By: Livson ThomasBy: Livson Thomas

M.Sc (N) 2M.Sc (N) 2ndnd Year Year

WILLIAM WILLIAM JOHN JOHN LITTLELITTLE(1810-(1810-1894)1894)

In 1860s, known as

"Cerebral Paralysis”

or “Little’s Disease”

After an English surgeon

who wrote the 1st

medical descriptions

William John Little.

Cerebral“- Latin Cerebrum;

Affected part of brain

“Palsy " -Gr. para- beyond, lysis –

loosening

Lack of muscle control

A motor function disorder caused by permanent, non-progressive brain

lesion present at birth or shortly thereafter. (Mosby, 2006)

Non-curable, life-long condition Damage doesn’t worsen May be congenital or acquired

A Heterogenous Group of Movement Disorders

– An umbrella term

– Not a single diagnosis

Muscle Strength

Movements

Balance

Coordination Posture

OF CEREBRAL PALSY

An insult or injury to the brain

– Fixed, static lesion(s)

– In single or multiple areas of the motor centers of the brain

– Early in CNS deveation

Development Malformations The brain fails to develop correctly.

Neurological damage Can occur before, during or after delivery Rh incompatibility, illness, severe lack of

oxygen

* Unknown in many instances

Severe deprivation of oxygen or blood flow to the brain

–Hypoxic-ischemic encephalopathy

or intrapartal asphyxia

OF CEREBRAL PALSY

Based on the - extent of the damage- area of brain damage

Each type involves the way a person moves

1. PYRAMIDAL - originates from the motor areas of the cerebral cortex

2. EXTAPYRAMIDAL

- basal ganglia and cerebellum

3. MIXED

2. According to Type of Movement

Photo from: Saunders, Elsvier.

1. Spastic CP

2. Athethoid CP 3. Ataxic CP

4. Spastic & Athethoid CP

ATHETOID-Fluctuating

Tone

ATAXIC-Unsteady,

uncoordinated

SPASTIC -Stiffness

ATHETOID-Uncontrolled

Movements

ATAXIC-Unsteady,

uncoordinated

TYPES

According to affected limbs:* plegia or paresis - meaning paralyzed or weak:

Paraplegia Diplegia Hemiplegia Quadriplegia Monoplegia –one limb (extremely

rare) Triplegia –three limbs (extremely

rare)

1. Mild CP- 20% of cases

2. Moderate CP- 50%

- require self help for assisting their impaired ambulation capacity.

3.Severe CP- 30%

-totally incapacited and bedridden and they always need care from others.

OF CEREBRAL PALSY

a.

b.

c.

d.e.

f.

g.

h.

• Stiff or floppy posture

• Weak suck/ tongue thrust/ tonic bite/ feeding difficulties

• Poor head control

• Excessive lethargy or irritability/ High pitched cry

Infancy (0-3 Months)

Abnormal or prolonged primitive reflexes

Moro’s reflexAsymmetric tonic neck reflex

Placing reflexLandau reflex

Slow to re

ach

developmental

milesto

nes

Poor ability to concentrate,

unusual tenseness, Irritability

OF CEREBRAL PALSY

Hearing and visual problems

Sensory integration problems

Failure-to-thrive, Feeding problems

Behavioral/emotional difficulties,

Communication disorders

• Bladder and bowel control problems, digestive problems

(gastroesophageal reflux)• Skeletal deformities,

dental problems• Mental retardation and

learning disabilities in some

• Seizures/ epilepsy

OF CEREBRAL PALSY

Physical evaluation, Interview MRI, CT Scan EEG Laboratory and radiologic work up Assessment tools

i.e. Peabody Development Motor Skills, Denver Test II

- INTERVIEW

Include all that may predispose an infant to brain damage or CP

Risk factors Psychosocial factors Family adaptation

Often admitted to hospitals for corrective surgeries and other complications.

