REVIEWER

1. Cerebral
Palsy
BY: JERARD LLOYD B. DOMINGO
BSN 2A
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2. Definition
1. Cerebral palsy (CP) is a group of disorders
that affect a person’s ability to move and
maintain balance and posture. CP is the most
common motor disability in childhood (CDC).
NOTE: “Cerebral” means having to do with the
brain. ”Palsy” means weakness or problems with
using the muscles.
2. Cerebral palsy (CP) is a group of permanent
movement disorders that appear in early
childhood (Wikipedia.org).
3. Cerebral palsy is a group of disorders that
affect movement and muscle tone or posture.
It's caused by damage that occurs to the
immature brain as it develops, most often
before birth. (mayoclinic.org).
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3. Definition
4. Cerebral Palsy is considered a neurological disorder caused by a
non-progressive brain injury or malformation that occurs while the
child’s brain is under development. Cerebral Palsy primarily affects
body movement and muscle coordination. Cerebral Palsy is actually
caused by brain damage. The brain damage is caused by brain injury
or abnormal development of the brain that occurs while a child’s
brain is still developing — before birth, during birth, or immediately
after birth(cerebralpalsy.org).
Prevalence: 2:1000 births.
Cerebral Palsy has 4 types, and damaged areas of the brain caused
its clinical manifestations.
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4. Types of Cerebral Palsy
SMAD
Spastic
Mixed
Ataxic
Dyskinetic
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5. 1. Spastic Cerebral Palsy (stiff muscles)
Note: Spasticity is a feature of altered skeletal muscle performance with a
combination of paralysis, increased tendon reflex activity, and hypertonia. It
is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of
muscles. Clinically, spasticity results from the loss of inhibition of upper motor
neurons due to decreased uptake of major inhibitory neurotransmitter
Gamma Amino Butyric Acid (GABA) , causing excessive velocity-dependent
muscle contraction/ spasm.
The most common type of CP is spastic CP.
Spastic CP affects about 80% of people with
CP.
People with spastic CP have increased
muscle tone. This means their muscles are
stiff and, as a result, their movements can
be awkward. Spastic CP usually is
described by what parts of the body are
affected.
1.1 Spastic diplegia/diparesis
1.2 Spastic hemiplegia/hemiparesis
1.3 Spastic quadriplegia/quadriparesis
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6. 1. Spastic Cerebral Palsy (stiff muscles)
1.1 Spastic diplegia/diparesis―In this type of CP, muscle stiffness is mainly in the legs,
with the arms less affected or not affected at all. People with spastic diplegia might
have difficulty walking because tight hip and leg muscles cause their legs to pull
together, turn inward, and cross at the knees (also known as scissoring).
1.2 Spastic hemiplegia/hemiparesis―This type of CP affects only one side of a person’s
body; usually the arm is more affected than the leg.
1.3 Spastic quadriplegia/quadriparesis―Spastic quadriplegia is the most severe form of
spastic CP and affects all four limbs, the trunk, and the face. People with spastic
quadriparesis usually cannot walk and often have other developmental disabilities
such as intellectual disability; seizures; or problems with vision, hearing, or speech.
Note: Spastic Monoplegia (one limb movement)
also occurs, and can progress into spastic
diplegia and quadriplegia.
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7. 2. Dyskinetic Cerebral Palsy
 People with dyskinetic CP have problems controlling the movement of
their hands, arms, feet, and legs, making it difficult to sit and walk. The
movements are uncontrollable and can be slow and writhing or rapid
and jerky. Sometimes the face and tongue are affected and the
person has a hard time sucking, swallowing, and talking. A person with
dyskinetic CP has muscle tone that can change (varying from too
tight to too loose) not only from day to day, but even during a single
day.
 Athetoid cerebral palsy or dyskinetic cerebral palsy (sometimes
abbreviated ADCP) is primarily associated with damage to the basal
ganglia and the substantia nigra in the form of lesions that occur
during brain development due to bilirubin encephalopathy and
hypoxic-ischemic brain injury.
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8. 2. Dyskinetic Cerebral Palsy
 ADCP is characterized by both hypertonia and hypotonia,
due to the affected individual's inability to control muscle
tone.
 Dyskinetic cerebral palsy can be divided into two different
groups; choreoathetoid and dystonic.
a. Choreoathetoid - characterized by involuntary movements
most predominantly found in the face and extremities.
b. Dystonic - is characterized by slow, strong contractions,
which may occur locally or encompass the whole body
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9. 3. Ataxic Cerebral Palsy
People with ataxic CP have problems with balance and coordination. They might be
unsteady when they walk. They might have a hard time with quick movements or
movements that need a lot of control, like writing. They might have a hard time
controlling their hands or arms when they reach for something.
