Treatment of children with cerebral palsy is a highly multidisciplinary approach involving medical professionals. Doctors diagnose the type of cerebral palsy and develop treatment plans that may include physical therapy from physiotherapists or medications advised by pharmacists. The goal is to enhance mobility and functional ability through various conservative and invasive medical interventions while educating caregivers on home exercises.

1. Multidisciplinary Management of Cerebral Palsy
Nurul Najihah,Daniel Koshy,Maheshwaran
http://www.nationwidechildrens.org/Document/Get/42099
http://www.hcocinc.com/wp-content/uploadsbigstock_Little_Boy_Sitting_Isolated_6867877.jpg

2. Questions that public would have in mind
1.What is Cerebral Palsy ?
2.What causes Cerebral Palsy?
3.What are the types of Cerebral Palsy?
3.What are the signs and symptoms?
4.How many children are affected worldwide?
5.What is the role of doctor, pharmacist and physiotherapist

3. What is Cerebral Palsy?
- It refers to any one of a number of neurological
disorders that appear in infancy or early childhood
and permanently affect body movement and
muscle coordination
Spastic
- Classification of cerebral palsy
Dyskinetic
Ataxic
Mixed
Rudolph’s Fundamentals of Pediatrics
http://nyp.org/health/pedneuro-cpalsy.html#top

4. What causes Cerebral Palsy?
(The Etiology)
Templates
http://medicina.ufm.edu/images/3/3c/Apgar.jpg
1. Injuries to the infant’s brain during birth
- Birth asphyxia - hypoxia > 4 mins during birth)
- APGAR Score (numbered rating that reflects a newborn's physical health).
Good Score is more than 7/10
Reddihough D,Collins K,Others. The epidemiology and cause of cerebral palsy.Australian Journal of Physiotherapy. 2003;49(1);7-14

5. What causes Cerebral Palsy?
(Etiology)
Templates
2. Metabolic disorders
- Lesch-Nyhan Syndrome
- Deficiency of Arginase (causes spastic diplegia)
3. Due to intake of certain toxins by mother during
pregnancy (accidentally ingested)
- eg: methyl mercury
4. Infection during perinatal period
-Intrauterine infections
eg: TORCH Virus (Toxoplasmosis,Rubella,Cytomeglovirus,Herpes)
5. Cerebro vascular accident (CVA)
- rapid loss of blood supply to the brain
- due to ischemia caused by thrombosis, arterial embolism or hemorrhage
Reddihough D,Collins K,Others. The epidemiology and cause of cerebral palsy.Australian Journal of Physiotherapy. 2003;49(1);7-14

6. What are types of Spastic
Cerebral Palsy?
Most common type of overall cerebral palsy, occurring in
90% of all cases according to the Society for Cerebral
Palsy in Europe (SCPE)

7. http://forkneedlepen.files.wordpress.com/2013/03/typesofcp.gif

8. What are the signs and symptoms?
• Delayed development milestones
– Head control, roll over, sitting, crawling and walking
• Low muscle tone (hypotonia)
– Problems with mobility
– Poor Muscle control
• Infantile reflexes persist for long time
– Sucking and startle reflex
• Failure to speak simple sentence by 24 months
• Seizures
http://www.healthcentral.com/adhd/h/hypotonia-fatigue-adhd.html
https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/signs-and-symptoms-of-cp/

9. How many children are affected?
According to an article published by American Academy of Family
Physicians, It is the most common childhood physical disability
and affects 2 to 2.5 children per 1,000 born in the United States.
There is insufficient statistics for cerebral palsy in Asia and Malaysia
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10. Role Of Doctor
http://shotofprevention.com/2012/02/24/how-the-doctorparentrelationship-can-impact-immunization-decisions/

