Cerebral Palsy

Stephanie J. Buchholz RN, MSN

Definition Of Cerebral Palsy

Non-progressive , CNS-based disorder of strength, muscle control, posture, or movement

due to brain injury acquired early in brain growth

Implies absence of ongoing disease

May be accompanied by perceptual problems, language deficits, and intellectual involvement

Etiology Of CP

76% are due to:

Teratogens/toxins

Genetic syndromes

Brain malfomations

Intrauterine infection

Preeclampsia

Complications of labor and delivery

Sepsis/CNS infection

Asphyxia

*Prematurity

Meningitis

Traumatic brain injury

Etiology Of CP (Cont’d.)

24% cause is not obvious

Pathophysiology Of CP

*Anoxia plays the most significant role, which is frequently secondary to other causative factors:

Hypoxia

Ischemia

Trauma

Hemorrhage

Congenital malformation

Asphyxia

Pathophysiology Of CP (Cont’d.)

CNS relies on uninterrupted supply of blood, O2, and glucose

O2 is essential to convert glucose to energy; if this action fails, acidosis results

With prolonged hypoxia/acidosis:

Infarction of white matter

IVH

Necrosis of cerebral cortex

Subarachnoid or subdural hemorrhage

Clinical Manifestations Of CP

Five clinical classifications:

Spastic CP

Dyskinetic CP

Ataxic CP

Rigid/tremor/atonic CP (rare)

Mixed CP

Spastic CP

Most common type

Impairment of fine & gross motor skills

Affected area of brain is motor cortex

May involve one or both sides

Characterized by:

Deep tendon reflexes

Hypertonia

Sometimes contractures

Spastic CP: Classified According
To Pattern Of Limb Involvement

Spastic quadriplegia:

All 4 extremities with complete loss of power and function

Flexion contractures are common

Associated defects

Spastic hemiplegia:

Leg and arm on one side are affected

Obvious atrophy on affected side

SZ disorders and mental retardation

Spastic CP: Classified According To Pattern Of Limb Involvement (Cont’d.)

Spastic diplegia:

Like parts on both sides of body affected

Mental retardation is unusual

Speech develops normally

Monoplegia: rare occurrences

Triplegia: rare occurrences

Paraplegia: rare occurrences

Dyskinetic CP

Refers to injury in the basal ganglia

Abnormal involuntary movements and postures

Chorea is rapid, forceful movements of head and limbs

Athetosis is slow, twisting, writhing of hands and feet; wormlike

Dyskinetic CP (Cont’d.)

Usually severe, but can be mild and confined to tongue, facial muscles or single limb

Causes drooling and imperfect speech articulation

Ataxic CP

Affected area of brain is cerebellum

Impaired balance and gait

Intention tremor is a prominent sign

Overall appearance of child is clumsy

Rigid/Tremor/Atonic CP

Rare

Characterized by prolonged increase of muscle tone and disturbed posture

Tremors at rest and on movement

Speech impairment is usually severe

Poor prognosis

Mixed CP

Combination of spasticity and athetosis

Associated Disabilities Of CP

Disturbed mental development

Seizure activity

Growth retardation

Vision impairment

Hearing impairment

Associated Disabilities Of CP (Cont’d.)

Drooling

Dental problems

Speech impairment

Constipation

Gait disturbances

Diagnosis Of Cerebral Palsy

Based on history and neuro exam

Laboratory tests:

Electrolyte imbalances

Metabolic defects

Infectious disease

Neoplastic disease

Diagnostic tests:

EEG

CT scan

Medical Interventions

Mobilizing devices

Orthopaedic surgery

Medication

Technical aids

Involvement of specialists

Mobilizing Devices

Used to prevent or reduce deformity

Ankle-foot orthoses (AFO’s)

Wheeled scooter boards/go-carts

Customized strollers

Orthopaedic Surgery

To correct deformities

To provide stability for an uncontrollable joint

To provide balanced muscle power

Surgery:Selective Dorsal Rhizotomy

Medication

Drugs to decrease spasticity have little usefulness in improving function in CP

Antianxiety agents

Skeletal muscle relaxants

Diazepam (Valium)

Local nerve blocks

Antiepileptic medications

Dextroamphetamines

Botulinum toxin

Technical Aids

Electromechanical toys

Appropriately designed toys and games

Microcomputers/computers

Electronic devices

Involvement Of Specialists

Visual and auditory deficits

Dental care

Physical therapy*

Family, PT, OT, ST, health team

Education

Recreation

Nursing Care Of The Child With CP

Collaborate with family and supportive services to identify how to fulfill special needs and treatments during hospitalization

Cerebral Palsy

Any questions?

Thank you for your attention

THE END!