CEREBRAL PALSY

C e re b ra l Pa lsy
 C e re b ra l = o f th e b ra in
 P a lsy = la c k o f m u sc le co n tro l

• C e re b ra l p a lsy is th e n a m e g ive n to a g ro u p o f d iso rd e rs

th a t a ffe c t a c h ild ’s co n tro l o f m o ve m e n t. T h e se d iso rd e rs
a p p e a r in th e fe w ye a rs o f life .
• co m p a re S p a stic p a ra lysis
Pa th o p h ysio lo g y :
• D isa b ilitie s u su a lly re su lt fro m in ju ry to th e c e re b e llu m , th e
b a sa l ga n g lia o r th e m o to r co rtex .
• It is d iffic u lt to e sta b lish th e p re c ise lo ca tio n o f n e u ro lo g ic
le sio n s b e ca u se th e re is n o ty p ica l p a th o lo g ic p ic tu re . In
so m e ca se s, th e b ra in h a s g ro ss m a lfo rm a tio n s; in o th e rs,
va sc u la r o c c lu sio n , a tro p h y, lo ss o f n e u ro n s a n d
d e g e n e ra tio n m ay b e e v id e n t.
• C e re b ra l P a lsy is n o n p ro g re ssive b u t m ay b e co m e m o re
a p p a re n t a s th e c h ild g ro w s o ld e r.

Classification
• 1. Spastic Cerebral Palsy – is the most
common type and may involve one or both
sides of the body.
C o m m o n ty p e s o f sp a stic ce re b ra l p a lsy in clu d e :

• 2 . D y s k in e tic /A t h e th o id C e re b ra l P a lsy – in v o lv e s
a b n o r m a l in v o lu n ta r y m o v e m e n ts th a t d is a p p e a r d u r in g
s le e p a n d in c re a s e w ith s tre s s .
• M a jo r m a n ife s ta tio n s a re a th e to s is (w o r m like
m o v e m e n t), d y s k in e tic m o v e m e n t o f m o u th , d ro o lin g
a n d d y s a r th r ia .
• M o v e m e n ts m a y b e c o m e c h o re o id (ir re g u la r, je r k y ) a n d
d y sto n ic (d is o rd e re d m u s c le to n e ), e s p e c ia lly w h e n
s tre s s e d a n d d u r in g th e a d o le s c e n t y e a rs .
• 3 . A ta x ic C e re b ra l P a lsy – is m a n ife s te d b y a w id e -b a s e d
g a it, ra p id re p e titiv e m o v e m e n ts p e r fo r m e d p o o r ly, a n d
d is in te g ra tio n o f m o v e m e n ts o f th e u p p e r e x tre m itie s
w h e n th e c h ild re a c h e s fo r o b je c ts .
• 4 . T h e M ix e d / d y s to n ic C e re b ra l P a lsy – is m a n ife s te d b y
a c o m b in a tio n o f th e c h a ra c te r is tic s o f s p a s tic a n d
a th e to id C P.
 S ig n s a n d sy m p to m s
E A R LY S IG N S :
A . A t b irth a b a b y w ith c e re b ra l p a lsy is o fte n lim p a n d
flo p p y, o r m a y e v e n s e e m n o r m a l.
a. a1.

a 1 .B a b y m a y o r m a y n o t b re a th e r ig h t a w a y a t b ir th , a n d
m a y tu r n b lu e a n d flo p p y. D e la y e d b re a th in g is a
c o m m o n c a u s e o f b ra in d a m a g e .
B . S lo w d e v e lo p m e n t C o m p a re d to o th e r c h ild re n in th e
v illa g e , th e c h ild is s lo w to h o ld u p h is h e a d , to s it, o r
to m o v e a ro u n d .
• H e m a y n o t u s e h is h a n d s . O r h e o n ly u s e s o n e
h a n d a n d d o e s n o t b e g in to u s e b o t h .
c.

C . F e e d in g p ro b le m s T h e b a b y m a y h a v e d iffic u lt ie s
w it h s u c k in g , s w a llo w in g a n d c h e w in g . S h e m a y
c h o ke o r g a g o fte n . E v e n a s t h e c h ild g e t s b ig g e r,
t h e s e a n d o t h e r fe e d in g p ro b le m s m a y c o n t in u e .