11. Role of Doctor
(Coordinator)
1.Doctors carry out physical examination
- complete prenatal and postnatal history of the child
2. Doctors look into the development milestones of the child
- Head control,turn-over,sitting,standing
3. Carry out diagnostic tests
- x-rays (spine ~ scoliosis ,hip ~ dislocation)
- electroencephalogram (EEG) ~ seizures
- magnetic resonance imaging (MRI) ~ brain abnormalities
- feeding studies
- genetic studies
https://www.unitypoint.org/filesimages/rightcallouts/doctor-with-child.jpg
http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#243683104
http://nyp.org/health/pedneuro-cpalsy.html#top ,
http://cshcn.org/sites/default/files/webfm/file/CriticalElementsofC
are-CerebralPalsy.pdf,

12. Role of Doctor
4. Determines the type of treatment child requires
- Conservative treatment
Physical – resistive or strength training programs (prevents contracture)
~ Special braces (orthotic devices) improve mobility and stretch
spastic muscles
Occupational - help individuals address new ways to cope with day-today activities
Recreation - encourages participation in art and cultural programs, sports, and
other events (improve child’s emotional well-being)
Speech and Language Therapy, Treatment for problems with eating and
drooling
Oral Medications (eg: Baclofen)
http://soap.org/abstracts-uploads-spring-2011/1010711131105Xray_Baclofen_pump.jpg

13. Role of Doctor
- Invasive treatment
Botulinum Toxin (anti-spasticity management)
Selective Dorsal Rhizotomy
Insertion of intrathecal baclofen pump
~ helps in ambulation of child
5. Delegates job to physiotherapist and pharmacist for further treatment
and counseling

14. Role Of Pharmacist
http://img.dailymail.co.uk/i/pix/2007/12_01/pharmacyREX0212_4
68x331.jpg

15. Role of Pharmacist
1. Educating parents about the medications given to their
child
- side effects of medication
- effectiveness
- Purpose of medication
http://uspharmacist.com/content/d/featured%20articles/c/10170

16. Role of Pharmacist
2. Advise and collaborate with doctors on the suitable
medication and dosage needed for cerebral palsy
patients
- suitable dosage, not to overdose or under dose patient
http://www.everydayhealtenh.com/drugs/baclofen

17. Role of Pharmacist
3. Support the doctor by providing the adverse effects that
occur to the patients because of the medication
- Information reaches the pharmacist about
the adverse effects of medication
which is then passed on to the doctor
http://www.pharmacynews.com.au/news/latest-news/new-prescribinginitiatives-to-be-investigated
http://uspharmacist.com/content/d/featured%20articles/c/10170

18. Role of Pharmacist
4. Obtain past medical records containing medications
taken by the patient and interpret for the doctor
- complications
- determine whether to change dosage
- effectiveness of the medicines
- toxicity
http://www.jacksongeneral.com/for-visitors---medical-records.php
http://uspharmacist.com/content/d/featured%20articles/c/10170

19. Role Of Physiotherapist
http://www.pretoria-south-africa.com/elarduspark-faerie-glen-physiotherapist.html

20. Role of Physiotherapist
Templates
1.Rehabilitation of physical impairments (Conservative
Treatment)
- second line of treatment
- main intervention for spasticity and dystonia
- maximize functional control of the body
- increase motor function
- improve posture of cerebral palsy patients
http://www.csp.org.uk/your-health/conditions/cerebral-palsy
http://www.tasputraperkim.org.my/images/serv_physio.jpg

21. Role of Physiotherapist
2. Give advice regarding walking aids
and equipment with the help of occupational
therapist
- improve the patient’s co-ordination and body
balance
- to allow children to go to school
- preform daily activities
- To enhance the ability of self-care
http://www.tasputraperkim.org.my/images/serv_physio.jpg

22. Role of Physiotherapist
3. Teaching parents physical therapy that have
to be carried out at home on daily basis
- to maintain effectiveness of Botulinum Toxin A injection
- encorage normal postures and movement
(legs, arms,head control)
http://www.childbirthinjuries.com/Cerebral-Palsy/Treatment/Physiotherapy
http://www.ctn-simcoeyork.ca/aboutctn/newsandupdates.php?article=80

