CEREBRAL PALSY

DEFINITION:

         ‘A Persistent but not unchanging disorder of posture

and movement, caused by damage to the developing

nervous system, before or during birth or in early months of

infancy’

                                         - World Commission of Cerebral Palsy

CAUSES

                            :

ANTENATAL CAUSES   

• Poor nutrition for mother

• Physical trauma

• Multiple births

• Infections of the mother while she is pregnant. These include

German measles and shingles (herpes zoster).

• Differences between the blood of mother and child (Rh

incompatibility).

• Problems of the mother, such as diabetes or toxemia of

pregnancy.

• Inherited. This is rare, but there is a 'familial spastic

paraplegia'.

• No cause can be found in about 30% of the children.

NATAL CAUSES:

• Lack of oxygen (air) at birth. The baby does not breathe

soon enough and becomes blue and limp. In some areas,

misuse of hormones (oxytocics) to speed up birth narrows

the blood vessels in the womb so much that the baby does

not get enough oxygen. The baby is born blue and limp-with

brain damage.

• Birth injuries from difficult births. These are mostly large

babies of mothers who are small or very young. The baby's

head may be pushed out of shape, blood vessels torn, and

the brain damaged.

• Prematurity, Low birth weight. Babies born before 9 months

and who weigh under 2 kilos (5 pounds) are much more

likely to have cerebral palsy. In rich countries, over half the

cases of cerebral palsy happen in babies that are born early.

• Cord around neck

• POST NATAL CAUSES:

• Very high fever due to infection or dehydration (water

loss from diarrhea). It is more common in bottle-fed

babies.

• Brain infections (meningitis, encephalitis). There are

many causes, including malaria and tuberculosis.

• Head injuries.

• Lack of oxygen from drowning, gas poisoning, or other

causes.

• Poisoning from lead glazes on pottery, pesticides

sprayed on crops, and other poisons.

• Bleeding or blood clots in the brain, often from unknown

cause.

• Brain tumors. These cause progressive brain damage in

which the signs are similar to cerebral palsy but steadily

get worse.

CLASSIFICATION

CLASSIFICATION BY TYPE

– Spastic

- Damage to the corticospinal tract, motor cortex,

or pyramidal tract

- Mainly the cerebrum. Charecterised by

hypertonicity.

– Ataxic

- Resulting from damage to the cerebellum.

Charecterised by hypotonia and tremors

• Athetoid/dyskinetic

- Damage to the extra pyramidal motor system and/or

pyramidal tract and to the basal ganglia.

- Characterized by mixed muscle tone - sometimes

hypertonia and sometimes hypotonia

- Often show involuntary motions.

• Mixed

- Mixure of any of the above three types can be seen

like, spastic athetoid

CLASSIFICATION BY TOPOGRAPHY:

∙ Spastic Hemiplegia

- One half of the body affected - Usually Contra

lateral

∙ Spastic Diplegia

- Whole body affected – lower limbs more affected

∙ Spastic Quadriplegia

- Whole body affected - all 4 limbs affected equally.

∙ Monoplegia

- Only one limb is affected,

∙ Paraplegia

- Both the lower limbs are affected

SIGNS AND SYMPTOMS :

• Abnormal muscle tone,

• Abnormal posture (i.e. slouching over while sitting),

• Exaggerated or diminished reflexes,

• Delayed motor development.

• Poor balance and coordination

ASSOCIATED PROBLEMS

• Other sensory problems- like visual or hearing deficit

• Mental retardation

• Dyslexia – learning disability

• Seizures

• Contractures and deformities

• Speech and language disorder

• Feeding disorder

• Behavioral problems

CONSERVATIVE MANAGEMENT

MEDICAL MANAGEMENT:

• Medications administered to control of the symptoms

prevent complications.

• Botulinum Toxin A (Botox) injections into muscles that are

either spastic or have contractures - Relieve the disability

and pain produced by the inappropriately contracting

muscle.

• Other medications

– Anticonvulsant medications for seizures.

– Anticholinergics to help manage uncontrollable body

movements (dystonic cerebral palsy) or frequent

drooling.

SURGICAL MANAGEMENT

• Surgery for people with CP usually involves one or a

combination of:

• Loosening tight muscles and releasing fixed joints, most

often performed on the hips, knees, hamstrings, and ankles,

commonly called as the tendon lengthening surgery. In

rare cases, this surgery may be used for people with stiffness

of their elbows, wrists, hands, and fingers.

• Straightening abnormal twists of the leg bones, i.e. femur

termed femoral anteversion or antetorsion and tibia - tibial

torsion. This is a secondary complication caused by the

spastic muscles generating abnormal forces on the bones,

and often results in intoeing (pigeon-toed gait). The surgery is

called derotation osteotomy, in which the bone is broken

(cut) and then set in the correct alignment

• Cutting nerves on the limbs most affected by movements

and spasms. This procedure, called a rhizotomy, "rhizo"

meaning root and "tomy" meaning "a cutting of“, reduces

spasms and allows more flexibility and control of the

affected limbs and joints

PHYSIOTHERAPY MANAGEMENT

AIMS:                                             

• Reducing abnormal patterns of movement and posture

and promoting the normal ones.

• Reduce spasticity / maintaining near normal muscle tone

• Achieve near normal developmental milestones

• Prevent contractures and deformities

• Maintain and achieve functional independence