Cerebral Palsy March 2013, 1 hour What is Cerebral Palsy? to walk and may require life-long care. Intellectual Disability may range from normal intelligence to profound Cerebral refers to the brain’s two placenta rendering it unable to intellectual disability. The pediatrician halves or hemispheres.; palsy deliver oxygen to the fetus, Rh or doctor may test for persistence in describes any disorder that incompatability (rare today), primitive reflexes, such as the moro impairs body movement. limited or poor prenatal care, and reflex (symmetrical extension of arms) Cerebral Palsy (CP) is the most multiple births: twins, triplets, etc. in response to stimulation or change in common movement disorder head position persisting past six among children. Although the Symptoms months of age. The child may also signs and symptoms are in the There are six hallmark features of display hypotonia (decreased muscle muscles and limbs, the disorder CP: movement disorders, seizures, tone) as shown in these illustrations: is caused by faulty development intellectual disability, behavior or damage to motor areas in the people intellectual with and de- disorder, hearing impairment, and of brain that disrupts the brain’s vision problems. “Failure to ability to control movement and Thrive” is sometimes diagnosed by posture. CP is a group of a doctor. This diagnosis is often neurological disorders; given to children who lag behind in symptoms appear in infancy or growth and development. Children early childhood. CP is with CP may have suckling and characterized by abnormal swallowing difficulties leading to control of movement or posture; poor nutrition and growth. it is diagnosed in the absence of Damage to the brain centers any other underlying disease. CP controlling growth and is not contagious, hereditary or development are affected. Muscles genetic in nature. It is permanent of limbs affected with CP tend to but not progressive. The be smaller than normal, and this is incidence is 2.5 in 1,000 live more evident in those diagnosed births in US & Canada. 70% of with spastic hemiplegia (only cases of CP are congenital physically affected on one side of meaning present at birth. 20% of the body.) Children with CP also those are acquired during the suffer milestone delays in head birthing process, usually due to control (usually around 3 months), hypoxia to the brain of the baby rolling over (4-5 months), sitting or injury to the brain during the without support at 6 months, and birthing process. Some 10% of walking (12-14 months). Many of cases are acquired after birth these symptoms are noticed by the from brain injury, hypoxia, parents. Symptoms vary from encephalitis or meningitis. Many person to person. Some persons times the cause of CP is never with mild CP may require no known. Risk factors for special attention; while others congenital CP are a damaged severely affected may not be able Since 1969, Milestone Centers, Inc. has provided programs and services to people with developmental and behavioral health challenges. Disclaimer : The information presented in this home isstudy intended to provide education and ideas promote to healththe and well being velopmental disabilities;is meant way itin tono replace a doctor’s orders oragency’s your policies. Cerebral Palsy | Page 2 HCQU Northwest The growing child may display weakness in one muscle tissue through injectable medication. or more limbs; they may stand or walk on their Three main other types of muscle relaxants tip toes, have an abnormal walk or gait used in medicating cerebral palsy are dragging one leg, or poor control over hand Diazepam, Baclofen, and Dantrolene. and arm movement. They may also display Diazepam (Valium), is taken orally and excessive drooling or difficulties swallowing. operates on the brain’s electric signals, Limbs are not paralyzed: they still feel hot, stemming them and their resulting muscle cold, and pressure. They may not be able to twitching. Baclofen pump implantation speak - but that doesn’t mean they don’t have (below) works by doing similar things, but something to say. The degree of the person’s primarily in the spinal cord. Dantrolene works physical disability does not indicate their level in the skeletal muscle, lessoning the muscle’s of intelligence. The condition does not get calcium content and stiffness. Many of these worse although effects may change for better muscle relaxants are benzodiazepines. These or worse. drugs work on the GABA receptors in the brain. The GABA chemical, when released by Risks the brain, can affect muscle and motor You can minimize the risk of your child having function. The benzodiazepines act by calming CP by getting good prenatal care and treating the muscle contractions, allowing for a Rh incompatibility properly. Jaundice can be treated with phototherapy or blood transfusion. Prevent head injures, use approved car carriers, and biking helmets, and eliminate child abuse. Always supervise young children, especially during bathing and swimming. If you are planning to get pregnant, you