CEREBRAL PALSY

1. Syed masood

2. DEFINITION
 DISORDER OF MOVEMENT AND POSTURE
DUE TO DEFECTIVE OR NON-PROGRESSIVE
LESION OF IMMATURE BRAIN.

3. EPIDEMOLOGY
 1-3/1000 LIVE BIRTHS
 MALES AND FEMALES ARE EQUALLY
AFFECTED

4. THE PRETERM INFANT
Prof. Dr. R Harihara Prakash, MPT (Paed. Neuro)
Definition by GESTATIONAL AGE BIRTH WEIGHT
WHO definition:
Less than 37 weeks gestation
LBW: < 2500 gms
VLBW: < 1500 gms
ELBW: < 1000 gms
Infant born before:
37 completed gestational weeks – preterm
32 completed gestational weeks – very preterm
28 completed gestational weeks – extremely preterm
Lower the gestational age,
more immature is the infant.

5. ETIOLOGY
1. PEMATURITY:
 TRAUMA AT DELIVERY
 AFTER BIRTH DUE TO IMMATURE
RESPIRATORY AND CVS
2. ASPHYXIA:
 ACCIDENTS AT BIRTH
 KNOTTED UMBLICAL CORD
 CORD AROUND NECK
 PROLAPSED CORD

6. ETIOLOGY CONTD.
3. BIRTH TRAUMA:
 DISPROPORTION
 FORCEP DELIVERY
 BREECH DELIVERY
4. SEVERE JAUNDICE:
UNCONJUGATE BILIRUBIN IN BLOOD
DEMAGES BASAL GANGLIA.

7. ETIOLOGY CONTD.
5. HYPOGLYCEMIA:
CAUSES SEVERE BRAIN DEMAGE.
6. INTRA-UTERINE VIRUS INFECTION:
RUBELLA VIRUS INFECTION AND
CYTOMEGALOVIRUS INFECTION.
7. NEONATAL MENINGITIS

8. ETIOLOGY CONTD.
8. GENETIC CAUSES
9. VASCULAR CAUSES
10. CHOREOAMNIONITIS

9. CLASSIFICATION
TOPOGRAPHICAL
• MONOPLEGIA
• HEMIPLEGIA
• DIPLEGIA
• QUADRIPLEGIA
ETIOLOGIC
• CONGENITAL
• ACQUIRED
PHYSIOLOGIC
• BASED ON
FUNCTIONAL
CLASSIFICATION.

10. CLASSIFICATION CONTD.
SYMPTOMATIC
• SPASTIC
• ATAXIC
• ATHETOID
ANATOMICAL
LOCALIZATION
• PYRAMIDAL
• EXTRAPYRAMIDAL
• CEREBELLAR

11. HEMIPLEGIA
1. Hemiplegic children become
independent walkers by age 3.
2. Sensory deficits and learning
disability add to movement
problem.
3. Children adopt compensatory
pattern.
4. Difficulty in having midline
orientation.

12. DIPLEGIA
1. Requires walking aids. Can usually walk by the age of 4 to 7.
2. Hand dexterity is impaired.
3. Children have difficult writing and other tasks requiring fine
motor control.
4. Surgery may be required for contractures and deformities.

13. QUADRIPLEGIA
1. Mobility is major problem.
2. All four limbs are affected.
3. Poor muscle endurance.
4. Difficulty maintaining static and dynamic
posture

14. SPASTIC
 DISORDER OF TONE
 CAUSED BY DEMAGE TO UMN OR ALONG
PATHWAYS
 INCREASED DTR AND EXTENSOR PLANTER
RESPONSES

15. CONTINUES
CONTRACTION OF
SPASTIC MUSCLE
AND APPARENT
WEAKENING OF
ANTAGONISTIC
MUSCLE
DEVELOPMENT OF
DEFORMITY AT
JOINT
BECOME FIXED
CONTRACTURES
WITH TIME

16. DIFFERENCES BETWEEN SPASTICITY
AND DYSTONIA
Spasticity Dystonia
Examination You feel You see
Tendon
reflexes
Increased Generally
normal
Clonus Present Absent
Pathological
reflexes
Present Rare

17. ATAXIC
 CAUSED BY DEMAGE TO CEREBELLUM OR ITS PATHWAYS.
 SIGNS:
i. HYPOTONIA
ii. DISTURBANCE OF BALANCE
iii. INCORDINATION
iv.INTENTION TREMORS
v. DYSARTHRIA
vi. NYSTAGMUS

18. ATHETOID
 DEMAGE CENTERED ON BASAL GANGLIA
 IRREPRESSIBLE SLOW WRITHING
MOVEMENTS.

19. EXTRAPYRAMIDAL
 CLINICAL MENIFESTATION:
i. DYSKINESIA
ii.DYSTONIA
iii.TREMORS
iv.RIGIDITY
• ARMS, LEGS, NECK AND TRUNK INVOLVED
• 30% OF PATIENTS
• MR AND HEARING DEFICITS MAY BE PRESENT.

20. COMMON SITES FOR CONTRACTURES
Upper extremity Lower extremity
Pronator Hip adductor – flexor
Wrist and finger flexor Knee flexor
Thumb adductor Ankle plantar flexor

21. COMMON SITES OF DEFORMITY
Place Deformity
Spine Scoliosis, kyphosis
Hip Subluxation, dislocation
Femur and tibia Internal or external torsion
Foot Equinus, valgus, varus

22. SPINAL DEFORMITIES
SPINAL DEFORMITY OCCURS IN
Scoliosis Total body involved spastic
and dystonia
Kyphosis (thoracolumbar) Patients with no sitting
balance
Kyphosis (lumbar) Patients with hamstring
contracture
Hyperlordosis (lumbar) Ambulatory patients with hip
flexion contractures

23. SPINAL DEFORMITIES

24. SPINAL DEFORMITIES
Long C shaped hyperkyphosis in
the child with weak spinal extensor
muscles.
Hamstring spasticity causes
posterior pelvic tilt and sactal
sitting resulting in lumbar kyphosis.

25. ASSOCIATED FEATURES
• OPTIC NERVE DEMAGE
• CORTICAL BLINDNESS
• SQUINTS
VISUAL
PROBLEMS
• DEAFNESS
AUDITORY
PROBLEMS
• APHASIA
• DYSARTHRIA
• DYSLEXIA
SPEECH

26. ASSOCIATED FEATURES
• ASTEREOGNOSIS
• SPATIAL DISORIENTATION
SENSORY
DEFICITS
• DEMAGE PREVENTING
DEVELOPMENT OF MEMORY
MENTAL
HANDICAP
• GENERALIZED OR
FOCALTONIC SEIZURES.
SEIZURES

27. CP IS LIKELY IF THERE IS NO
1.HEAD CONTROL AT 3 MONTHS
2.SITTING AT 6 MONTHS
3.ROLLING OVER AT 6 MONTHS
4.WALKING AT 18 MONTHS