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Cerebral Palsy Guide by Dr M Saleem Laghari
1. CEREBRAL
PALSY
by dr M Saleem
Laghari
MBBS,MCPS,FCPS(GOLD
MEDALIST)
Assistant
professor
Paediatrics
2. DEFINITION
1. Disorder of Movement and posture
2. Damage to immature brain
3. Permanent
4. Non progressive (static encephalopathy)
5. Non hereditary
6. Onset before or at birth or during early months
of life.
3. INCIDENCE / PREVALENCEINCIDENCE / PREVALENCE
• In the industrialized world, the incidence
of cerebral palsy is about 2 per 1000 live
births while in developing world is 7/1000
live births.
7. Pathology
• Extent of pathological lesion variable
• Wide spread cerebral atrophy
• Atrophy of basal ganglia.
• Atrophy and gliosis of one or both cerebral
hemispheres
8. Clinical Types of cerebral palsyClinical Types of cerebral palsy
• Spastic C. Palsy 75 %
• Extra pyramidal C.Palsy 9 to 22%
(Choreoathetosis, dystonia)
• Mixed cerebral palsy
• Atonic cerebral palsy
Atonic Diplegia
Cong.Cerebellar Ataxia
10. FUCTIONAL CLASSIFICAITONFUCTIONAL CLASSIFICAITON
• CLASS 1 No limitation of actitivity
• CLASS ii Slight to moderate limitation
• CLASS III Moderate to great limitation
• CLASS IV No useful physical activity
11. Different forms of cerebral palsyDifferent forms of cerebral palsy
• Spastic diplegia (10 – 33%)
• Spastic quadriplegia (9-43%)
• Spastic hemiplegia (25-40%)
• Extrapyramidal CP (9-22%)
• Atonic CP
• Mixed CP (9-22%)
12. Clinical featuresClinical features
• Manifestation may not be apparent before
one year of age.
• Reflex hyperactivity
• Pseudobulbar palsy when spasticity is
bilateral.
• Excessive drooling.
• Microcephaly
13. Clinical featuresClinical features
• Delayed motor
milestones
• Decreased power
• Abnormality of tone
• Abnormal
Persistence of
primitive reflexes
Moro reflex
14. • Paucity of movements and facial
expression
• Arching back
• Scissoring of legs and gait
• Clenching of hands with adducted
thumb
• Sustained Ankle Clonus
15. • Spastic gait
• Clasp knife type spasticity
• Exaggerated deep tendon
reflexes
• Delayed / slurred speech
• Choreo athetosis
• Ataxia
• Babinski sign positive after
the age of two years.
28. • Prone position
• Keep legs apart
with pillow in
between while
sleeping.
• Stretching
exercises to
prevent
contractures.
29. • Help the baby to learn
and maintain sitting
posture
• Teach the baby to hold
his head and balance it
• Teach baby to use
hands by grasping and
relaxing, use soft ball or
rubber toy.
• Turn him frequently
from supine to prone
and vice versa
30. • Teach him to crawl.
• Help him to stand
and walk
• Use walking aids
when necessary.
• Correct application
of splints and
braces
• Protection from
injuries and
infections.
31. Teach necessary skills
for daily life; feeding,
dressing, toilet training,
speech, writing etc.
Provide recreational
facilities like games,
cycling,swimming etc.
32. • Take care of the
child's education
and find out the
appropriate
institution and
occupation
33. Vision and hearing
i) Perform careful assessment of vision
and hearing
ii) Seek help of ophthalmologist for squints
and errors of refraction
iii) Refer for audiometry and guidance for
hearing aids.
34. Speech and feeding
1. Give feeding and speech advise
2. Advise more frequent and small feeds, to
prevent malnutrition.
3. Give more time for chewing and
swallowing
4. Provide constant stimulation of hearing
to help the development of speech
35. Orthopedic advise
1. Advice for boots and shoes
2. Surgical help for elongation of tendo
calcaneus.
3. Surgical procedure for reduction of
adduction spasm
4. Tendon transfer procedures to help
supination and pronation.
5. Division of spinal nerves for severe
spasticity.
36. PSYCHIATRIC HELP
For behavior disturbance
EPILEPSY
Anticonvulsants
SPASTICITY
Diazepam, baclofen, benzhexol and
Inj. of botulin toxin into posterior nerve
roots