Dreams Are Something To Work For, Not Something To Wait For!

Dreams
are something
to work for,
not something
to wait for!
CEREBRAL PALSY
Guidance
From
Dr.K.Shivakanthan
Consultant
paediatrician
&
Dr.K.Sundaresan
Cosultant Physician
CEREBRAL PALSY
Was first described by William Little in 1862.

Then it was known as Little disease.
The term Cerebral palsy originated with Freud.
Definition
In all cases the following must be true…
Cerebral palsy is the result of a brain lesion. Therefore, the spinal cord and muscles are
structurally and biochemically normal.
The brain lesion must be fixed and non progressive. Thus, all of the progressive neuro
degenerative disorders are excluded from the definition.
The abnormality of the brain result in motor impairment.
Jhamak Ghimire
Cerebral palsy is the most common motor disorder in
children 2 – 2.5 per 1000 live births
Stanley et al
year 2000
Disorders of movement & posture due to a
non progressive lesion of motor pathways in
the developing brain.
Causes
 Antenatal (80%)
 Intra natal(10%)
 Postnatal
Antenatal
 Cerebral dysgenesis
 Cerebral malformation
 Congenital infection
 Threatened abortion
 Maternal systemic illness
 PIH
 IUGR
 Drugs
 Genetic-ataxic type
Intrapartum
 Birth asphyxia/trauma
 Prematurity
 Difficulty in labour
Postnatal
 Intraventricular hemorrhage
 Neonatal sepsis
 Head trauma
 Symptomatic hypoglycemia
 Hydrocephalus
 Hyperbilirubinaemia
 Near drowning
 Epilepsy
Stephan Hopkins
"My hand trembles, my heart does not."

Types
 Depends on the extent of brain damage

 Which part of the brain is damaged
● Spastic – stiffness
 Ataxic hypotonic- unsteady uncoordinated
 Dyskinetic- fluctuating tone
 Flaccid- floppy
 Mixed
Classification
Physiologic classification
Describes the type of movement disorder present…
 Spasticity: the most common. Increased tone in the extremities.. (the Clasped knife
model)
 Hypotonia: usually a phase, leading most frequently to spasticity.
 Dystonia: lead pipe model.
 Athetosis: abnormal writing movements, patient cannot control.
 Ataxic: in cerebellar lesions.
Patients frequently have a mixed form of movement disorders.

Geographic classification
Describes what part of body is affected..
 Hemiplegia: one side, upper usually more involved.
 Diplegia: both sides, with both lower extremities and lesser involvement of upper
extremities.
 Triplegia: both lower and one upper extremity.
 Quadriplegia: Total body involvement.
◊Spastic CP – 70%
 Hemiplegia
 Quadriplegia
 Diplegia
Spastic quadriplegia
Spastic diplegia
Spastic hemiplegia
◊Ataxic hypotonic CP
 Dysfunction in the cerebellum or its

connections
 Signs are relatively symmetrical
◊Dyskinetic CP
 Chorea
 Dystonia & athetosis
Associated Problems
(Sheffield Series)
Hearing 4% Often with dyskinesia
Vision 24%
Epilepsy 30% Up to 90% with

quadriplegia
Learning difficulties 49% Mostly with

quadriplegia but SpLD
with others
Mobility 30-40% Still not walking at 5

years
Chris Fonseka
Your
Responsibilities
 Help Make the Diagnosis

 Identify Challenges
 Prevent the Preventable
 Determine and Encourage Child’s Abilities
 Refer & Coordinate Services/Supports
 Educate & Advocate
Diagnosis
CAUTION !
Not all “CP” is really Cerebral Palsy

Make the Diagnosis
RED FLAGS
 Is there a similar illness in other family
members?
 Is there a progression of symptoms?
 Has the child lost abilities?
Diagnosis
 Mainly by the careful history & examination

 MRI
 CT
 EEG
Evaluation
Diagnosing..
Physical examination..
 Increased
Obtainingmuscle
a complete
tone.history (birth history, birth weight,
 complications following
Deep tendon reflexes arebirth..)
increased.
 Asking about
Fine motor the child’s
activities preferential use of one hand or leg.
testing.
 Related
Retainedmedical
infantileconditions
reflexes. (seizures, speech disorders)
 Balance, sitting and gait of child.
If a child comes to you, and you are suspecting
the CP what are the investigations you’ll
order?
Management
Multidisciplinary system
Doctors
Nurses
Occupational therapist
Physiotherapist
Speech therapist
Surgical applicants makers
Special education officers
Treatment
Treatment, Surgical or nonsurgical, must be goal

oriented..
The goals of treatment that have linked to productive

lives as adults are: Communication, education,
mobility and ambulation.
Treatment ranges from observation, physical therapy,

medications.. to surgery.
Our Children are Unique
 Age
 Type
 Distribution
 Associated Challenges
 Personal Strengths
 Family
 Environment
Affects on the family
frustration
disappointment
anger
Rehabilitation
 Counseling to parents
 Treat the condition that are treatable
 Physiotherapy
 Occupational therapy
 Solve the social problem
Occupational Therapy
PHYSIOTHERAPY
Follow up
 Need to change the therapy as child grows

 Change the applicants
 Find out how the family continuing the
management
 Provide constant motivation
PROGNOSIS
 Depends on the rehabilitation programme

 People with CP are more likely to have some type
of learning disability, not related to intellect or
IQ level
 The ability to live independently with CP varies
widely depending on the severity of each case.
Prevention
CANNOT ENTIRELY
•Before & during pregnancy
•Care of the baby
•Care for the sick child
Questions from the parents
 Causes
 Will it happen again
 Can it be prevented
 Is it infectious
 Will medicines help
 Will an operation help
 Will my child walk
 Can vaccination be given
Will the child of a CP person will have
CP?
On the wall of a therapy room at
Euromed in Mielno, Poland
is the following saying:
Dreams
are something
to work for,
not something
to wait for!
Even O’ Hanlon
“A disabled child has the right to enjoy a full and decent life, in
conditions which ensure dignity, promote self-reliance and
facilitate the child’s active participation in the community”
UN convention on the
rights of the Child
1989
THANK YOU

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Dreams

Was first described by William Little in 1862.

"My hand trembles, my heart does not."

 Depends on the extent of brain damage

Patients frequently have a mixed form of movement disorders.

 Dysfunction in the cerebellum or its

Epilepsy 30% Up to 90% with

Learning difficulties 49% Mostly with

Mobility 30-40% Still not walking at 5

 Help Make the Diagnosis

Not all “CP” is really Cerebral Palsy

 Mainly by the careful history & examination

Treatment, Surgical or nonsurgical, must be goal

The goals of treatment that have linked to productive

Treatment ranges from observation, physical therapy,

 Need to change the therapy as child grows

 Depends on the rehabilitation programme

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