Chapter 28: Cerebral Palsy Flashcards
Cerebral Palsy
characterized by permanent physical impairment and mild to severe physical and mental dysfunction
-non-progressive neurological disorder that results from brain injury occurring before cerebral development is complete
>because brain development continues for the first 2 years of life, the disorder can be a result of brain injury occurring not only during the prenatal period but during perinatal and postnatal periods
Prenatal Risk Factors
- asphyxia
- infections (e.g. rubella, cytomegalovirus, and toxoplasmosis)
- intracranial hemorrhage
- blood incompatibility
- trauma
Perinatal Risk Factors
- low birth weight
- birth at less than 32 weeks of gestation
- intracranial hemorrhage
Postnatal risk factors
- viral encephalitis
- bacterial meningitis
- falls
- child abuse
- motor vehicle crashes
Four Types of CP
- spastic
- ataxic
- athetoid or dyskinetic
- mixed
Spastic CP
- most common
- has stiff muscles b/c of increased muscle tone; predisposed to contracture
- poor control of posture, coordinated movement, and balance
- classified according to the limbs affected (diplegia, hemiplegia, quadriplegia, monoplegia, and triplegia)
- with spastic diplegia (both legs involved) have difficulty walking b/c of tight muscles in the hips and legs and may have scissoring (legs turn inward and cross at the knees)
Ataxic CP
- difficulties with balance and depth perception
- walk with an unsteady gait
- poor coordination
- have fine motor problems
Athetoid or Dyskinetic CP
- uncontrolled involuntary writhing movements of extremities
- in severe cases, the facial muscles may be affected, and drooling, speech difficulties, and grimacing may occur
Mixed CP
child has two or more types of CP
- difficulty or inability to walk
- speech difficulty
- swallowing problems
- breathing difficulties
- bowel or bladder incontinence
- seizures
- vision problems
- learning disabilities
- hearing deficits
- attention or behavioral problems
- impaired senses
Signs and Symptoms
- muscle rigidity
- muscle spasticity
- poor control of posture
- ataxia (impaired coordination)
- important sign of CP is persistence of some primitive infant reflexes (i.e. Moro and crossed extensor reflexes) which normally disappear between 6 months and 12 months of age
Diagnosis
based on clinical symptoms and a history of delay in reaching developmental milestones
- may exhibit muscular hypotonia (low muscular tension) or hypertonia (high muscular tension)
- may demonstrate hand preference by 6 months of age instead of 12 months
- important sign of CP is persistence of some primitive infant reflexes (i.e. Moro and crossed extensor reflexes) which normally disappear between 6 months and 12 months of age
- CT, MRI, and cerebral ultrasound used to diagnose alterations in brain integrity that is often present with CP
Prevention
provide education about various risk factors, including infection during pregnancy, premature birth, and injury
-stresses the importance of routine prenatal counseling and visits
Nursing Care
- splints and braces may be necessary to facilitate muscle control and improve body functioning
- assistive devices are necessary to allow the child to perform these tasks, including large-handled brushes and toothbrushes
- encourage child to perform self-care tasks
- clothing should be easy to manipulate
- to reduce muscle spasms and prevent fatigue, allow frequent rest periods
CP and Intellectual development
some may or may not demonstrate intellectual deficits; depends of severity of brain injury
- need intellectual stimulation
- if possible, enrolled in school to foster relationships, self-esteem, and normalcy
- participating in activity programs helps incorporate play into exercise
- toys are chosen based on cognitive, not chronological age
- environment needs to be safe; may not comprehend concept of danger
CP and Feeding
may experience feeding problems b/c of impaired muscle control and strength
- if can feed independently, encouraged to do so; utensils with large handles may be used for easier manipulation
- must be fed in an upright position and not hurried to prevent aspiration
- assistance provided by standing behind the child and guiding the hand to the mouth; stabilize the mandible in a child with poor facial muscle control by placing a hand on the child’s mandible
