Cerebral Palsy - Tagged

Cerebral Palsy: An Introduction

Overview

• Cerebral Palsy (CP) is a spectrum of permanent movement disorders caused by non-progressive disturbances in the developing brain.

• It is the most common physical disability in childhood, found in 1.4 per 1000 live births in high-income countries.

Purpose of the Lecture

• Understand CP: aetiology, presentations, and classifications.

• Explore typical impairments faced by children with CP.

• Learn the principles of physiotherapy assessment.

Understanding Cerebral Palsy

Definition

• CP is characterized by disorders of voluntary movement and coordination, impacting the central nervous system (CNS).

• It mainly arises from disturbances during brain development.

Incidence and Outcomes

• Despite improved care, CP remains prevalent, affecting approximately 2-3 individuals per 1000 live births.

• Around 80% of children with CP reach adulthood.

Causes of Cerebral Palsy

Congenital Causes (70% of cases)

• Brain injuries during gestation or delivery contribute significantly to CP.

• Factors include:

  • Infections during pregnancy (e.g., TORCH infections).

  • Asphyxiation and head trauma at birth.

  • Brain hemorrhage.

Pathophysiology

• Damage affects the brain's white matter, essential for signaling movement.

• Sensitivity to injury exists particularly between 26 and 34 weeks gestation.

• Abnormal brain development, infections, and lack of oxygen significantly disrupt normal CNS growth.

Acquired Cerebral Palsy (Post-28 Days Birth)

• Can result from:

  • Brain damage in early life.

  • Infections (meningitis, encephalitis).

  • Stroke or head injuries.

Risk Factors for Cerebral Palsy

Prenatal Factors (7-80% of cases)

• Includes chromosomal/gene mutations, multiple pregnancies, and maternal infections.

Perinatal Factors

• Issues like lack of oxygen during birth (10% of cases)

Postnatal Factors

• Accidents and infections like encephalitis contribute to CP.

Types of Cerebral Palsy

Classification by Movement Disorders

• Spastic: Increased muscle tone.

• Dyskinetic:

  • Athetoid: Involuntary movements.

  • Dystonic: Fixed, twisted posture.

• Ataxic: Impaired coordination and balance.

• Mixed: Combination of types.

Details of Movement Disorders

• Ataxic CP:

  • Affects balance, posture and eye coordination.

  • Wide and irregular gait, difficulty in fine motor skills.

• Dyskinetic CP:

  • Includes both athetoid (involuntary movements) and dystonic (twisted posture) forms.

• Spastic CP:

  • Can range from mild to severely disabling, affects voluntary muscle control, sometimes affects cognitive function.

Assessment and Management

Importance of Standardized Assessment

• Use outcome measures to guide treatment. Examples include Gross Motor Function Classification Measure (GMFM) and Goniometry.

GMFCS Levels

• A five-level system classifying mobility and gross motor function:

  • Level I: Walks without restrictions.

  • Level II: Walks without assistive devices but faces limitations.

  • Level III: Walks with assistive devices.

  • Level IV: Self-mobility with limitations, often reliant on wheelchairs.

  • Level V: Severely limited self-mobility even with assistance.

Intervention Strategies

• Focus on exercise & targeted rehabilitation (balance, coordination, strength).

• Specific therapies (neurodevelopmental, hydrotherapy).

• Include a multidisciplinary team approach: physiotherapy, occupational therapy, speech therapy, and more.

Associated Problems

• Common issues accompanying CP:

  • Eating and swallowing difficulties.

  • Speech and communication concerns.

  • Mental health problems and sleep disturbances.

  • Additional health concerns: vision, hearing impairments, potential learning disabilities.

Conclusion

• Cerebral Palsy varies widely, necessitating individual assessments and interventions.

• Ongoing surveillance is important, tailored to the needs of each child throughout their development.