1. Dr harshuti shah
Child neurologist
Ahmedabad

2.  Graduate in child neurology-Telaviv uni, Israel
 Fellowship in epilepsy-Great Ormond street
hospital for children,london
 Fellowship in electrophysiology-Japan
 Research in galactosemia- gold prize at world
child neurology congress, Taiwan
 New modality for Opsoclonus myoclonus
syndrome, Child neurology congress, Australia

4.  Common relative:
Not much fruitful, unnecessary to spend
 Child specialist
May or may not improve, needs lots of time to
improve
 Fact by neurologist:
Good part of brain may start taking the
function and
with therapy u can make functional child

5.  Mental retardation with cerebral palsy
 Common terminology to be used in the
prescription paper
MISNOMER
 It is not always so.
 Mental retardation may or may not be
associated
 BECAUSE

6.  Definition: disordered motor function in
early infancy which leads to abnormalities in
muscle tone, muscle weakness and
involuntary movements either alone or in
combination.
 Delayed Sitting
Walking
Intelligence and cognition are not included

7.  Visual field defect-blindness,squinting
 Deafness
 Speech problems like, apraxia,dyspraxia
dysarhtria
 Mental retardation
 Dyslexia-difficulty in learning
 Behavioral disturbances-ADHD ,Autism
ARE NOT INCLUDED IN CP

8.  They may or may not be associated
BUT
 It is not included in CP

9.  Mental stress to mother antenattaly
 Fall of mother
Damage to developing brain
Usually ,
 Hypoxic ischemic encephalopathy
 Hypoglycemia
 Hyperbilirubinemia
 Intracerebral hemorrages
 Maternal infections

10.  Recently increased
 Due to survival of low birth weight and
premature babies
 Awareness of parents
 Early recognition

11.  Not so,
 CP means altered tone which may be
hypotonic/hypertonic or even normal tone in
few with delayed normal development
 There may be involuntary movements
associated with delayed development

12. Types
Hypotonic
Spastic
Ataxic
Choreoathetotic
Mixed

17. ADHD AUTISM
 Hyperactive
 Short attention span
 Good in cognition
 Normal or near normal
speech
 destructive
 Poor eye eye contact
 Poor communication
 Meaningless
repeatation of words
 Repetitive activity
 Keeps things in place

18. Any Child is
 Delayed in development
 out of the normal range is labeled as
cerebral palsy

19. Anything
which is
slow
is not
always
cerebral palsy

20.  Sometimes it can happen
 Single tab in very low dose changes the life
 Dopa responsive dystoina

21. TRUE IN FEW BIOTINIDASE DEF.

24.  His/her father/mother walked late
 Spoke late
 Was dull in studies
 Wait & watch policy does not help
 Child will improve with the advancement in
age

25.  Start the investigation and treatment as
early as possible
 Advantage of plasticity of developing brain
 Synaptic connections are yet to develop till 1
½ year of age
 Give more and more stimuli for good part of
brain to take over the function
 Right from the NICU

26.  What therapy?
 We are massaging the child daily
 Useful for absorption of Vit. D from the
sunlight
 Needs stretching and balancing exercises
daily for recovery of lost muscle power

27.  Done for weeks/months
 Doing for 15 min.
 We DO BETTER!!
 MOTHER IS ALWAYS THE BEST
THERAPIST FOR THEIR OWN CHILD BUT
IT HAS TO BE FREQUENT /REPEATATIVE
 ALLOW the good part of brain to take over
the function of BAD /damaged part
 So till the brain takes over the function

28.  What occupational therapy?
 ACCUPRESSURE IS EFFECTIVE
 Good function of hand and oral muscles are
to be taken care of.
 Speech therapy
 Special education

29.  Regular
 Precise
Why medicines?
 For control of hurdles in improvement
 i.e. epilepsy,spasticity,dystonia,contractures
ADHD,Autism

30.  85% of CP do have epilepsy
 Major seizures in severe cases and mild
seizures in mild cases need to be controlled
for faster normalization of brain activity
and allowing the the brain to take over the
function
 Many are unrecognized

32.  Always feeling that damage is progressive
 Could be due to epilepsy
 Increased tone which increase in height
NOT A CP

33.  Spasticity and dystonia can be improved with
medicines
 NO IMPROVEMENT DESPITE OF
MEDICINES
 medicines are to relax the muscle for
effective stretching it does not improve the
muscle power directly

34.  So expensive inj. Has been given repeatedly
still there is no walking
 THESE HAS THE SAME EFFECT AS
MEDICINE but it acts precisely on
particular muscle NO DIRECT EFFECT ON
MUSCLE POWER

35.  SHOULD NEVER BE DONE(Multiple example
of spoiled cases)
It is essential
 to relieve contracture
 To keep the bones in neutral position
 To prevent the deformity
 Has to be in right person with proper
decision

36.  It is a God’s gift to special parents who can
take care of special child
 It is never the mother’s fault
 It is a mishap
 Everyone in the family should support
morally and by all possible means

37.  Change the mother
 Divorce
 Single parent
 Non hereditary
 Non familial
 Non contagious

38.  Useless to spend a lot
If it is CP
 They always improve
 Once improved they never regress
Degree of improvement depends upon
underlying brain damage

39. Defective Parents
 Next normal child not possible
 Lots of investigation
 Purely a damage to the developing brain
 Except routine extra precaution, nothing is
necessary

40.  Never
 They are retarded OR dyslexic
 Physically handicapped
 Normal OR Extra normal intelligence
 Can do better, normal or at least functional

41.  By elective caesarian section
 Good fetal monitoring is essential
 Skillful gynecologist, careful fetal
monitoring and knowledgeable neonatologist
reduce the incidence of Cp

42.  CP is a disease of developing brain.
 It has to be identified as early as possible.
 It has to be treated as early as possible to
take the advantage of the plasticity of the
brain
 Maximum efforts are to be guided for
making a functional child
 All parents have a right to have one normal
child and it has to be encouraged as much as
possible

43. Photo of join hands