Respiratory status Motor function Presence of fever Feeding and weight loss Any changes in physical state Medical regimen

- Physical Examination

P osturing / Poor muscle control and strength

O ropharyngeal problems

S trabismus/ Squint

T one (hyper-, hypotonia)

E volutional maldevelopment

R eflexes (e.g. increaseddeep tendon)

*Abnormalities 4/6 strongly point to CP

PO S

TER

OF CEREBRAL PALSY

- No treatment to cure cerebral palsy.

- Brain damage cannot be corrected. Crucial for children with CP:

Early Identification; Multidisciplinary Care; and

Support

I. Nonphysical Therapy

A. General management

- Proper nutrition and personal care

B. Pharmacologic Botox, Intrathecal, Baclofen

- control muscle spasms and seizures, Glycopyrrolate -control drooling

Pamidronate -may help with osteoporosis.

C. Surgery

-To loosen joints,

-Relieve muscle tightness,

- Straightening of different twists or unusual curvatures of leg muscles

- Improve the ability to sit, stand, and walk.

Selective posterior rhizotomy In some cases nerves need to be severed

to decrease muscle tension of inappropriate contractions.

D. Physical Aids Orthosis, braces and splints Positioning devices Walkers, special scooters, wheelchairs

E. Special Education

F. Rehabilitation Services- Speech and occupational therapies

G. Family Services -Professional support

H. Other Treatment

- Therapeutic electrical stimulation,

- Acupuncture,- Hyperbaric therapy - Massage Therapy might help

 

II. Physical Therapy

A. Sitting- Vertical head

control and control of head and trunk.

B. Standing and walking- Establish an equal

distribution of weight on each foot, train to use steps or inclines

C. Prone DevelopmentD. Supine Development

o Head control on supine and positions

NURSING RESPONSIBILITIES

A. Functioning as a member of the health team

B. Providing counseling and education for the parents and promote optimal family functioning

- Encourage family members to express anxieties, frustrations and concerns

- Provide emotional support and help with problem solving as necessary.

- Explore support networks. Refer them to support organizations

C. Promoting physical and psychological health

- Administer prescribed medications

- Encourage self-care by urging the child to participate in activities of daily living (ADLs) (e.g. using utensils and implements that are appropriate for the child’s age and condition).

- Provide rest periods to foster relaxation. Provide safe & appropriate toys

- As necessary, seek referrals for corrective lenses and hearing device to decrease sensory deprivation related to vision and hearing losses

D. Assisting with feeding management and toilet training

- Promote adequate fluid and nutritional intake. Position upright after meals

- During meals, maintain a quiet, unhurried atmosphere with as few distractions as possible. The child may need special utensils and a chair with a solid footrest

- Teach him to place food far back in his mouth to facilitate swallowing.

- Encourage the child to chew food thoroughly, drink through a straw, and suck on a lollipop between meals to develop the muscle control needed to minimize drooling.

E. Assisting with rehabilitation therapies (physical, occupational and speech)

- Promote mobility by encouraging the child to perform age-and condition-appropriate motor activities

- Inform parents but their child will need considerable help and patience in accomplishing each new task.

- Encourage them not to focus solely on the child’s inability to accomplish certain

- Explain the importance of providing

positive feedback.

- Facilitated communication. Talk to the child deliberately and slowly, using pictures or sign language to reinforce speech when needed

- Technology such as computer use may help children with severe articulation problems.

F. Providing counseling for educational and vocational pursuits

G. Preventing child abuse

H. Providing care during hospitalization

- Prepare the child and family for procedures, treatments, appliances and surgeries if needed. Assign the child a room with children in the same age-group.

I. Prevent physical injury by providing the child with a safe environment, appropriate toys, and protective gear (helmet, kneepads) if needed.

J. Prevent physical deformity by ensuring correct use of prescribed braces and other devices and by performing ROM exercises.

K. Promote a positive self-image in the child:

- Praise his accomplishments- Set realistic and attainable goals- Encourage and appealing physical

appearance- Encourage his involvement with age and

condition appropriate peer group activities.