Cerebral palsy
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CEREBRAL PALSY. Kate Morton. 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

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CEREBRAL PALSY

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Cerebral palsy

CEREBRAL PALSY

Kate Morton


Cerebral palsy1

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%)


  • 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

    CAUSES OF CP


    Presentation

    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)


    Clinical types

    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


  • Management

    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


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