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.