Talking about Children with Cerebral Palsy

1. Children with Cerebral Palsy
Daw Khin Lay Yu
Chief Physiotherapist
Physical Medicine & Rehabilitation Department
Mandalay General Hospital
2 – 12 – 2020

2. Introduction
• The term `cerebral’ refers to the hemispheres
of the brain, to the motor area of the brain’s
outer layer, the part of the brain that direct
muscle movement.
• `Palsy’ refers to the loss or impairment of
motor function
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3. Definition
• Cerebral palsy (CP) describes a group of
disorders of the development of movement
and posture, causing activity limitation, that
are attributed to non- progressive
disturbances that occurred in the developing
fetal or infant brain. The motor disorders of
cerebral palsy are often accompanied by
disturbances of sensation, perception,
cognition, communication, and behaviour, by
epilepsy, and by secondary musculoskeletal
problems (Rosenbaum et al, 2007).
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4. • The damage to the brain is permanent and
cannot be cured but the consequences can be
minimized.
• The lesion in the brain may occur during the
prenatal, perinatal, or postnatal periods .
• Any nonprogressive central nervous system
(CNS) injury occurring during the first 2 years
of life is considered to be CP
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5. Epidemiology
• CP is the most common cause of childhood
disability.
• The incidence is 2-2.5/1000 live births
• Recent improvements in neonatal care would
decrease the incidence of CP
• The low birth weight (˂2.5kg) infant with
higher CP risk
• Risk factors associated with CP are grouped
into prenatal, perinatal and postnatal factors.
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6. Caused by Risk Factors
Prenatal
• Prematurity (gestational age less than 36
weeks)
• Low birth weight (less than 2500 g)
• Maternal epilepsy
• Hyperthyroidism
• Infections (TORCH)
• Bleeding in the third trimester
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7. • Severe toxemia, eclampsia
• Drug abuse
• Trauma
• Multiple pregnancies (twins, triplets and other
multiple births are linked to an increased risk
of CP)
• Placental insufficiency
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8. Perinatal
• Prolonged and difficult labor
• Premature rupture of membranes
• Presentation anomalies
• Vaginal bleeding at the time of admission for
labor
• Bradycardia
• Hypoxia
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9. Postnatal (0-2 years)
• CNS infection (encephalitis, meningitis)
• Hypoxia
• Seizures
• Neonatal hyperbilirubinemia
• Head trauma
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10. Classification
• Cerebral palsy is generally classified in one of
several ways:
(1) area of brain damage (neuroanatomical);
(2) type of movement disorder (spastic,
dyskinetic, ataxic, and mixed);
(3) limb involvement (topographical); and
(4) function.
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11. Classification according to neuroanatomy and
type of movement disorder
Neuromuscular deficits and site of lesion
• Spastic - Cortex
• Dyskinetic - Basal ganglia –
extrapyramidal system
• Hypotonic / Ataxic - Cerebellum
• Mixed - Diffuse
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12. 12

13. 13

14. 14

15. Mixed CP
• This typed have combination of movement
disorder or show features of more than one
type of CP.
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16. Classification according to location (
topography)
• Hemiplegia - Upper and lower extremity on
one side of body
• Diplegia - Four extremities, legs more
affected than the arms
• Quadriplegia - Four extremities plus the
trunk, neck and face
• Triplegia - Both lower extremities and
one upper extremity
• Monoplegia - One extremity (rare)
• Double hemiplegia - Four extremities, arms more
affected than the legs
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17. 17

