Cerebral

Palsy

CEREBRAL
PALSY
is a group of nonprogressive
disorders of upper motor
neuron impairment that result
in motor dysfunction. Affected
children also may have
speech,ocular difficulties,
seizures, cognitive challenges
or hyperactivity.

1. PYRAMIDAL
OR SPASTIC
TYPE

-increased resistance to manipulation, strtch reflex

hyperactive, deep tendon reflexes, clout, tendency toward
contracture deformities, lower extremities are more involved
- lesion is in cerebrum

2. EXTRAMIRAMIDAL

a. Dyskinetic or
Athetoid Type

-worm-like
-involuntary and uncoordinated motions without conscious
control, normal reflexes when in a relaxed state, upper
extremities often more involved
-lesion is in the basal ganglia

a. Ataxic type

-Disturbance of autonomic balances, nystagmus, difficulty

in concentrating vision of a fixed field, normal tendon
reflexes disturbance of equilibrium and balance
-lesion is in the cerebellum

a. Rigidity

-Lead pipe resiliency of involved member, tendency to

maintain position of extension, absent stretch reflex

Risk factors:
1Ante-natal
a. Congenital defects resulting from an arrested
development of the cerebrum and cyamidal tract
b. Maternal infections, disease (influenza, German
measles)
c. Excessive radiation
d. Nutritional deficiencies on the mother( Iron,
Calcium, Phosphorus)
e. Incompatibility
f. Thalidomide drugs during pregnancy

2. Natal
a. nerve cell injury ff
cerebral hemorrhage due
to trauma at
birth( forceps, breech
presentation)
b. anoxia of hyporix ff
winding of the umbilical
cord around the babys
neck

3. PostNatal
a.
oncephalitis
b. meningitis
c. brain
tumors

 oxygen supply
anoxia
Cell destruction
Brain cell
dysfunction

Common signs and

symptoms
Muscles that are very tight and do
not stretch. They may tighten up
even more over time.
Abnormal gait
Joints are tight and do not open up
all the way (called joint contracture)
Muscle weakness or loss of
movement in a group of muscles
(paralysis)

Nervous System
Decreased intelligence or
learning disabilities are
common, but intelligence
can be normal
Speech problems (dysarthria)
Hearing or vision problems
Seizures
Pain, especially in adults

Eating and Digestion

Difficulty sucking or
feeding in infants, or
chewing and swallowing in
older children and adults
Problems swallowing (at all
ages)
Vomiting or
constipation

Diagnostic test
Brain scans
Brain-imaging technologies can reveal
areas of damage or abnormal
development in the brain. These tests
may include the following:
Magnetic resonance imaging
(MRI).An MRI uses radio waves and a
magnetic field to produce detailed 3-D
or cross-sectional images of your
child's brain. An MRI can often identify
any lesions or abnormalities in your
child's brain.

 Cranial ultrasound.This can be

obtained during infancy. A cranial
ultrasound uses high-frequency sound
waves to obtain images of the brain..
Computerized tomography (CT)
scan.A CT scan uses X-rays to obtain
cross-sectional images of your child's
brain. A CT scan may be used to
identify abnormalities in your child's
brain.

 Electroencephalogram (EEG)
If your child has had seizures, your doctor
may order an electroencephalogram (EEG)
to determine if he or she has epilepsy.
Laboratory tests
Your child's blood may need to be checked
to rule out other conditions, such as bloodclotting disorders that can cause strokes,
which may mimic cerebral palsy signs and
symptoms. Laboratory tests may also
screen for genetic or metabolic problems.

MEDICAL
MANAGEMENT
Muscle relaxant (Diazepam)
Anticonvulsant
seizures(Phenytoin)
Behaviour disturbance and
hyperkinesias (Amphetamines)
Spasticity-( Intrathecal
Baclofen therapy)

Additional tests
If your child is diagnosed with
cerebral palsy, you'll likely be
referred to specialists for
assessments of other conditions
that are often associated with the
disorder. These tests may identify:
Vision impairment
Hearing impairment
Speech delays or impairments
Intellectual disabilities
Other developmental delays
Movement disorders

SURGICAL
MANAGEMENT
SURGICAL MANAGEMENT
To correct existing deformities
Atoffel operation- cutting the
nerves causing spasm
Osteotomy
Release of contracture
Arthrodesis
Lenghtening of Achilles Tendon

Nursing diagnosis
and Interventions
a. Risk for injury r/t spasms,
uncontrolled movements and seizures
1) avoid children from harmful objects, for
example can be dropped.
2) watch the children during activity.
3) give the kids a break when tired.
4) usesafety equipmentwhen necessary.
5) when a seizure;installa safety device in
the mouth so that the tongue is not bitten.
6) do suction.
7) the provision of anti-seizure in the event
of a seizure.

 b. ImpairedPhysical mobilityr/t spasms

and muscle weakness.
1) examine the movement of the joints and
muscle tone.
2) do physical therapy.
3) do repositioning every 2 hours.
4) evaluation of the needs of special
equipment for eating, writing and reading
and activities.
5) teach the use of a walker.
6) teach how to sit, crawl in young children,
walking, and others.
7) teaches how toreach forobjects.
8) taught to move the limbs.
9) teach appropriate ROM.
10) provide a rest period.

 c. Impaired verbal communication r/t

difficulty in articulation
1) examine the response to communication.
2) use the cards / pictures / whiteboards to
facilitate communication.
3) Involve the family in training a child to
communicate.
4) refer to a speech therapist.
5) teach and assess non-verbal meaning.
6) trained in the use of the lips, mouth and
tongue.