Cerebral Palsy in Childhood
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Brain Death and the Cervical Spinal Cord: a Confounding Factor for the Clinical Examination
Spinal Cord (2010) 48, 2–9 & 2010 International Spinal Cord Society All rights reserved 1362-4393/10 $32.00 www.nature.com/sc REVIEW Brain death and the cervical spinal cord: a confounding factor for the clinical examination AR Joffe, N Anton and J Blackwood Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada Study design: This study is a systematic review. Objectives: Brain death (BD) is a clinical diagnosis, made by documenting absent brainstem functions, including unresponsive coma and apnea. Cervical spinal cord dysfunction would confound clinical diagnosis of BD. Our objective was to determine whether cervical spinal cord dysfunction is common in BD. Methods: A case of BD showing cervical cord compression on magnetic resonance imaging prompted a literature review from 1965 to 2008 for any reports of cervical spinal cord injury associated with brain herniation or BD. Results: A total of 12 cases of brain herniation in meningitis occurred shortly after a lumbar puncture with acute respiratory arrest and quadriplegia. In total, nine cases of acute brain herniation from various non-meningitis causes resulted in acute quadriplegia. The cases suggest that direct compression of the cervical spinal cord, or the anterior spinal arteries during cerebellar tonsillar herniation cause ischemic injury to the cord. No case series of brain herniation specifically mentioned spinal cord injury, but many survivors had severe disability including spastic limbs. Only two pathological series of BD examined the spinal cord; 56–100% of cases had upper cervical spinal cord damage, suggesting infarction from direct compression of the cord or its arterial blood supply. -
Lower Extremity Orthoses in Children with Spastic Quadriplegic Cerebral Palsy Implications for Nurses, Parents, and Caregivers
NOR200210.qxd 5/5/11 5:53 PM Page 155 Lower Extremity Orthoses in Children With Spastic Quadriplegic Cerebral Palsy Implications for Nurses, Parents, and Caregivers Kathleen Cervasio Understanding trends in the prevalence of children with cerebral prevalence for cerebral palsy in the United States is palsy is vital to evaluating and estimating supportive services for 2.4 per 1,000 children, an increase over previously re- children, families, and caregivers. The majority of children with ported data (Hirtz, Thurman, Gwinn-Hardy, Mohammad, cerebral palsy require lower extremity orthoses to stabilize their Chaudhuri, & Zalusky, 2007). Cerebral palsy is primar- muscles. The pediatric nurse needs a special body of knowledge ily a disorder of movement and posture originating in to accurately assess, apply, manage, teach, and evaluate the use the central nervous system with an incidence of 2.5 per 1,000 live births with spastic quadriplegia being the of lower extremity orthoses typically prescribed for this vulnera- common type of cerebral palsy (Blair & Watson, 2006). ble population. Inherent in caring for these children is the need This nonprogressive neurological disorder is defined as to teach the child, the family, and significant others the proper a variation in movement, coordination, posture, and application and care of the orthoses used in hospital and com- gait resulting from brain injury around birth (Blair & munity settings. Nursing literature review does not provide a Watson, 2006). Numerous associated comorbidities are basis for evidence in designing and teaching orthopaedic care usually present with cerebral palsy requiring various for children with orthoses. A protocol for orthoses management interventions. -
Management of Children with Cerebral Palsy