18. Classification according to functional
impairment (Best, 2012)
Mild
1. Ambulation and speech are present
2. Head and neck control are present
3. Limitation of activity is slight to
unimpaired
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19. Moderate
1. Impairments affect ambulation and
speech
2. Head and neck control are affected
3. Limitation of activity is moderate to
severe
4. Activities of daily living or other useful
physical activity are limited without
assistive technology
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20. Severe
1. Impairments are incapacitating
2. Head and neck control are absent or
severely limited
3. Physical deformities and contractures
are present
4. Individuals are unable to complete
activities of daily living or other useful
activity without assistive technology
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21. Associated Problems
• Seizures
• Visual impairments
• Intellectual impairment
• Learning disabilities
• Hearing problems
• Communication problems and dysarthria
• Oromotor dysfunction
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22. • Gastrointestinal problems and nutrition
• Teeth problems
• Respiratory dysfunction
• Bladder and bowel problems
• Social and emotional disturbances
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23. Rehabilitation & Physiotherapy
Rehabilitation Team Members
1. Physician – Physiatrist, Pediatric Physiatrist,
Pediatrician, Pediatric Neurologist
2. Orthopedic Surgeon
3. Physiotherapist
4. Occupational Therapist
5. Rehabilitation Nurse
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24. 6. Speech and Language Therapist
7. Prosthetics and Orthotics
8. Social Worker
9. Psychologist
10. Educator
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25. Goals of rehabilitation
Improve
mobility
Teach the child to use his remaining
potential
Teach the child functional movement
Gain muscle strength
Prevent
deformity
Decrease spasticity
Improve joint alignment
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26. Educate the
parents
To set reasonable expectations
Do the exercises at home
Teach daily
living
skills
Have the child participate in daily living
activities
Social
integration
Provide community and social support
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27. Physiotherapy for Cerebral Palsy
• PT for CP children is based on the problems of
individuals.
• Physiotherapy begins in early infancy and
continues throughout adolescence.
• The primary purpose is to facilitate normal
neuromotor development
• With the help of correct positioning,
appropriate stimulation and intensive exercise
the therapist tries to gain head control,
postural stability and good mobility in the
child.
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28. • Possible problems mainly are m/s pb (m/s
shortening) and joint pbs ( contracture, joint
subluxation or dislocation)
• The following ex:s help to prevent m/s and
joint pbs
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29. Conventional exercises
1. Positioning
2. Lifting & carrying
3. Stretching
4. Balance & co-ordination
5. Functional re-education
6. Range of motion exercises
7. Brace
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30. Positioning
Supine lying position
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31. Prone lying & side lying position
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32. Sitting position
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33. Lifting and carrying
Possible ways of carrying a child
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35. Stretching exercises
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36. Functional re-education
1. Easy head-up exercises
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37. 2. Back-lying exercises
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38. 3. Exercises for tummy time with play
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39. 4. Encouraging protective extension reaction
forward
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40. 5. Sitting activities
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41. 6. Getting up and crawling
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42. 7. Training in kneeling
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43. 8. Sit to stand
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44. 9. Standing
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45. 10. Walking with arm support, or with walker
or with crutches
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46. 11. Typical methods of encouraging walking
and walking stairs
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47. Improving balance and co-ordination
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48. Bracing
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49. Range of Motion Exercises
Upper Limb
Shoulder Abduction & Adduction Shoulder Flexion & Extension
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50. Elbow Flexion & Extension Wrist Flexion & Extension
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51. Fingers Flexion & Extension
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52. Lower Limb
Hip Abduction & Adduction Hip Flexion & Extension
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53. Knee Flexion And Extension Ankle Flexion & Extension
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54. Toe Flexion & Extension
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55. Bridging for Core muscle Strengthening
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56. References
1. TOT for CP ( 2011)
2. Jica (2012).
3. Shepherd RB (1995). Physiotherapy in Pediatrics, 3rd
edn.
4. Downie PA (1986). Cash’s Textbookof Neurology for
Physiotherapist, 4th edn.
5. Miller F (2007). Physical Therapy of Cerebral Palsy.
Spinger Science + Business Media, Inc.
6. Berker N and Yalcin S (2005). The Help Guide to
Cerebral Palsy.
7. Martin S (2006). Teaching Motor Skills to Children
with CP, 1st edn.
8. Tidy’s Physiotherapy, 12th edn.
9. Photos from Internet sources
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57. THANK YOU
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