D. D iffic u lt ie s in ta k in g c a re o f t h e b a b y o r y o u n g c h ild . H e r
b o d y m a y st iffe n w h e n s h e is c a r r ie d , d re s s e d , o r w a s h e d , o r
d u r in g p la y. L a te r s h e m a y n o t le a r n to fe e d o r d re s s h e rs e lf,
to w a s h , u s e t h e to ile t , o r to p la y w it h o t h e rs . T h is m a y b e
d u e to s u d d e n st iffe n in g o f t h e b o d y, o r to b e in g s o flo p p y
s h e 'fa lls a ll o v e r t h e p la c e '.
• T h e b a b y m a y b e s o lim p t h a t h e r h e a d s e e m s a s if it w ill fa ll
o ff. O r s h e m a y s u d d e n ly s t iffe n lik e a b o a rd , s o t h a t n o o n e
fe e ls a b le to c a r r y o r h u g h e r.
• T h e b a b y m a y c r y a lo t a n d s e e m v e r y fu s sy o r 'ir r ita b le '. O r
s h e m a y b e v e r y q u ie t (p a s s iv e ) a n d a lm o st n e v e r c r y o r
s m ile .
E. C o m m u n ic a t io n d iffic u lt ie s T h e b a b y m a y n o t re s p o n d o r
re a c t a s o t h e r b a b ie s d o . T h is m a y p a r t ly b e d u e to
flo p p in e s s , st iffn e s s , o r la c k o f a r m g e st u re s , o r c o n t ro l o f
fa c e m u s c le s . A ls o , t h e c h ild m a y b e s lo w in b e g in n in g to
s p e a k . L a te r s o m e c h ild re n d e v e lo p u n c le a r s p e e c h o r o t h e r
s p e a k in g d iffic u lt ie s .

• A lth o u g h p a re n ts fin d it h a rd to k n o w e x a c tly w h a t th e c h ild w a n ts , th e y g ra d u a lly

fin d w a y s o f u n d e rsta n d in g m a n y o f h is n e e d s . A t first th e c h ild c rie s a lo t to s h o w
w h a t h e w a n ts . L a te r h e m a y p o in t w ith h is a rm , fo o t o r e y e s .
F. In te llig e n c e S o m e c h ild re n m a y s e e m d u ll b e c a u s e th e y a re s o lim p a n d s lo w
m o v in g . O th e rs m o v e s o m u c h a n d a w k w a rd ly th e y m a y a p p e a r stu p id . T h e ir
fa c e s tw ist, o r th e y m a y d ro o l b e c a u s e o f w e a k fa c e m u s c le s o r d iffic u lty
s w a llo w in g . T h is c a n m a ke a n in te llig e n t c h ild a p p e a r m e n ta lly s lo w .
• A b o u t h a lf o f th e c h ild re n w ith c e re b ra l p a lsy a re m e n ta lly re ta rd e d , b u t th is
s h o u ld n o t b e d e c id e d to o s o o n . T h e c h ild n e e d s to b e g iv e n h e lp a n d tra in in g to
s h o w w h a t s h e is re a lly like . P a re n ts c a n o fte n te ll th a t s h e u n d e rsta n d s m o re th a n
sh e ca n sh o w.

• W ith h e lp a n d tra in in g , s o m e c h ild re n w h o h a v e b e e n c o n s id e re d re ta rd e d

p ro v e to b e q u ite in te llig e n t.
G. H e a r in g a n d s ig h t a re s o m e t im e s a ffe c te d . If t h is p ro b le m is n o t
re c o g n ize d , t h e fa m ily m a y t h in k t h a t t h e c h ild la c k s in te llig e n c e .
O b s e r v e t h e c h ild c a re fu lly a n d te st h im to fin d o u t h o w w e ll h e c a n h e a r
a n d se e .
H. F it s (e p ile p sy, s e iz u re s , c o n v u ls io n s ) o c c u r in s o m e c h ild re n w it h c e re b ra l
p a lsy.
I. R e st le s s b e h a v io r S u d d e n c h a n g e s o f m o o d fro m la u g h in g to c r y in g ,
fe a rs , fit s o f a n g e r, a n d o t h e r d iffic u lt b e h a v io r m a y b e p re s e n t . T h is m a y
p a r t ly b e d u e to t h e c h ild 's fr u st ra t io n o f n o t b e in g a b le to d o w h a t h e
w a n t s w it h h is b o d y. If t h e re is to o m u c h n o is e a n d a c t iv it y t h e c h ild c a n
b e c o m e fr ig h te n e d o r u p s e t . T h e b ra in d a m a g e m a y a ls o a ffe c t b e h a v io r.
T h e s e c h ild re n n e e d a lo t o f h e lp a n d p a t ie n c e to o v e rc o m e t h e ir fe a rs
a n d o t h e r u n u s u a l b e h a v io r.

