PATHOPHYSIOLOGY OF CEREBRAL PALSY

Legend:
Pathophysiology is the discussion of the disease process; the physiology of abnormal states and the functional ↓ - disease process
* - manifested by client X’s mother
changes that accompanies a particular syndrome or disease.
 - manifested by the client
- - - signs and symptoms
■ – client undergoes treatment or diagnostic tests

Predisposing Factors Precipitating Factors

 Age (less than 37 weeks) * Socio-economic status

 Small for gestational age (less than 5.5 lbs or 2.5 kg) Cerebral anoxia
 Gender (Male/Female 1:3) * Chemicals such as lead, mercury and teratogenic drugs
 First child or child born later in the family Alcohol drinking and cigarette smoking
Metabolic disorder or conditions such as Prenatal:
hyperbilirubinemia, hypoglycemia, hyperosmolarity, * Maternal bleeding
amino acid disorders) * Mother with heart failure
Developmental brain malformation Maternal infection such as rubella
Mother aged 40 above or 20 below Maternal diabetes
Exposure to radiation
Perinatal and Birth:
Breech presentation
Postnatal
Kernicterus

Abnormality in early brain development

Delay subcortical myelination of white matter

Diminished subcortical u-fibers myelination (last areas to myelinate)

 Structural or functional defects

Absent or slow connections between adjacent gyri in the cerebral cortex

Impaired motor function or cognition

Decrease communication mediator both to inform cortical association areas

Disruptions of synaptic functions or intracellular signaling

Increase favor of a sudden-onset of network excitation Decrease speed of nerve impulse conduction

Seizure Delayed acquisition of developmental milestone or domains

Gross and fine Speech or Cognition Social or

motor language personal

Apraxia Dysartia Decrease Lack of

Inability to learning ability curiosity
perform ADL’s Failure to meet
intellectual
developmental
markers
(writing.
reading)

CEREBRAL PALSY
  Spastic Athetoid Ataxic Mixed

Involuntary disturbed balance Combination of

Hemiparesis Quadreparesis  Diplegia Monoplegia Triplegia Paraplegia movements usually Incoordination of spasticity and
affecting arms more the arms athetoid movement
severely than legs Hypoactive reflexes
Increase tone in  Delay in  Spasticity in Involving one Involves 3 Pure cerebral Grimacing Nystagmus Combination of ataxic
the legs attaining legs than in extremity extremities paraplegia of Worm like writing Muscle weakness and athetoid
Increase tone in developmental arms only lower Dystonia Tremor movements which
the arms milestone  Late extremities Sharp jerks Lack of leg results to severe
Parietal lobe proportionate to attainment of Difficulty with speech movement during impairment
increase severity of infancy
syndrome degree of motor gross motor
movements during Wide gait as the
deficit. milestone stress, decreases with child begins to walk
Speech (sitting, relaxation and Sudden fine
Dysarthric standing, disappear when sleep movements are
Impaired walking) impossible (due to
swallowing  Walking on ataxia)
Incomplete toes with
tongue scissors gait,
protrusion crossing one
foot of the
other.
 Under
development
of affected
limbs.
 Muscle
contraction in
response to
manipulation
 Muscle
weakness
 With medical and nursing interventions Without medical and nursing interventions
■History Taking & no therapy
DIAGNOSTIC TEST
MRI
Denver Development Screening Test Further exacerbation of above mentioned signs
EEG
CT scan
Intelligence Test Contractures
■Good enough – Harris Drawing Test
TREATMENT
■Educational Therapy Immobility of joints or extremities
■Physical Therapy
■Speech Therapy
Occupational Therapy Muscle atrophy
■Using adaptive equipments
Such as wheel chairs, walkers, and crutches
PHARMACOLOGICAL TREATMENT Seizure disorder
Seizure medications (Tegretol)
Decrease spasticity medications (Badofen)
■VITAMINS AND MINERALS such as: Speech, hearing and vision problems
Ascorbic Acid (Ceelin)
Multivitamins (Nutroplex)
PREVENTION Complications may occur such as
Adequate nutrition Inability to interact with other appropriately
Reduce environmental exposure Inability to care for self social isolation
Totoxins such as lead and mercury
Reduce exposure to stressors
POOR PROGNOSIS
WITH NURSING INTERVENTION
■ Plan an increase calorie diet that’s adequate to
meet the child’s high energy needs.
■ Provide educational resources on proper usage
of assistive devices such as crutches
■Plan activities to use gross such as action songs,
have the client sit on a chair and have a catching
exercise

Enhancement of capabilities and possible

acquisition of other developmental milestone

GOOD PROGNOSIS