Cerebral Palsy

CEREBRAL PALSY is an umbrella term encompassing a group of non progressive, non contageous (non communicable) motor condition that causes physical disabilities in human development it occurs due to damage to the brain at or around birth. Clinical picture changes as the nervous system develops and child grows.

In cerebral palsy cerebrum is the affected area in the brain.

Causes of cerebral palsy

Prematurity

preterm babies are much more likely to be brain damaged both at delivery by trauma , and after because of their immature respiratory and cardiovascular systems making them more likely to develop hypoxia and low blood pressure.

Immaturity of the liver makes haemmorhage more likely to occur and be severe.

Asphyxia

It is a condition caused by insufficient intake of oxygen to the brain.

Severe asphyxia is still an important cause of cerebral palsy even in mature infants, and may be caused by accidents at birth, knotted umblical cord, cord around the neck or prolapsed cord.

Multiple deliveries may be associated with delay and asphyxia of the second or third infant, especially with malpresentation.

Trauma

Birth trauma occurs in following ways

• Disproportion- baby's head or legs are too large to pass from birth canal.
• Forceps delivery-with high forceps pressure on baby's head.
• breech delivery
• rapid delivery- especially with preterm infant with very soft skull/

Severe jaundice

high level of unconjugated bilirubin in the blood damages the basal ganglia causing athetoid cerebral plasy and high tone deafness.

Hypoglycemia

low blood sugar for long period can cause severe brain damage and epilepsy.

The cerebellum seems vulnurable causing ataxia, and there are often visual problems.

Intauterine virus infections

Rubella virus infections

cytomegalovirus infections are two viruses can cause severe brain damage and associated deafness and visual problems including cataracts.

Neonatal meningitis

Early meningitis may cause sever brain damage.

Vascular causes

occlusion of internal carotid or middle cerebral artery may occur before or after birth and cause hemiplegia.

Classification of Distribution

one side of the body affected- Hemiplegia

all four limbs affected (upper more than lower)- Quadriplegia

all four limbs affected (one side more then the other)- Bilateral Hemiplegia

legs more affected, but arms less so-Diplegia

 One limb only affected- Monoplegia

Types of cerebral palsy(CP)

Spastic Cerebral palsy

It is a disorder of tone where there is an increase in initial resistance to stretch which may be lessen abruptly.

It is the damage in the upper motor neuron in the cortex or along the pathways which terminate in the spinal cord.

Spastic muscles are contineusly contracting and there is weakness in the antagonostic muscles leading to abnormal positioning of the joints on which they act.

Deformities of joints develop which may become fixed contactures with time.

Dystonic Cerebral palsy

It is a movement disorder in which involuntary muscle contractions occur which may be sustained or intermittent causing repititive and twisting movements, abnormal postures or both.

In Dystonic CP there is hypertonia involuntary postures or movement or both.

Choreo athetoid Cerebral palsy

Choreic movements are rapid involuntary jerks present at rest which are increased by voluntary movements.

Athetoid Cerebral palsy

It is the damage to the brain as in other types of CP

Area of brain affected- Basal Ganglia or its pathways.

It is charaterized by the occurance of slow movements with muscle rigidity and persistant abnormal postures that relax after second or minutes.

Ataxic Cerebral palsy

It occurs due to damage to the cerebellum or its pathways.

Signs 

• Hypotonia
• Disturbed Balance and Coordination
• Intention Tremors 
• Dysarthria
• somtimes Nystagmus

Common associated problems

• visual problems
• optic nerve damage
• visual handicap or complete blindness
• hearing problems
• nerve deafness
• speech 

unclear speech or other speech disorder may occur.

• Mental handicap

• Epilepsy

Infrequent seizures are there and medications should be considered carefully.

• Emotional problems
• poor sleep
• etreme irritability
• spasctic child may be hypersenstive and very anxious
• depression may occur in severly affected children.

Most of the cases have multiple neurological defecits.

Associated features

Eyes

Squint, cataracts, perceptual and refractive errors may be present.

Ears

Partial or complete loss of hearing

Speech

Aphasia, Dysarthria and misarticulation may be present.

Sensory defecit

Seizures

May have generalized or focal tonic seizures

Causes of cerebral palsy physiotherapy

Prenatal

Medical disease or infections to the mother during pregnancy like

• Anemia
• Uterine infections
• Thyroid
• Severe cardiac illness in mother
• Uncontrolled diabetes mellitus in mother during pregnancy
• Placental dysfunction
• Fetal hypoxia and fetal distress
• Increase or decrease amniotic fluid during pregnancy.
• Multiple pregnancy
• Complications of pregnancy eg placenta previa.
• Congenital malformations
• Breech presentation of baby

Antenatal

• Complications occurring at the time of birth.
• Severe blood loss during delivery
• Prolonged labour
• Forceps delivery
• Vaccum delivery
• Late baby cry after birth

Postnatal

• Head injury
• Jaundice
• Severe infections occurring to baby after birth

PHYSICAL EXPECTATIONS FROM CHILD

 AT 1YR

 Physical and movement development

• Stands alone
• Walks with one hand held or walks independently

AT 2YR

 Physical and movement development

• Stand on tiptoe
• SKicks a ball
• Begins to run
• Climbs onto and down from furniture without help
• Walks up and down the stairs holding bar

AT 3YR

 physical and movement development

child is able to

• run
• jump
• climb stairs independently
• plays small outdoor sports

 AT 5YR

 Physical development

• Stands on one foot for 10 seconds or longer
•  Hops; may be able to skip
• Can do a somersault
• Uses a fork and spoon and sometimes a table knife
• Can use the toilet on her own
• Swings and climbs