 Ataxic cerebral palsy is observed in approximately 5-10% of all cases of cerebral
palsy, making it the least frequent form of cerebral palsy.
 NOTE: Ataxic cerebral palsy is caused by damage to cerebellar structures. Because
of the damage to the cerebellum, which is essential for coordinating muscle
movements and balance, patients with ataxic cerebral palsy experience problems
in coordination, specifically in their arms, legs, and trunk. Ataxic cerebral palsy is
known to decrease muscle tone.
 The most common manifestation of ataxic cerebral palsy is intention (action) tremor,
which is especially apparent when carrying out precise movements, such as tying
shoe laces or writing with a pencil. This symptom gets progressively worse as the
movement persists, making the hand shake. As the hand gets closer to
accomplishing the intended task, the trembling intensifies, which makes it even
more difficult to complete.
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10. 4. Mixed Cerebral Palsy
Mixed cerebral palsy has symptoms of athetoid, ataxic and
spastic CP appearing simultaneously, each to varying
degrees, and both with and without symptoms of each. Mixed
CP is the most difficult to treat as it is extremely heterogeneous
and sometimes unpredictable in its symptoms and
development over the lifespan.
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11. Cause/Etiology
 Gene mutations that lead to abnormal brain development.
 Maternal infections that affect the developing fetus.
 Fetal stroke, a disruption of blood supply to the developing brain.
 Bleeding into the brain in the womb or as a newborn.
 Infant infections that cause inflammation in or around the brain.
 Traumatic head injury to an infant from a motor vehicle accident or
fall.
 Lack of oxygen (HYPOXIA) to the brain related to difficult labor or
delivery, although birth-related asphyxia is much less commonly a
cause than historically thought.
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12. Risk Factors
A. Maternal health
Note: Certain infections or toxic exposures during pregnancy can significantly increase cerebral
palsy risk to the baby. Infections of particular concern include:
1. Cytomegalovirus (CMV). This common virus causes flu-like symptoms and can lead to birth
defects if a mother has her first active infection during pregnancy.
2. German measles (rubella). This viral infection can be prevented with a vaccine.
3. Herpes. This can be passed from mother to child during pregnancy, affecting the womb and
placenta. Inflammation triggered by infection can damage the unborn baby's developing
nervous system.
4. Syphilis. This is a sexually transmitted bacterial infection.
5. Toxoplasmosis. This infection is caused by a parasite found in contaminated food, soil and the
feces of infected cats.
6. Zika virus infection. Infants for whom maternal Zika infection causes their head size to be smaller
than normal (microcephaly) can develop cerebral palsy.
7. Other conditions. Other conditions that can increase the risk of cerebral palsy include thyroid
problems, intellectual disabilities or seizures, and exposure to toxins, such as methyl mercury.
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13. Risk Factors
B. Infant illness
Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:
1. Bacterial meningitis. This bacterial infection causes inflammation in the membranes surrounding
the brain and spinal cord.
2. Viral encephalitis. This viral infection similarly causes inflammation in the membranes surrounding
the brain and spinal cord.
3. Severe or untreated jaundice. Jaundice appears as a yellowing of the skin. The condition occurs
when certain byproducts of "used" blood cells aren't filtered from the bloodstream.
4. Bleeding into the brain. This condition is commonly caused by the baby having a stroke in the
womb.
c. Other Factors
 Breech presentation. Babies with cerebral palsy are more likely to be in this feet-first position at
the beginning of labor rather than being headfirst.
 Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of
developing cerebral palsy. This risk increases as birth weight drops.
 Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. If one
or more of the babies die, the survivors' risk of cerebral palsy increases.
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14. Clinical Manifestations
 The symptoms of CP vary from person to person. A person with severe CP
might need to use special equipment to be able to walk, or might not be
able to walk at all and might need lifelong care. A person with mild CP,
on the other hand, might walk a little awkwardly, but might not need any
special help. CP does not get worse over time, though the exact
symptoms can change over a person’s lifetime.
 All people with CP have problems with movement and posture. Many also
have related conditions such as intellectual disability; seizures; problems
with vision, hearing, or speech; changes in the spine (such as scoliosis); or
joint problems (such as contractures).
