
Symptoms
● Not noticeable in early infancy - become more obvious as nervous system matures
○ Early signs are delayed milestones, persistence of primitive reflexes, in toddlers
not walking or forming sentences
● Spasticity – most common
● Athetoid movements – slow and writhing
● Choreiform – movements are quick, uncontrolled and without purpose; do not stop with sleep
● Ataxia – lack of coordination and clumsiness of movements; ataxia in the face causes grimacing
Classic gait pattern
“Scissors gait” due to adductor spasticity
Diagnosis (according to CDC)
● Developmental Monitoring
○ tracking child‘s growth & development over time
● Developmental Screening
○ Testing motor or movement delays, lacking milestones
○ Done at 9 months, 18 months, 24 or 30 months
● Developmental and Medical Evaluations
○ Goal is to diagnose specific type of disorder
○ Evaluation of movement/motor delays - mm tone, reflexes, posture
○ Related conditions like intellectual disability, seizures, vision, hearing, speech problems
○ MFI, CT, X-ray, electroencephalogram (EEG)
Treatment
● There is no cure
● Treatments such as physical and occupational therapy, speech therapy, drugs to control seizures, relax muscle spasms and alleviate pain
● Surgery to correct anatomical abnormalities or release tight muscles
● Braces and other orthotic devices
● Wheelchairs and rolling walkers
● Communication aids
Massage considerations
- Communication
Some people with CP are non-verbal or non-communicative. Establishing a method of communication via a carer is most important.
Yes / no / stop signal
- Comfort
Pillow and positioning (often in a wheelchair) for support and comfort
May need to accommodate high amounts of salivary secretions