CEREBRAL PALSY MANAGEMENT OF CHILDREN WITH CEREBRAL PALSY The term cerebral palsy refers to motor impairments that result from an insult to the immature motor cortex and/or its motor pathways. I would like to dedicate this article to Dr Leila J Arens, whose passion for manag- ing children with cerbral palsy spans more than 4 decades, and has inspired so many of us to work in this field. The neurological lesion causing cerebral palsy (CP) is static, but the clinical con- dition changes over time. CP has a wide clinical spectrum with a number of aeti- ologies. It is not sufficient just to make the diagnosis of CP; the term needs further qualification by a more detailed description of the clinical condition. There are different types of CP, ranging in severity and associated with a variety of prob- lems. Doctors at primary and secondary level often feel inadequate, due to the complex and diverse nature of the CPs and their associated problems. There is also no magic cure, but rather intervention to allow the patient to reach maxi- BARBARA LAUGHTON mum function and potential and to prevent further complications. This article MB ChB, DCH (SA), FCPaed (SA) aims to give a logical and sound approach to the assessment and management Registered Developmental of the common problems and complications in patients with CP. These children Paediatrician may then be referred when a need for specialised intervention is identified, if Paediatric Neurology Clinic they are deteriorating on current management, or if there is doubt about the diagnosis or management plan. Tygerberg Children’s Hospital Cape Town ASSESSMENT OF CHILDREN WITH CEREBRAL PALSY Dr Laughton works as a consultant at Careful assessment of a patient with CP Tygerberg Children’s Hospital. -
Understanding Cerebral Palsy
Understanding Cerebral Palsy Abstract Inclusion within sports, recreation, fitness and exercise is essential as every individual has the right to engage, participate in and have a choice of different sports, recreation, fitness and exercise activities. This is no different for individuals who have Cerebral Palsy. Although, in society, one of the main issues is how to make activities accessible and inclusive for individuals with disabilities. Additionally, within society there can be little understanding and appreciation of how different medical conditions can effect individuals and what this means when trying to engage in an activity. Therefore, the aim of this article is to give readers an understanding of Cerebral Palsy and how it can affect individuals. It will discuss the different types and forms of Cerebral Palsy, how it can affect individuals as well as the importance of recognising the individual even though they may have Cerebral Palsy. Keywords: Cerebral Palsy, Functional Implications of Cerebral Palsy, Cerebral Palsy and Impairment, Individuals with Cerebral Palsy Introduction CPISRA (Cerebral Palsy International Sports and Recreation Association) is extending its activities to facilitate and promote research into exercise, sport and recreation for individuals with Cerebral Palsy and related conditions. This is in response to the increasing interest in sports, recreation, fitness and exercise for individuals with Cerebral Palsy and a demand for further research. In embarking on this activity, we at CPISRA quickly became aware the need to increase awareness and understand various sport and recreation participation aspects relating to individuals with Cerebral Palsy. Before understanding these various aspects though, there is firstly the need to have a critical understanding of Cerebral Palsy. -
Cerebral Palsy the ABC's of CP
Cerebral Palsy The ABC’s of CP Toni Benton, M.D. Continuum of Care Project UNM HSC School of Medicine April 20, 2006 Cerebral Palsy Outline I. Definition II. Incidence, Epidemiology and Distribution III. Etiology IV. Types V. Medical Management VI. Psychosocial Issues VII. Aging Cerebral Palsy-Definition Cerebral palsy is a symptom complex, (not a disease) that has multiple etiologies. CP is a disorder of tone, posture or movement due to a lesion in the developing brain. Lesion results in paralysis, weakness, incoordination or abnormal movement Not contagious, no cure. It is static, but it symptoms may change with maturation Cerebral Palsy Brain damage Occurs during developmental period Motor dysfunction Not Curable Non-progressive (static) Any regression or deterioration of motor or intellectual skills should prompt a search for a degenerative disease Therapy can help improve function Cerebral Palsy There are 2 major types of CP, depending on location of lesions: Pyramidal (Spastic) Extrapyramidal There is overlap of both symptoms and anatomic lesions. The pyramidal system carries the signal for muscle contraction. The extrapyramidal system provides regulatory influences on that contraction. Cerebral Palsy Types of brain damage Bleeding Brain malformation Trauma to brain Lack of oxygen Infection Toxins Unknown Epidemiology The overall prevalence of cerebral palsy ranges from 1.5 to 2.5 per 1000 live births. The overall prevalence of CP has remained stable since the 1960’s. Speculations that the increased survival of the VLBW preemies would cause a rise in the prevalence of CP have proven wrong. Likewise the expected decrease in CP as a result of C-section and fetal monitoring has not happened. -
