Mobility - Cerebral Palsy

Question 1

What is Cerebral Palsy (CP)

Answer 1

Cerebral Palsy is a disorder of the neuromuscular dysfunction.

Question 2

Is cerebral palsy curable?

Answer 2

NO: CP is a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain

Question 3

What causes CP?

Answer 3

Anoxia APPEARS to play the most significant role in causation.

Question 4

What is Anoxia?

Answer 4

Anoxia is the absence of oxygen reaching the tissues

Question 5

What are some risk factors of CP (prenatal)?

Answer 5

• Premature Birth
• existing prenatal brain abnormalities
• maternal infections
• multiple births

Question 6

What are some risk factors of CP (postnatal)?

Answer 6

• perinatal ischemic stroke
• bacterial meningitis
• viral encephalitis
• Motor vehicle accidents
• Child abuse (shaken baby syndrome)

Question 7

single MOST important risk for CP:

Answer 7

PREMATURITY

• *increased risk with birth weight 1000-1499 grams OR
• *born prior to 28 week gestation completed

Question 8

What types of CP are there?

Answer 8

Spastic (pyramidal) CP
Dyskinetic (nonspastic, extrapyramidal) CP
Ataxic (nonspastic, extrapyramidal) CP
Mixed: most commonly a mixture of spastic + dyskinetic

Question 9

How is CP diagnoised?

Answer 9

-DXd via neurologic examination + history
^^^are there delayed developmental
milestones?
**infants at high-risk are monitored CLOSELY

-neuroimaging
^^^MRI + head ultrasound

-metabolic + genetic testing if NO structural abnormalities are identified

Question 10

What are the S/S of CP in 0-6 month olds?

Answer 10

• *poor head control
• **feels stiff or floppy when held
• clenched fists
• failure to smile
• poor sucking

Question 11

What are the S/S of CP in 6-10 month olds?

Answer 11

• *Inability to sit by 8 months
• tongue pushing food out of mouth
• difficulty bringing their hands to the center

Question 12

What are the S/S of CP in 10+ month olds?

Answer 12

• *using one side of the body to crawl
• walking on toes
• not speaking simple sentences by 24 months

Question 13

Is CP progressive?

Answer 13

NO; cerebral palsy is NOT a progressive disease - prognosis depends on severity of impairment

Question 14

Mild-Moderate CP

Answer 14

**usually able to participate in regular classes
85% have the ability to achieve ambulation between 2 - 7 years of age
-can usually participate in recreational activities

Question 15

Moderate-Severe CP

Answer 15

• *may have cognitive impairments

- often succumb to respiratory tract infection in childhood due to impaired mobility and feeding problems

Question 16

CP & Seizures

Answer 16

***Development of SEIZURES is COMMON in patients with CP

Question 17

Independence and CP

Answer 17

**Normalization and promotion of self care activities that EMPOWER the child AND family is CRITICAL to nursing management

***One of the MOST USEFUL INTERVENTIONS to help children cope with immobility is participation in their OWN CARE!!!

Question 18

What are some “negative consequences” of immobility?

Answer 18

• *feelings of helplessness/hopelessness
• boredom
• depression
• grieving
• anxiety
• anger
• disturbed body image
• decreased verbal and nonverbal communication

Question 19

Functional Ability & CP

Answer 19

• *goal is to promote MOBILITY & INDEPENDENCE
• *Manual or powered WHEELCHAIRS allow for more independent mobility
• strollers can be equipped with custom seats for dependent mobilization
• ankle-foot orthoses (**AFO’s & braces)

Question 20

CP contractures - nursing interventions

Answer 20

• *HIP SURVEILLANCE
• ROM exercises
• orthopedic surgery

Question 21

CP & Surgical Intervention

Answer 21

• *goal is to IMPROVE FUNCTION of affected areas (not to cure CP)
• used only after conservative methods have failed
• correct deformities from spasticity

Question 22

CP & skin breakdown

Answer 22

• *INCREASED RISK for children with orthotics and assistive devices
• pressure areas
• malalignment
• poor bracing
• nutrition
• immobility

Question 23

Family support & CP

Answer 23

• *One of the most valuable nursing interventions in care of the child with CP is FAMILY SUPPORT!
• help in COPING with the emotional aspects of the disorder
• provide education, assessment, and mobilization of resources
• *stress principles of NORMALIZATION

Question 24

Parents & CP

Answer 24

**Parents SUPPORT GROUPS are most helpful through sharing experiences and accomplishments!

Question 25

CP & ADL: dental hygiene

Answer 25

DENTAL HYGIENE is ESSENTIAL - regular visits to the dentist - decreased oral intake can lead to more tartar buildup!

Question 26

CP & fatigue

Answer 26

**more frequent REST PERIODS should be arranged to avoid fatigue

Question 27

CP & Nutrition

Answer 27

The diet should be tailored to the child's ACTIVITY & METABOLIC needs * *Gastrostomy feedings MAY be necessary to supplement regular feedings and ensure adequate weight gain * *CONSTIPATION management due to neurologic deficits and lack of exercise, may be necessary

Question 28

CP & Muscle spasms

Answer 28

* *Intense pain may occur | * *PAIN MANAGEMENT is an important aspect of the care

Question 29

CP & Medications (for pain)

Answer 29

Oral pharmacologic agents for CP include: - baclofen (Lioresal) & diazepam (Valium) * **DIAZEPAM should be RESTRICTED to older children and adolescents - gabapentin (Neurontin) has been used for decreasing SPASTICITY PAIN

Question 30

CP & Botox

Answer 30

**Botulinum toxin A (Botox) is also used to reduce spasticity in targeted muscles. ^^^minimizes muscle contractures **often used in the LOWER EXTREMITIES ^^^delays or minimizes the need for surgical procedures - the goal is to allow stretching of the muscle as it relaxes and permit ambulation with an AFO - onset of action occurs within 24 - 72 hours, with a peak effect observed at 2 weeks and a duration of action of 3 - 6 months

Question 31

CP & Baclofen pump

Answer 31

-Implantation of a pump to infuse baclofen directly into the intrathecal space surrounding the spinal cord to provide relief of spasticity **best suited for children with SEVERE SPASTICITY ^^^provides relief without as many side effects - the pump is placed in the subcutaneous space of the mid-abdomen. An intrathecal catheter is tunneled from the lumbar area to the abdomen and connected to the pump. - outpatient visits to refill the pump and make dosage adjustments are scheduled about every 3 - 6 months depending on the patients response to the treatment.

Question 32

CP & collaborative care: physical therapy

Answer 32

**PHYSICAL THERAPY is one of the MOST frequently used treatment modalities. ^^^should involve the family; the physical therapist; and often other members of the healthcare team >>stretching, passive, active, and resistive movements applied to specific muscle groups or joints to maintain or increase ROM, strength, or endurance

Question 33

CP & collaborative care: occupational therapy

Answer 33

**OCCUPATIONAL THERAPY (OT) to help with posture and participation in ADLs

Question 34

CP & collaborative care: speech therapy

Answer 34

**SPEECH THERAPY (OT) to improve communication abilities and help with swallowing disorders

Question 35

CP & collaborative care: recreational therapy

Answer 35

**REC THERAPY to expand physical and cognitive abilities

Question 36

CP & Safety

Answer 36

* **risk for altered perception and SUBSEQUENT FALLS * *ADAPT THE HOME and play environments to meet the child's needs to prevent bodily harm - immunizations such as FLU or pneumonia in addition to normal well child vaccines * *REAR-FACING CAR SEATS as long as possible because of their poor head, neck and trunk control