Cerebral Palsy

Question 1

Define Cerebral Palsy?

Answer 1

A non progressive lesion which causes damage to the developing brain causing a deficit in motor or posture in the 1st 2 years of life.

Question 2

What are the different types of cerebral palsy?

Answer 2

Spastic (pyramidal): Extensor weakness and stiffness

Dyskinetic: characterised by involuntary uncontrolled movements such as:

• chorea (irregular sudden movements)
• athetosis (slow writhing movements)
• dystonia (simultaneous contraction of agonist and antagonist).

Ataxic (cerebellar): Affecting balance and coordination

Question 3

What is the most common form of CP and how can it be categorised?

Answer 3

Spastic CP

Quadriplegia: affecting all four limbs
Hemiplegia: affecting one side of the body
Monoplegia: affecting one limb

Question 4

What are the risk factors/causes of Cerebral Palsy?

Answer 4

Antenatal (80%):

• vascular occlusion
• genetic syndromes
• congenital infection
• toxins

Perinatally (10%):
-Hypoxic ischaemic injury during delivery

Postnatally:

• Infection (meningitis/encephalitis)
• Head trauma
• Symptomatic hypoglycaemia
• Hydrocephalus
• Hyperbilirubinaemia.

Question 5

What is the medical management for a child with cerebral palsy?

Answer 5

Physiotherapy:

• to prevent weakness of muscles not normally used.
• to prevent muscles getting stuck in a rigid position (contractures).

Medication to reduce muscle stiffness:

• Diazepam (s/e drowsiness + addictive)
• Botox injections into muscles
• Intrathecal baclofen therapy (ITB)

ITB consists of delivering a liquid form of baclofen into the spinal fluid, using a device called a baclofen pump this drug helps to improve excessive muscle tone.

Surgery:
Orthopaedic surgery can be used to lengthen muscles