Cerebral Palsy and Epilepsy in Children: Clinical Perspectives on a Common Comorbidity
children Article Cerebral Palsy and Epilepsy in Children: Clinical Perspectives on a Common Comorbidity Piero Pavone 1 , Carmela Gulizia 2, Alice Le Pira 1, Filippo Greco 1, Pasquale Parisi 3 , Giuseppe Di Cara 4, Raffaele Falsaperla 5, Riccardo Lubrano 6, Carmelo Minardi 7 , Alberto Spalice 8 and Martino Ruggieri 9,* 1 Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, AOU “Policlinico”, PO “G. Rodolico”, University of Catania, 95123 Catania, Italy; [email protected] (P.P.); [email protected] (A.L.P.); [email protected] (F.G.) 2 Postgraduate Training Program in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; [email protected] 3 NESMOS Department of Pediatrics, Sapienza University of Rome, Sant’Andrea University Hospital, 00161 Rome, Italy; [email protected] 4 Department of Pediatrics, University of Perugia, 06132 Perugia, Italy; [email protected] 5 Neonatal Intensive Care Unit (NICU), Neonatal COVID-19 Center, AOU “Policlinico”, PO San Marco, University of Catania, 95123 Catania, Italy; [email protected] 6 Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, UOC di Pediatria, Neonatologia, Ospedale Santa Maria Goretti, Polo di Latina, 04010 Latina, Italy; [email protected] 7 Department of Anaesthesia and Intensive Care, University Hospital “G. Rodolico” of Catania, 95123 Catania, Italy; [email protected] 8 Child Neurology Division, Department of Pediatrics, -
Cerebral Palsy
Cerebral Palsy Cerebral palsy encompasses a group of non-progressive and non-contagious motor conditions that cause physical disability in various facets of body movement. Cerebral palsy is one of the most common crippling conditions of childhood, dating to events and brain injury before, during or soon after birth. Cerebral palsy is a debilitating condition in which the developing brain is irreversibly damaged, resulting in loss of motor function and sometimes also cognitive function. Despite the large increase in medical intervention during pregnancy and childbirth, the incidence of cerebral palsy has remained relatively stable for the last 60 years. In Australia, a baby is born with cerebral palsy about every 15 hours, equivalent to 1 in 400 births. Presently, there is no cure for cerebral palsy. Classification Cerebral palsy is divided into four major classifications to describe different movement impairments. Movements can be uncontrolled or unpredictable, muscles can be stiff or tight and in some cases people have shaky movements or tremors. These classifications also reflect the areas of the brain that are damaged. The four major classifications are: spastic, ataxic, athetoid/dyskinetic and mixed. In most cases of cerebral palsy, the exact cause is unknown. Suggested possible causes include developmental abnormalities of the brain, brain injury to the fetus caused by low oxygen levels (asphyxia) or poor circulation, preterm birth, infection, and trauma. Spastic cerebral palsy leads to increased muscle tone and inability for muscles to relax (hypertonic). The brain injury usually stems from upper motor neuron in the brain. Spastic cerebral palsy is classified depending on the region of the body affected; these include: spastic hemiplegia; one side being affected, spastic monoplegia; a single limb being affected, spastic triplegia; three limbs being affected, spastic quadriplegia; all four limbs more or less equally affected. -
Potentially Asphyxiating Conditions and Spastic Cerebral Palsy in Infants of Normal Birth Weight
