NLST (finals) - Cerebral Palsy

Cerebral Palsy

It is a group of permanent, non-progressive neurological disorders caused by injury or abnormal development of the developing brain.

Before, During or Shortly after birth

When does Cerebral Palsy usually occur?

Movement, Muscle Tone, Posture

What does Cerebral Palsy affect?

Sensory, Cognitive and Feeding Impairements

Cerebral Palsy is usually associated with?

Motor Control Areas (Motor Cortex/Basal Ganglia)

CP results from brain damage that affects what?

Prenatal Factors

- Intrauterine Infections (TORCH Infections)

- Maternal Malnutrition

- Low Birth Weight

Perinatal Factors

- Birth asphyxia (Lack of Oxygen)

- Prematurity (MOST COMMON RISK FACTOR)

- Low birth weight

Postnatal Factors

- Neonatal Infections (such as MENINGITIS AND ENCEPHALITIS)

- Head Trauma

- Severe Jaundice (KERNICTERUS)

Kernicterus

Characterized by severe jaundice

Motor signal transmission, Muscle coordination, Tone regulation

Damage to the developing brain disrupts what?

Spasticity

Damage to the MOTOR CORTEX?

Dyskinesia

Damage to the BASAL GANGLIA?

Ataxia

Damage to the CEREBELLUM?

Spastic

- 70 TO 80%

- MOST COMMON

- Increased muscle tone (hypertonia)

- Stiff, jerky movements

Dyskinetic

- 6%

- Involuntary Movements (twisting, writhing)

Ataxic

- 6%

- Poor balance and coordination

- Shaky movements

- Affects balance and sense of positioning in space

Mixed

Combination of types

Hemiplegia

Damage by body distribution on ONE SIDE OF THE BODY

Diplegia

Damage by body distribution primarily on the LOWER LIMBS

Quadriplegia

Damage by body distribution on ALL FOUR LIMBS, it is the MOST SEVERE

Motor Symptoms

Clinical Manifestations characterized by:

- delayed developmental milestones

- abnormal posture and gait

- muscle stiffness or floppiness

- poor coordination

Associated Conditions

Clinical Manifestations characterized by:

- Intellectual disability

- Seizures

- Visual and hearing impairments

- Speech and Communication difficulties

Feeding and Gastrointestinal Issues

Clinical Manifestations characterized by:

- Dysphagia (difficulty swallowing)

- Poor sucking/chewing

- Gastroesophageal reflux

- Chronic constipations

Highly individualized

Energy needs are?

Increase energy expenditure

Nutritional requirement for Spastic CP?

Decrease energy needs

Nutritional requirement for limited mobility?

90-120%

Recommended ENERGY intake for CP patients

1.5 to 2.0 kg/day

Recommended PROTEIN intake for CP patients

For energy density

Why is FAT important?

Calcium and Vit D

Micronutrients needed for CP patients, it helps with the prevention of OSTEOPENIA and FRACTURES

Iron

Nutrient that helps prevent ANEMIA

Pureed, Mashed, Soft foods

Preferred texture modifications for CP patients?

90 degrees

Upright __ during feeding (Positioning)

30 mins

Avoid more than ___ feeding time

Nasogastric tube

Enteral nutrition for SHORT-TERM

Gastrotomy

Enteral nutrition for LONG-TERM

Severe dysphagia, Failure to thrive, Risk of aspiration

Indicators to give Enteral Nutrition to patient?

Baclofen

Muscle relaxant for CP patients

Physical therapy

Helps improve mobility

Occupational therapy

Helps with daily living skills

Speech therapy

Helps with communication and swallowing

Surgical

- Orthopedic surgery

- Selective dorsal rhizotomy

Complication in CP

- Malnutrition

- Growth retardation

- ASPIRATION PNEUMONIA

- Bone deformities

- PRESSURE ULCERS

Non-progressive

CP is ___, but symptoms may change over time