J. S e n s e o f to u c h , p a in , h e a t, c o ld , a n d b o d y
p o s itio n a re n o t lo s t. H o w e v e r, th e c h ild re n m a y
h a v e tro u b le c o n tro llin g m o v e m e n ts o f th e ir
b o d ie s a n d tro u b le w ith b a la n c e . B e c a u s e o f
th e ir d a m a g e d b ra in s th e y m a y h a v e d iffic u lty
le a r n in g th e s e th in g s . P a tie n t te a c h in g w ith lo ts
o f re p e titio n c a n h e lp .
K . A b n o rm a l re fle xe s B a b ie s h a v e c e r ta in 'e a r ly
re fle xe s ' o r a u to m a tic b o d y m o v e m e n ts th a t
n o r m a lly g o a w a y in th e firs t w e e k s o r m o n th s o f
life . In c h ild re n w ith b ra in d a m a g e , th e y m a y la s t
m u c h lo n g e r. H o w e v e r, th e s e a re o n ly im p o r ta n t
if th e y a ffe c t h o w th e c h ild m o v e s . 'K n e e je rk '
a n d o th e r te n d o n -ju m p re fle xe s a re u s u a lly
o v e r -a c tiv e ( ju m p h ig h e r th a n n o r m a l). If y o u
a re n o t s u re , te s tin g fo r a b n o r m a l re fle xe s m a y
h e lp y o u te ll c e re b ra l p a lsy fro m p o lio .
R is k fa c to rs :
• C e re b ra l P a lsy c o m m o n re s u lt s fro m e x is t in g p re n a ta l
b ra in a b n o rm a litie s .
• P re m a tu rity is th e s in g le m o s t im p o rta n t d e te rm in a n t
o f C e re b ra l P a lsy .
• O th e r p re n a ta l o r p e rin a ta l ris k fa c to rs in c lu d e :
a s p h y x ia , is c h e m ia , p e rin a ta l t ra u m a , c o n g e n ita l a n d
p e rin a ta l in fe c tio n s , a n d p e rin a ta l m e ta b o lic p ro b le m s
s u c h a s h y p e rb iliru b in e m ia a n d h y p o g ly c e m ia .
• In fe c tio n , tra u m a a n d t u m o rs c a n c a u s e C e re b ra l P a lsy
in e a rly in fa n c y.
• M u ltip le b ir th s Tw in s , t rip le t s
• S o m e c a s e s (a b o u t 2 4 % ) o f C P re m a in u n e x p la in e d .

D ia g n o s is
• P re n a ta l, b ir t h a n d p o s t n a ta l h is to r y
• N e u ro lo g ic e x a m in a t io n
• A s s e s s m e n t o f m u s c le to n e , b e h a v io r a n d a b ilit ie s
• O t h e r d is o rd e rs , s u c h a s m e ta b o lic d is o rd e rs , d e g e n e ra t iv e
d is o rd e rs a n d e a r ly s lo w -g ro w in g b ra in t u m o rs a re r u le d o u t .
N U R S IN G D IA G N O S IS
• P o te n t ia l fo r t ra u m a re la te d to p h y s io lo g ic d is a b ilit y, n e u ro m u s c u la r
im p a ir m e n t
• Im p a ire d p h y s ic a l m o b ilit y re la te d to n e u ro m u s c u la r im p a ir m e n t
• R / F S e lf c a re d e fic it re la te d to n e u ro m u s c u la r im p a ir m e n t
• Im p a ire d v e r b a l c o m m u n ic a t io n re la te d to n e u ro m u s c u la r
im p a ir m e n t
• B o d y im a g e o r s e lf e s te e m d is t u r b a n c e re la te d to p h y s ic a l d is a b ilit y
a p p e a ra n c e
• A lte re d fa m ily p ro c e s s re la te d to b ir t h o f c h ild w it h d is a b ilit y
 N u rs in g M a n a g e m e n t
• P re v e n t p h y s ic a l in ju r y b y p ro v id in g t h e c h ild w it h a s a fe e n v iro n m e n t ,
a p p ro p r ia te to y s , a n d p ro te c t iv e g e a r (h e lm e t , k n e e p a d s ) if n e e d e d .
• P re v e n t p h y s ic a l d e fo r m ity b y e n s u r in g c o r re c t u s e o f p re s c r ib e d b ra c e s
a n d o th e r d e v ic e s a n d b y p e r fo r m in g R O M e xe rc is e s .
• P ro m o te m o b ility b y e n c o u ra g in g t h e c h ild to p e r fo r m a g e -a n d c o n d it io n -
a p p ro p r ia te m o to r a c tiv itie s .
• P ro m o te a d e q u a te flu id a n d n u t r it io n a l in ta ke .
• F o ste r re la xa tio n a n d g e n e ra l h e a lt h b y p ro v id in g re st p e r io d s .
• A d m in iste r p re s c r ib e d m e d ic a t io n s w h ic h m a y in c lu d e s e d a t iv e s , m u s c le
re la xa n ts a n d a n tic o n v u ls a n ts .
• E n c o u ra g e s e lf-c a re b y u rg in g t h e c h ild to p a r t ic ip a te in a c t iv it ie s o f d a ily
liv in g (A D L s ) (e .g . u s in g u te n s ils a n d im p le m e n t s t h a t a re a p p ro p r ia te fo r
th e c h ild ’s a g e a n d c o n d itio n ).
• Fa c ilita te d c o m m u n ic a tio n
– Ta lk to th e c h ild d e lib e ra te ly a d s lo w ly, u s in g p ic tu re s to re in fo rc e s p e e c h
w hen needed.
– E n c o u ra g e e a rly s p e e c h th e ra p y to p re v e n t p o o r o r m a la d a p tiv e
c o m m u n ic a tio n h a b its .
– P ro v id e m e a n s o f a rtic u la te s p e e c h s u c h a s s ig n la n g u a g e o r a p ic tu re b o a rd .
– Te c h n o lo g y s u c h a s c o m p u te r u s e m a y h e lp c h ild re n w ith s e v e re a rtic u la tio n
p ro b le m s .

