Cerebral Palsy

non-progressive brain lesions
involving motor or Postural abnormalities

"A group of disorers of the development of movement and posture causing activity limitations that are attributed to non-progressive disturbances that occured in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, cognition, communication, perception and/or behavior and/or a seizure disorder" (Bax,2005)

onset: fetal or neonatal period upto 3 years
restricted to brain only
Associated: 30-50% MR, 15-60% Epilepsy

Aetiology:

Brain lesions due to
Prenatal, Perinatal, Postnatal insults
Risks - preterm birth, multiple gestation, intrauterine growth restriction, male sex, low Apgar scores, intrauterine infections, maternal thyroid abnormalities, prenatal strokes, birth asphyxia, maternal methyl mercury exposure, and maternal iodine deficiency

Classification:

Spastic most common (80%)
due to cortical/pyramidal lesions
Spastic hemiplegia
Spastic diplegia (lower more affected)
Spastic quadriplegia
Dyskinetic CP
(athetoid CP, choreoathetoid CP, and dystonic CP) abnormal movements; hypertonicity often is associated
Mixed CP
Hypotonic CP - hypotonia with hyperreflexia, persistent primitive reflexes; rare

History:

Prenatal - drug exposure, toxins/infections, DM, tauma, radiation, prenatal care, fetal movements
Perinatal - Gestational age, presentation & delivery type, birth weight, APGAR
Neonatal - ICH, feeding difficulties, apnea, bradycardia, infection, hyperbilirubinemia
Developmental - gorss, fine, language, social
Gross - head control (2 months), Roll (4 months), Sit (6 months), walk (1 year)

Examination:

observe for abnormal neck & truncal tone
asymmetric posture, gait, coordination
increased reflexes
persistence of primitive reflexes
Spasticity
Athetosis, Chorea, Dystonia

Complications:

GIT/Nutritional - FTT, Obseity, GER, Constipation, Dental Caries
Resp - Increased risk of aspirational pneumonia, Chronic lung disease, bronchilitis/asthma
Skin - Decubitus ulcer
Orthopedic - Contractures, hip dislocation, scoliosis
Neurologic - Epilepsy, Hearing loss, MR

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