Cerebral palsy in children

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Cerebral palsy in children

• Prevalence 3-4 / 1000
• Clinical forms following evident motor
  involvement
• spastic diplegiaquadriparesiaHemiplegia
  triplegia
• ataxic
• dyskynetic dystonic athetoid
• Hypotonic

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Muscles contraction relevant anatomy
Adjacent structures
Cortex primary motor area

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Basal ganglia Bulbar reticular structure cerebellu
m

Posterior horn


Alpha / gamma motoneurons of anterior horn
-

Sensory receptors Muscles, tendons, bones,
peritoneum
muscles
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Muscles contractions1 nerve per motor unit,
componed of 3-15 interlaced muscles fibers that
cannt be individualized )
nicotin
D membrane Pot
Curare, Ach esterase
Release of Ac Cho
ATP, glycogen, Pcri energy
Na influx
SRE Ca efflux
Troponin ( actinmyosin ) overlap Muscles
contraction
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Clinical presentation

• Motor involvement spasticity, ataxia,
  dyskinesia, hypotonia
• Vision impairement and disorder of communication
• Feeding disorder
• Epilepsy
• Orthopedic disorder
• Emotional and psychological disturbances

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Therapeutics in CP

• Physiotherapy
•  castings 
• Botulinum toxin
• Intrathecal baclofen
• Improve daily life function
• Mental pattern
• Self-esteem
• Nutrition
• Pain
• convulsions

• Increase in force
• Increase in dexterity
• Better movements
• Better equilibrium
• Better self-concept
• More independency

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Muscles concerned by the injections example for
one side

• Iliopsoas 2 sites
• Hamstrings 4 sites
• Adductors 2 sites
• Gastrecnomius 4 sites
• Tibialis anterior 2 sites
• Other

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Then normal program of physiotherapy

• But with another energy and motivation
• More interaction between infant, family, physio,
  doctor, friends and school

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En  résumé