• A s n e c e s s a r y, s e e k re fe rra ls fo r c o rre c t iv e le n s e s a n d
h e a rin g d e v ic e s to d e c re a s e s e n s o r y d e p riv a t io n re la te d to
v is io n a n d h e a rin g lo s s e s .
• H e lp p ro m o te a p o s itiv e s e lf -im a g e in t h e c h ild :
– P ra is e h is a c c o m p lis h m e n ts
– S e t re a lis t ic a n d a tta in a b le g o a ls
– E n c o u ra g e a n d a p p e a lin g p h y s ic a l a p p e a ra n c e
– E n c o u ra g e h is in v o lv e m e n t w ith a g e a n d c o n d itio n - a p p ro p r ia te
p e e r g ro u p a c t iv it ie s .
• P ro m o te o p tim a l fa m ily fu n c t io n in g
– E n c o u ra g e fa m ily m e m b e rs to e x p re s s a n x ie tie s , fr u stra tio n s a n d
c o n c e r n s a n d to e x p lo re s u p p o r t n e tw o r k s .
– P ro v id e e m o t io n a l s u p p o r t a n d h e lp w ith p ro b le m s o lv in g a s
n e c e s s a r y.
– R e fe r t h e fa m ily to s u p p o r t o rg a n iza tio n s s u c h a s th e U n ite d
C e re b ra l P a lsy A s s o c ia tio n .
• P re p a re th e c h ild a n d fa m ily fo r p ro c e d u re s , t re a t m e n t s ,
a p p lia n c e s a n d s u rg e rie s if n e e d e d .
• A s s ist in m u ltid is c ip lin a r y th e ra p e u tic m e a s u re s
d e s ig n e d to e sta b lis h lo c o m o tio n , c o m m u n ic a tio n a n d
s e lf-h e lp , g a in o p tim a l a p p e a ra n c e a n d in te g ra tio n o f
m o to r fu n c tio n s ; c o rre c t a s s o c ia te d d e fe c ts a s
e ffe c tiv e ly a s p o s s ib le a n d p ro v id e e d u c a tio n a l
o p p o rtu n itie s b a s e d o n th e in d iv id u a l’s n e e d s a n d
c a p a b ilitie s . T h e ra p e u tic m e a s u re s in c lu d e :
– B ra c e s to h e lp p re v e n t o r re d u c e d e fo r m it ie s , in c re a s e
e n e rg y o f g a it , a n d c o n t ro l a lig n m e n t .
– M o to r ize d d e v ic e s to p e r m it s e lf -p ro p u ls io n .
– O r t h o p e d ic s u rg e r y to c o r re c t d e fo r m it ie s a n d d e c re a s e
s p a st ic it y (m e d ic a t io n s a re n o t h e lp fu l fo r s p a s t ic it y ).
– M e d ic a t io n s to c o n t ro l p o s s ib le s e iz u re a c t iv it y o r
a tte n t io n d e fic it d is o rd e r.
– S p e e c h t h e ra p y a n d p h y s ic a l t h e ra p y.