should be vaccinated for Rubella or German Measles pre-pregnancy. Despite the best efforts of the mother and pediatrician, CP cannot absolutely be prevented. In a large number of CP cases the cause is never found. Types of CP loosening effect in the muscles of the cerebral Limb involvement can be described as follows: palsy patient. Physical therapy or surgery can quadriplegia - all four limbs involved; diplegia - sometimes help when on benzodiazepines. all four limbs involved but both legs are more severely affected than the arms; hemiplegia - Selective Dorsal Rhizotomy-(below) for one side of the body is affected, and the arm is spastic CP, is a surgery that is only done once. usually more involved than the leg; triplegia - It decreases spasticity in the lower limbs. It can three limbs are involved, usually both arms and improve function; the spasticity does not a leg; and monoplegia - only one limb is return. Five Dorsal Nerve roots are cut on each affected, usually an arm. side. Stimulation can distinguish normal from CP is further classified as spastic, meaning stiff abnormal nerve roots. or difficult movement, with limbs stiff and contracted. Spastic CP accounts for 80% of all cases. For example, a person with CP may be said to have Spastic Quadriplegia - meaning their limbs are stiff and contracted and all four limbs are affected. Spastic type CP causes muscle contractions, or tight, stiff limbs. Muscle relaxants are usually given to help ease the symptoms. These relaxants can take the form of Botox A injections, which tend to relax the topical HCQU Northwest Cerebral Palsy | Page 3 Athetoid or dyskinetic CP: typically characterized by slow, or precise movements such as writing or buttoning a shirt. uncontrolled movements of the trunk and extremities. This They may also have intention tremor, which occur toward the abnormal movement usually affects the hands, feet, arms, or end of an intentional movement, such as reaching for a book legs, and in some cases the muscles of the face and tongue, or pressing a button. Tremors worsen as the movement causing grimacing and/or drooling. Muscles change from persists, often becoming so intense that it becomes difficult floppy to tense. Movements sometimes increase with stress to complete the task. and disappear with sleep. Patients may have problems with Mixed Type: doesn’t correspond to any single type; symptoms coordinating the muscle movement needed for speech, a are a mix of types: spastic, athetoid, and ataxic. For example, condition known as dysarthia. Athetoid Cerebral Palsy affects the person may have some muscles that are too spastic about 10 to 20% of persons with CP. (tight ), some muscles that are atonic (low tone), and display Ataxic Cerebral Palsy (5 - 10%): The individual may have poor athetoid type movements; creating a mix of symptoms. Some coordination, balance, and depth perception. They may walk people have more than one type of CP. The most common unsteadily with a wide-based gait, placing their feet unusually type of mixed is spastic + athetoid movements. far apart, and experiencing difficulty when attempting quick MANAGEMENT OF CP focuses on SPEECH THERAPISTS OR LANGUAGE promoting capabilities and trying to PATHOLOGISTS diagnose and treat help the individual achieve a maxi- communication problems. They mum level of independence. Treat- evaluate articulation problems affect- ment of person’s with CP may involve ing verbal communication they may design special electronic communica- the following disciplines: a primary tion boards that people can point to, or physician familiar with developmental eye gaze computers for those able to disabilities, an orthopedic specialist communicate but not point, as well as who treats disorders of bones, joints, test for and recommend special muscles and tendons. A Neurologist textured diets for person’s with who may diagnose and treat seizures dysphagia (trouble swallowing). and neuralgias. A physical therapist OCCUPATIONAL THERAPISTS (OT’s) (PT) designs therapy sessions to help patients learn skills of day to day improve movement and strength. PT’s living, school or work. An OT designs also promote physical independence therapies attempting to increase by teaching alternatives to ambulation independence through developing or improving fine motor skills. OT’s also and how to use walkers, crutches, teach adaptive equipment for feeding, braces and wheelchairs or alternative seating and bathroom skills. modes of ambulation. SEIZURES. Children who experience at controlling or reducing the remaining SEIZURE FIRST AID GOALS and what to seizures, especially severe and 20%. Medication regimen adherence is do. To Prevent injury, maintain an frequent seizures, in addition to vital, as the number one cause of a open airway, provide reassurance to cerebral palsy are at risk for dimin- seizure is a missed dose. Seizure the individual and bystanders, and ished life expectancy compared to medications may need a period of fine recognize an emergency situation: children who don’t have seizures.