1. Cerebral palsy

2. Group of disorders which result from non-progressive brain damage during early development

3. Incidence : 2/ 1000 lives

4. Causal factors: 1- Prematurity 2- Perinatal anoxia 3- Kernicterus 4- Post-natal brain infection 5- Post-natal injury

5. Early Diagnosis 1- perinatal difficulty 2- Stiff Baby

6. 3- Dribbling at the mouth

7. 2- Difficulty in sucking and swallowing

8. 5- Developmental milestones delayed ( Normally holds head up at 3 months Sits up at 6 months Walking at 12 months

9. Later Diagnosis 3 typs: Spastic Paresis(% 60) Spasticity Weakness Brisk reflexes Babiniski sign (+ve) Normal sensation ± Fits ± Impaired intelligence

11. Appear as (1) Hemiplegia( One side of body) (2) Diplegia ( Both lower limbs) (3) Total body paresis( Usually low IQ) (4) Isolated asymmetrical paresis

12. Athetosis Continous , involuntary writhing movements

13. Ataxia Muscular incoordination during voluntary movements

14. Characteristic deformities Elbow flexion Wrist flxion Fingers flexion Hip adduction( scissor posture) Knee flexion Ankle equinus

15. Treatment

16. Medication: Fits and Hyperactivity

17. Physiotherapy: 1st year of life

18. Splintage: (1) To counteract spastic deformitie (2) Hold position after surgery

19. Botulinum A toxine: to decrease muscle tone

20. Surgery: (1) Spastic postures which cannot be controlled by conservative Measures. (2) Fixed deformities (3) Secondary complications ( Bone deformity, Hip dislocation, Joint instability)

21. Principles and Guidelines of Treatment (1) Hemiplegia = Good response to conservative or surgical treatment Will be able to walk unaided. Diplegia = More difficult but will be able to walke Total body involvement: Poor prognosis for walking (2) Surgery at 6 years age( Unless fixed deformity threatening)

22. (3) Surgical options: (a) Tight muscles are released OR Their tendons lengthened

23. (b) Nerve transaction when severe spasticity

24. (c) Correction of fixed deformities by: (1) Osteotomy (2) Joint fusion (3) Arthroplasty