23. Summary
 Cerebral Palsy is a neurological disorder
 No Known Cure
 Mobility of child can be greatly enhanced with correct diagnosis and treatment
 Doctors advise on available treatment (conservative and invasive)
 Physiotherapist offer physical treatment
 Pharmacist advise on medications

24. Summary
Doctor
Physiotherapist
Pharmacist
“Treatment of children with cerebral palsy is a multidisciplinary approach that is
highly dependant upon a team of medical professionals”

25. Reference List
Templates
1) Bejing Puhua International Hospital. Bejing Puhua International Hospital. [Online] [Viewed 5 Dec 2013].
Available from: http://www.puhuahospital.com/?gclid=CJux66LqorsCFUcB4godUUQASQ#!cerebralpalsy/c1tc6
2) Cerebralpalsy.org.au. Signs and Symptoms of Cerebral Palsy | Cerebral Palsy Alliance. [Article], [Viewed
5 Dec 2013]. Available from: https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/signs-and-symptomsof-cp/.
3) Csp.org.uk. What is physiotherapy? | The Chartered Society of Physiotherapy. [Article], [Viewed 5 Dec
2013]. Available from: http://www.csp.org.uk/your-health/what-physiotherapy
4) Csp.org.uk. Cerebral palsy | The Chartered Society of Physiotherapy. [Article], [Viewed 4 Dec 2013].
Available from: http://www.csp.org.uk/your-health/conditions/cerebral-palsy
5) Drugs.com. Baclofen Side Effects in Detail - Drugs.com. [Website], [Viewed 6 Dec 2013]. Available from:
http://www.drugs.com/sfx/baclofen-side-effects.html
6) Minciu I. CEREBRAL PALSY MANAGEMENT. [Online Journal] Therapeutics, Pharmacology & Clinical
Toxicology.; 2011 , [Viewed 3 Dec 2013]
7) Nhs.uk. Cerebral palsy - Treatment - NHS Choices. [Online]. [Viewed 4 Dec 2013]. Available from:
http://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Treatment.aspx
8) Ninds.nih.gov. Cerebral Palsy Information Page: National Institute of Neurological Disorders and Stroke
(NINDS). [Online], [Viewed 4 Dec 2013]. Available from:
http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm

26. Reference List
Templates
9) Nyp.org. Cerebral Palsy - New York Presbyterian Hospital. [Article], [Viewed 3 Dec 2013].
Available from: http://nyp.org/health/pedneuro-cpalsy.html#top ,
10) Placzek R, Siebold D, F. Funk J. Development of Treatment Concepts for the Use of Botulinum
Toxin A in Children with Cerebral Palsy. [Online Journal], Toxins.; 2010, [Viewed 4 Dec 2013].
11) Reddihough D, Collins K, Others. The epidemiology and causes of cerebral palsy. Australian
Journal of physiotherapy. 2003; 49 (1): 7--14.
12) Tang KL. Interviewed by: Koshy DI. 5 Dec 2013
13) The Centre For Children with Special Need. Cerebral Palsy CRITICAL ELEMENTS OF CARE.
[Article] [Accessed 4 Dec 2013]. Available from:
http://cshcn.org/sites/default/files/webfm/file/CriticalElementsofCare-CerebralPalsy.pdf
14) Uspharmacist.com. USPharmacist.com > Cerebral Palsy: Pharmacologic Treatment of
Spasticity. [Online], [Viewed 6 Dec 2013]. Available from:
http://uspharmacist.com/content/d/featured%20articles/c/10170/
15) Zimbio.com. Untitled. [Online], [Accessed 8 Dec 2013]. Available from:
http://www.zimbio.com/Cerebral+palsy/articles/H6K4PmzsnyM/Role+physiotherapy+Cerebral+pals
y

27. Q&A

28. THANK YOU