• In fo r m p a re n ts b u t th e ir c h ild w ill n e e d
c o n s id e ra b le h e lp a n d p a tie n c e in a c c o m p lis h in g
e a c h n e w ta s k .
– E n c o u ra g e th e m n o t to fo c u s s o le ly o n th e c h ild ’s
in a b ility to a c c o m p lis h c e r ta in ta s k s .
– U rg e th e m to re la x a n d d e m o n stra te p a tie n c e .
– E x p la in th e im p o r ta n c e o f p ro v id in g p o s itiv e fe e d b a c k .
• E n c o u ra g e th e fa m ily to s e e k a p p ro p r ia te
fu n c tio n a l, a d a p tiv e a n d v o c a tio n a l tra in in g fo r
th e c h ild .
• E n c o u ra g e fa m ily m e m b e rs to a c h ie v e b a la n c e in
th e ir liv e s b e tw e e n c a r in g fo r th e ir d is a b le d c h ild
a n d o th e r fa m ily a n d p e rs o n a l m a tte rs .
 C o m m o n M is c o n c e p t io n s A b o u t C P
M y t h : C P is g e n e tic .
• F a c t: C P is n o t g e n e tic . It c a n n o t b e p a s s e d fro m p a re n t to
o ffs p rin g . It is th e re s u lt o f in ju r y to t h e b ra in b e fo re ,
d u rin g , o r a fte r b irth .
M y t h : C P is h e re d ita r y.
• F a c t: C P is n o t in h e rite d fro m o n e g e n e ra t io n to t h e n e x t .
M y t h : C P is life -th re a te n in g .
• F a c t: P e o p le d ia g n o s e d w it h C P c a n h a v e a n o rm a l life s p a n .
M y t h : C P is u s u a lly th e p rim a r y c a u s e o f d e a t h .
• F a c t: B e c a u s e C P is n o t a s ic k n e s s o r d is e a s e , a n d n o t
p ro g re s s iv e , it is n o t t h e p rim a r y c a u s e o f d e a t h .
M y t h : C P is a d is e a s e .
• F a c t: C P is n o t a s ic k n e s s o r d is e a s e t h a t c a n b e p a s s e d o n
fro m o n e in d iv id u a l to a n o t h e r o r b e c u re d . It is a life -lo n g
c o n d itio n .

M y th : C P is p ro gre ssive .
• Fa ct: In ju ry to th e b ra in is a o n e -tim e e ve nt, so th e co n d itio n w ill n o t
w o rse n , ch a n ge o r exp a n d , a lth o u gh th e e ffe cts o f C P m ay ch a n ge o ve r
tim e . So m e m ay im p ro ve ; fo r exa m p le , a ch ild w h o se h a n d s a re
affe cte d m ay b e a b le to ga in e n o u gh h a n d co ntro l to w rite a n d to d re ss
h im se lf. A lte rn ative ly, m u scle s m ay tighte n a n d ca n ca u se p ro b le m s in
th e h ip s a n d sp in e s o f gro w in g ch ild re n . T h is m ay re q u ire o rth o p e d ic
su rge ry to co rre ct.
M y th : C P is a lw ays p re ve nta b le .
• Fa ct: T h e re a re m e a su re s th at m ay b e ta ke n to p re ve nt so m e ca se s o f
C P. H o w e ve r, d e sp ite b e st effo rts o f p a re nts a n d p hysicia n s, ch ild re n
a re still b e in g b o rn w ith C P.
M y th : T h e p hysica l d isa b ilitie s o f C P a re a n in d icatio n o f le ve l o f
inte llige n ce .
• Fa ct: Pe o p le w ith C P ca n h ave d ifficu lty sp e a kin g , b u t th is d o e s n o t
e q u ate to lo w inte llige n ce o r lo w co gn itive le ve ls fo r th e ir a ge . M a ny
p e o p le liv in g w ith C P h ave ave ra ge to a b o ve ave ra ge inte llige n ce le ve ls.
M y th : C P m e a n s lim b p a ra lysis.
• Fa ct: T h e m u scle s in lim b s affe cte d b y C P a re n o t p a ra lyze d . Pa in , h e at,
co ld a n d p re ssu re a re fe lt b u t th e re ca n b e d im in ish e d se n satio n .

SOURCE: http://www.dinf.ne.jp/doc/english/global/david/dwe002/dwe00211.html