Fetus-Placenta-N ewborn Potentially asphyxiating conditions and spastic cerebral palsy in infants of normal birth weight Karin B. Nelson, MD, and Judith K. Grether, PhD Bethesda, Maryland, and Emeryville, California OBJECTIVE: Our purpose was to examine the association of cerebral palsy with conditions that can inter rupt oxygen supply to the fetus as a primary pathogenetic event. STUDY DESIGN: A population-based case-control study was performed in four California counties, 1983 through 1985, comparing birth records of 46 children with disabling spastic cerebral palsy without recognized prenatal brain lesions and 378 randomly selected control children weighing 2:2500 g at birth and surviving to age 3 years. RESULTS: Eight of 46 children with otherwise unexplained spastic cerebral palsy, all eight with quadriplegic cerebral palsy, and 15 of 378 controls had births complicated by tight nuchal cord (odds ratio for quadriplegia 18, 95% confidence interval 6.2 to 48). Other potentially asphyxiating conditions were uncommon and none was associated with spastic diplegia or hemiplegia. Level of care, oxytocin for augmentation of labor, and surgical delivery did not alter the association of potentially asphyxiating conditions with spastic quadriplegia. Intrapartum indicators of fetal stress, including meconium in amniotic fluid and fetal monitoring abnormalities, were common and did not distinguish children with quadriplegia who had potentially asphyxiating conditions from controls with such conditions. CONCLUSION: Potentially asphyxiating conditions, chiefly tight nuchal cord, were associated with an appre ciable proportion of unexplained spastic quadriplegia but not with diplegia or hemi-plegia. Intrapartum abnor malities were common both in children with cerebral palsy and controls and did not distinguish between them. -
Cerebral Palsy
Cerebral Palsy What is Cerebral Palsy? Doctors use the term cerebral palsy to refer to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but are not progressive, in other words, they do not get worse over time. • Cerebral refers to the motor area of the brain’s outer layer (called the cerebral cortex), the part of the brain that directs muscle movement. • Palsy refers to the loss or impairment of motor function. Even though cerebral palsy affects muscle movement, it is not caused by problems in the muscles or nerves. It is caused by abnormalities inside the brain that disrupt the brain’s ability to control movement and posture. In some cases of cerebral palsy, the cerebral motor cortex has not developed normally during fetal growth. In others, the damage is a result of injury to the brain either before, during, or after birth. In either case, the damage is not repairable and the disabilities that result are permanent. Patients with cerebral palsy exhibit a wide variety of symptoms, including: • Lack of muscle coordination when performing voluntary movements (ataxia); • Stiff or tight muscles and exaggerated reflexes (spasticity); • Walking with one foot or leg dragging; • Walking on the toes, a crouched gait, or a “scissored” gait; • Variations in muscle tone, either too stiff or too floppy; • Excessive drooling or difficulties swallowing or speaking; • Shaking (tremor) or random involuntary movements; and • Difficulty with precise motions, such as writing or buttoning a shirt. The symptoms of cerebral palsy differ in type and severity from one person to the next, and may even change in an individual over time. -
Children with Ataxia in Conductive Education
Central Journal of Neurological Disorders & Stroke Short Communication *Corresponding author Erzsébet Balogh, International Pető Association, András Pető College, Gizella út 1. 1143 Budapest, Hungary, Tel: Children with Ataxia in Conductive 003613837255; Email: [email protected] Submitted: 16 September 2020 Education Accepted: 29 September 2020 Published: 30 September 2020 1 2 Erzsébet Balogh * and Éva Feketéné Szabó ISSN: 2334-2307 1International Pető Association, András Pető College, Hungary Copyright 2 András Pető College, Semmelweis University, Hungary © 2020 Balogh E, et al. OPEN ACCESS Abstract Impaired coordination caused by cerebral, cerebellar or spinal impairment, with hypoxic or Keywords genetic causes, answer to the Pető’s conductive education quite fair. It might mean the most favorable • Pető method facilitation for developmental processes and by the so called structural cerebellar reserve or by • Conductive education extra-cerebellar parts of the brain. • Ataxia ABBREVIATIONS CP: Cerebral Palsy; CE: Conductive Education induced abnormal coordination test, become increasingly INTRODUCTION successful with repeated new trials – even in a few minutes. Some elements of classical