CEREBRAL PALSY

1
CEREBRAL PALSY

• Kate Morton

2
CEREBRAL PALSY

• Disorder of movement and posture
• Most common cause of motor impairment in children
• Due to a non-progressive lesion of the motor
  pathways in the developing brain
• Clinical manifestations can change as the
  cerebrum matures
• Most common cause of motor impairment in children
• Associated conditions
• Learning impairment (60)
• Visual impairment (20)
• Squints (30)
• Hearing loss (20)
• Speech and language disorders
• Behaviour disorders
• Epilepsy (40)

3
CAUSES OF CP

• ANTENATAL (80)
• Cerebral dysgenesis
• Cerebral malformation
• Congenital infection
• INTRAPARTUM (10)
• Birth asphyxia/trauma

• POSTNATAL (10)
• Intraventricular haemorrhage/ ischaemia
• Meningitis/ encephalitis/ encephalopathy
• Head trauma/ NAI
• Symptomatic hypoglycaemia
• Hydrocephalus
• Hyperbilirubinaemia

4
PRESENTATION

• Abnormal tone and posturing
• Feeding difficulties
• Delayed motor milestones
• Abnormal gait once walking
• Developmental delay language/ social skills
• Other signs
• Hand preference under 12m
• Persistence of primitive reflexes (should
  disappear by 12m)

5
CLINICAL TYPES

• Spastic (70) - damage to UMN pathway
• Increased limb tone
• Brisk tendon reflexes, extensor plantar response
• Different distributions possible hemiplegia,
  diplegia, quadriplegia
• Ataxic hypotonic (10) usually genetic cause
• Usually symmetrical
• Early hypotonia, poor balance, delayed motor
  development
• Followed by incoordinate movements, intention
  tremor
• Dyskinetic (10) damage to basal ganglia or
  extrapyramidal pathway
• Constant involuntary movements
• Poor postural control
• Floppiness and delayed motor development
• Intellect relatively intact

6
MANAGEMENT

• Importance of child health surveillance
• MDT approach
• Give parents as much information as possible
• Medical treatments for muscle spasm baclofen,
  dantrolene, diazepam
• Surgical scoliosis, hip reduction, tendon
  lengthening, osteotomy
• Others mobility aids botulinus toxin heat,
  cold and vibration for spasticity splinting
• Management of associated conditions eg epilepsy,
  learning disability, dental problems, aspiration
  pneumonia