1. CEREBRAL
PALSY
By: Ida Sherri L. Corvera
BSN III - NM

2. • In 1860s, known as
"Cerebral Paralysis” or
William “Little’s Disease”
John Little
• After an English surgeon
(1810-1894)
wrote the 1st medical
descriptions

3. CEREBRAL PALSY (CP)
• Cerebral“- Latin Cerebrum;
– Affected part of brain
• “Palsy " -Gr. para- beyond,
lysis – loosening
– Lack of muscle control

4. CEREBRAL
PALSY
• A motor function disorder
– caused by permanent, non-progressive brain lesion
– present at birth or shortly thereafter. (Mosby, 2006)
• Non-curable, life-long condition
• Damage doesn’t worsen
• May be congenital or acquired

5. CEREBRAL PALSY
A Heterogenous Group
of Movement Disorders
– An umbrella term
– Not a single diagnosis

6. CP Affects
ements
Balance
ation Posture

7. CAUSES
OF CEREBRAL PALSY

8. An insult or injury to the brain
– Fixed, static lesion(s)
– In single or multiple
areas of the motor
centers of the brain
– Early in CNS dev’t

9. CAUSES
• Development Malformations
– The brain fails to develop correctly.
• Neurological damage
– Can occur before, during or after delivery
– Rh incompatibility, illness, severe lack of oxygen
* Unknown in many instances

10. CHIEF CAUSE
Severe deprivation of oxygen or
blood flow to the brain
– Hypoxic-ischemic
encephalopathy
or intrapartal
asphyxia

11. TYPES
OF CEREBRAL PALSY

12. 1. Accdg. to Neurologic Deficits
• Based on the
- extent of the damage
- area of brain damage
• Each type involves the way
a person moves

13. 3 MAIN
TYPES
1. PYRAMIDAL
- originates from the motor
areas of the cerebral cortex
2. EXTAPYRAMIDAL
- basal ganglia and cerebellum
3. MIXED

14. 2. Accdg. to Type of Movement
Photo from: Saunders, Elsvier.

15. 4 MAIN TYPES
PYRAMIDAL 1. Spastic CP
EXTAPYRAMIDAL 2. Athethoid CP
3. Ataxic CP
MIXED 4. Spastic &
Athethoid CP

16. TYPES
SPASTIC -Stiffness
ATHETOID
--Fluctuating
Uncontrolled
Tone
Movements
ATAXIC
-Unsteady,
Unsteady,
uncoordinated
uncoordinated

17. Types of Spastic CP
According to affected limbs:
* plegia or paresis - meaning paralyzed or weak:
• Paraplegia
• Diplegia
• Hemiplegia
• Quadriplegia
• Monoplegia –one limb (extremely rare)
• Triplegia –three limbs (extremely rare)

18. DEGREE OF SEVERITY
1. Mild CP- 20% of cases
• Moderate CP- 50%
- require self help for assisting their
impaired ambulation capacity.
• Severe CP- 30%;
-totally incapacited and bedridden
and they always need care from others.

19. Signs and
Symptoms
OF CEREBRAL PALSY

20. d.
e.
c.
f.
b.
g.
a. h.

21. Early Signs
Infancy (0-3 Months)
• Stiff or floppy posture
• Excessive lethargy or
irritability/ High pitched
cry
• Poor head control
• Weak suck/ tongue thrust/
tonic bite/ feeding difficulties

22. Early Signs
• Abnormal or prolonged
primitive reflexes
Moro’s reflex
Asymmetric tonic neck reflex
Placing reflex
Landau reflex

23. CHILD with CP
ch al
ea nt
r e
t o m es
ow elop ton
Sl v
e i l es
d m

24. Behavioral Symptoms
• Poor ability to concentrate,
• unusual tenseness,
• Irritability

26. ASSOCIATED
PROBLEMS
OF CEREBRAL PALSY

27. • Hearing and visual
• Bladder and bowel
problems
control problems,
• Sensory integration digestive problems
problems
(gastroesophageal reflux)
• Failure-to-thrive, Feeding • Skeletal deformities,
problems dental problems
• Behavioral/emotional • Mental retardation and
difficulties, learning disabilities in
• Communication some
disorders • Seizures/ epilepsy

28. Diagnosis
OF CEREBRAL PALSY

29. DIAGNOSIS
• Physical evaluation, Interview
• MRI, CT Scan EEG
• Laboratory and radiologic work up
• Assessment tools
– i.e. Peabody Development Motor Skills,
Denver Test II

30. ASSESSMENT

31. 1. SUBJECTIVE
- INTERVIEW

32. a. History Taking
–Include all that may predispose
an infant to brain damage or CP
•Risk factors
•Psychosocial factors
•Family adaptation

33. b. Child’s Health
History
• Often admitted to hospitals for corrective
surgeries and other complications.
– Respiratory status
– Motor function
– Presence of fever
– Feeding and weight loss
– Any changes in physical state
– Medical regimen

34. 2. OBJECTIVE
- Physical Examination

35. CRITERIA
P osturing / Poor muscle control and strength
O ropharyngeal problems
O
S trabismus/ Squint
S
T one (hyper-, hypotonia)
T
E volutional maldevelopment
E eflexes (e.g. increaseddeep tendon)
R
R *Abnormalities 4/6 strongly point to CP

36. Treatment
OF CEREBRAL PALSY

37. - No treatment to cure cerebral palsy.
- Brain damage cannot be corrected.
• Crucial for children with CP:
–Early Identification;
–Multidisciplinary Care; and
–Support

38. I. Nonphysical Therapy
“The earlier we start,
the more improvement can be made”
-Health worker

39. • General management
- Proper nutrition and personal care
B. Pharmacologic
Botox, Intrathecal, Baclofen
- control muscle spasms and seizures,
Glycopyrrolate -control drooling
Pamidronate -may help with osteoporosis.

40. C. Surgery
-To loosen joints,
-Relieve muscle tightness,
- Straightening of different twists or
unusual curvatures of leg muscles
- Improve the ability to sit, stand, and
walk.

41. Selective posterior rhizotomy
In some cases nerves need to be severed to decrease
muscle tension of inappropriate contractions.

42. D. Physical Aids
• Orthosis, braces and splints
• Positioning devices
• Walkers, special scooters, wheelchairs
E. Special Education
F. Rehabilitation Services- Speech and
occupational therapies
G. Family Services -Professional
support

43. H. Other Treatment
- Therapeutic electrical stimulation,
- Acupuncture,
- Hyperbaric therapy
- Massage Therapy might help

44. II. Physical Therapy
'The ultimate long-term goal is realistic independence. To
get there we have to have some short-term goals.
Those being a working communication system, education to his potential,
computer skills and, above all, friends'.
- Parent of boy with CP

45. A.Sitting
- Vertical head control and
control of head and trunk.
B. Standing and walking
- Establish an equal distribution of
weight on each foot, train to use steps
or inclines

46. C. Prone Development
D. Supine Development
o Head control on supine and positions

47. NURSING
RESPONSIBILITIES

48. NURSING RESPONSIBILITIES
C. Functioning as a member of the
health team
D. Providing counseling and education
for the parents and promote optimal
family functioning
C. Promoting physical and
psychological health

49. D. Assisting with feeding management
and toilet training
E. Assisting with rehabilitation therapies
(physical, occupational and speech)
F. Providing counseling for educational
and vocational pursuits
G. Preventing child abuse
H. Providing care during hospitalization

50. I. Prevent physical injury
C. Prevent physical deformity
K. Promote a positive self-image

51. "Time and gravity
are enemies of very aging body,
especially mine." - Adult with CP