neurological tests for coordination adapted An accumulation of children with ataxia can be observed in to age can be used extremely advantageously in rehabilitation, conductive educational services worldwide. including conductive education (CE), e.g. imitated play – finger MATERIALS AND METHODS movements on imaginary piano keys, rhythmic, bilateral synchronous or alternating movement series. These are applied facilitationalso in Pető’s tool CE in which CE is usescalled holistic, rhythmical pedagogical intention, tools intention for the global upbringing of infants and children [5,6]. The most powerful Based on the files of previously assessed children with ataxia will be create soon special conductive educational groups. -
Neuro-Developmental Treatment (NDT) and Neurological Disorders: the Latest Research and Resources for Ots and Pts
Neuro-Developmental Treatment (NDT) and Neurological Disorders: The Latest Research and Resources for OTs and PTs (2 CEs) Learning Objectives • Summarize foundational theories and treatment behind NDT. • Explain what NDT looks like as delivered through physical and occupational therapy practitioners. • Summarize current peer-reviewed NDT research. • Identify and describe NDT-appropriate neurological disorders outside of cerebral palsy (CP) and hemiplegia. • Identify updated resources for proper billing of NDT in specific practice settings. • Discuss current therapy resources for NDT to enhance the clinical practice. Introduction Neuro-developmental treatment (NDT) also referred to as the Bobath Concept or approach, has been around since the 1940s when it was first developed by Berta and Dr. Karel Bobath. Initially, the Bobaths introduced innovative therapeutic approaches for children with cerebral palsy and adults with hemiplegia. Today, NDT is widely used in the therapy realm for numerous neurological conditions and has revolutionized hands-on clinical work. Physical and occupational therapists working in various settings and capacities worldwide have incorporated NDT principles and practices into their patients’ treatment sessions. Like other theoretical and practical roots of physical therapy and occupational therapy, NDT’s foundations have aged; this, however, does not mean that NDT is less applicable or is out-of-date. As with other treatment theories, NDT was designed to evolve as clinicians learned more about the human function. In fact, the Bobaths insisted that NDT must be applied so that it could evolve over time in order to fully understand the recovery of function in neurological conditions (Runyan, 2006). As new treatments take the limelight, however, older treatment approaches are at risk of fading. -
Cerebral Palsy a Message of Hope for Illinois Families
CEREBRAL PALSY A MESSAGE OF HOPE FOR ILLINOIS FAMILIES A WHITE PAPER PRESENTED BY WHAT YOU NEED TO KNOW AFTER YOUR BABY RECEIVES A DIAGNOSIS OF CEREBRAL PALSY A white paper presented by the medical malpractice trial lawyers of Cirignani, Heller & Harman, LLP A diagnosis of cerebral palsy means a significant change for your family. You probably want to find out as much as you can about the condition to answer the following questions: What will the diagnosis mean for your child’s future? How severe are your child’s symptoms? Why did this happen to your child? We want you to know there is hope. In our white paper, you will learn more about the condition, its causes and its symptoms. We have also compiled a checklist for raising a child with cerebral palsy, which may include legal action as part of advocating for your child’s best interests. At the end of the white paper, you will find a list of groups and associations that may be able to provide you with additional resources to help your child. 2 THERAPY AND TECHNOLOGY EXPAND OPPORTUNITIES Many people with cerebral palsy live Today, kids with cerebral palsy typical lives and go to school, have routinely attend school in fulfilling careers, get married, have mainstream classrooms with the children and maintain their own help of a caregiver. The expanded homes. As your child grows, he or she treatment and mobility options now can develop the skills and abilities available offer a better opportunity needed to be as independent for a satisfying and productive as possible through physical, life than in past decades, when occupational and speech therapy.