Cerebral Palsy

Question 1

Cerebral Palsy Is a

Answer 1

term used for motor function disorders that result from damage to the immature brain.
Is a non-progressive condition; is the result of lesions that occur during the perinatal period, from half-way through pregnancy to seven days postpartum, and up to three years of age

Question 2

“Cerebral”means

Answer 2

brain

Question 3

“Palsy” refers to

Answer 3

a lack of movement control

Question 4

Fetal brain development begins approximately

Answer 4

midway through pregnancy; the brain is susceptible to damage
The majority of children with CP are born with it although it may not be detected until months or years later. The early signs usually appear before a child reaches three years of age

Question 5

Causes

Answer 5

Hypoxia and ischemia – in utero from a kink in the umbilical cord or the cord wrapping around the fetus’s neck, maldevelopment of the placenta or shock in the mother from an accident.
Postpartum hypoxia or ischemia can result from suppression of the respiratory centres b/c of overmedication of the mother; or pneumonia, a collapsed lung or drowning of the infant
Trauma to, or rupture of, cerebral blood vessels – due to separation of the placenta; difficult or prolonged delivery; postpartum head injury from an accident or abuse
The brain of a premature baby is particular susceptible to hemorrhage. Strokes can occur as a result of dehydration.

Toxicity and infection – can lead to brain damage. RH factor incompatibility or infection in the mother such as measles, shingles or a virus can damage brain cells; postpartum meningitis, viral encaphalitis and lead and carbon monoxide poisining

Question 6

It is estimated that

Answer 6

one in every 500 babies and up to one in three premature babies are affected to some extent with CP.
The type and severity of symptoms will depend on the location and extent of the brain lesion, from few or no obvious signs to a severe lack of motor control.

Question 7

Four Main Types

Answer 7

Spastic, Athetoid, Ataxic, Mixed – usually spastic and athetoid

Question 8

Spastic

Answer 8

increased tone; accounts for 75% of all cases
Monoplegia – one arm or leg
Diplegic – both legs usually; most common of spastic form; fully ambulatory scissors gait
Hemiplegic – one side of body; usually most ambulatory
Quadriplegic – all four limbs; least likely to be able to walk

Question 9

Athetoid

Answer 9

– uncontrolled movement; slow and writhing, increases with intention and stops with sleep; have trouble holding themselves upright

Question 10

Ataxic –

Answer 10

poor coordination; least common; damage to cerebellum

Question 11

The signs of CP

Answer 11

are usually not noticeable in early infancy but become more obvious as the child’s nervous system matures.
Early signs are delayed milestones, persistence of primitive reflexes and developing handedness before 18 months (indicates weakness or abnormal muscle tone on one side).
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
Flaccidity – may be present in the first year or two then change to spasticity or athetoid movement
Reflex movements – development reflexes not integrated
Pain – resulting from muscular, neurological and bony changes; can be acute or chronic
Postural dysfunctions – scoliosis (can lead to respiratory difficulties), hyperlordosis, hyperkyphosis
Contracture formation – equinus deformity (short Achilles); internal rotation of hip, hip flexion
Permanent skeletal changes and arthritis
Stenosis of cervical spine
Osteoporosis
Epilepsy, mental development delay and emotional disturbances
Compromised tissue health – disuse atrophy >60 yrs; edema → decubitus ulcers
Peripheral nerve compression – due to postural imbalances
Variety of sensory losses; decreased proprioception
Perception of pain, temperature and pressure is not affected
Speech – dysarthria; can be difficulty swallowing and inability to control saliva
Hearing impairment
Bowel and bladder function compromised
Vision can be normal or limited
Frustration and anger
Intellect may or may not be affected

Question 12

Athetoid movements –

Answer 12

slow and writhing

Question 13

Choreiform –

Answer 13

movements are quick, uncontrolled and without purpose; do not stop with sleep

Question 14

Ataxia –

Answer 14

lack of coordination and clumsiness of movements; ataxia in the face causes grimacing

Question 15

Diagnosis

Answer 15

Development delays such as reaching for toys (3-4 months), sitting (6-7 months) and walking (10-14 months)
Physical findings – such as abnormal muscle tone, abnormal movements, abnormal reflexes and persistent infantile reflexes
Most times, children can be diagnosed by the age of 18 months

Question 16

Treatment

Answer 16

There is no cure
Treatments such as physical and occupational therapy, speech therapy, drugs to control seizures, relax muscle spasms and alleviate pain will often improve a child’s capabilities
Surgery to correct anatomical abnormalities or release tight muscles
Braces and other orthotic devices
Wheelchairs and rolling walkers
Communication aids