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15. Clinical Manifestations
Movement and coordination problems associated with cerebral palsy
include:
1. Variations in muscle tone, such as being either too stiff or too floppy
2. Stiff muscles and exaggerated reflexes (spasticity)
3. Stiff muscles with normal reflexes (rigidity)
4. Lack of balance and muscle coordination (ataxia)
5. Tremors or involuntary movements
6. Slow, writhing movements
7. Delays in reaching motor skills milestones, such as pushing up on arms,
sitting up or crawling
8. Favoring one side of the body, such as reaching with one hand or
dragging a leg while crawling
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16. Clinical Manifestations
9. Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with
knees crossing, a wide gait or an asymmetrical gait
10. Excessive drooling or problems with swallowing
11. Difficulty with sucking or eating
12. Delays in speech development or difficulty speaking
13. Learning difficulties
14. Difficulty with fine motor skills, such as buttoning clothes or picking up utensils
15. Seizures
Cerebral palsy can affect the whole body, or it might
be limited primarily to one limb or one side of the
body. The brain disorder causing cerebral palsy
doesn't change with time, so the symptoms usually
don't worsen with age or NON-PROGRESSIVE.
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17. Clinical Manifestations
However, as the child gets older, some symptoms might become more or less
apparent. And muscle shortening and muscle rigidity can worsen if not treated
aggressively.
Note: Brain abnormalities associated with cerebral palsy might also contribute to other
neurological problems, including:
1. Difficulty seeing and hearing
2. Intellectual disabilities
3. Seizures
4. Abnormal touch or pain perceptions
5. Oral diseases
6. Mental health conditions
7. Urinary incontinence
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18. Diagnosis
1. General movements assessment, which involves measuring movements
that occur spontaneously among those less than four months of age,
appears most accurate. Children who are more severely affected are more
likely to be noticed and diagnosed earlier. Abnormal muscle tone, delayed
motor development and persistence of primitive reflexes are the main early
symptoms of CP.
2. Neuroimaging with CT or MRI - can suggest the timing of the initial
damage. An abnormal neuroimaging study indicates a high
likelihood of associated conditions, such as epilepsy and intellectual
disability.
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19. Medical and Surgical Treatment
 There is no cure for CP, but treatment can improve the lives of those
who have the condition. It is important to begin a treatment program
as early as possible.
1. Physical Therapy
2. Occupational Therapy
3. Speech Therapy
4. External Braces
5. Orthopedic Braces
6. Cutting of Overactive Nerves
Medications: a. Diazepam
b. Baclofen
c. Botulinum Toxin
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20. Complications
Note: Muscle weakness, muscle spasticity and coordination problems can contribute to a number of
complications either during childhood or in adulthood, including:
1. Contracture. Contracture is muscle tissue shortening due to severe muscle tightening (spasticity).
Contracture can inhibit bone growth, cause bones to bend, and result in joint deformities, dislocation
or partial dislocation.
2. Premature aging. Some type of premature aging will affect most people with cerebral palsy in their
40s because of the strain the condition puts on their bodies.
3. Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral
palsy, particularly an infant, to get enough nutrition. This can impair growth and weaken bones. Some
children need a feeding tube to get enough nutrition.
4. Mental health conditions. People with cerebral palsy might have mental health conditions, such as
depression. Social isolation and the challenges of coping with disabilities can contribute to depression.
5. Heart and lung disease. People with cerebral palsy may develop heart disease and lung disease and
breathing disorders.
6. Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity may lead to the
early onset of this painful degenerative bone disease.
7. Osteopenia. Fractures due to low bone density (osteopenia) can stem from several common factors
such as lack of mobility, nutritional shortcomings and anti-epileptic drug use.
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21. Prevention
 Most cases of cerebral palsy can't be prevented, but you can lessen risks. If you're
pregnant or planning to become pregnant, you can take these steps to keep
healthy and minimize pregnancy complications: Make sure you're
vaccinated. Getting vaccinated against diseases such as rubella, preferably
before getting pregnant, might prevent an infection that could cause fetal brain
damage.
 Take care of yourself. The healthier you are heading into a pregnancy, the less
likely you'll be to develop an infection that results in cerebral palsy.
 Seek early and continuous prenatal care. Regular visits to your doctor during your
pregnancy are a good way to reduce health risks to you and your unborn baby.
Seeing your doctor regularly can help prevent premature birth, low birth weight
and infections.
 Practice good child safety. Prevent head injuries by providing your child with a
car seat, bicycle helmet, safety rails on beds and appropriate supervision.
 Avoid alcohol, tobacco and illegal drugs. These have been linked to cerebral
palsy risk.
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22. Reference
1. Mayoclinic.org (https://www.mayoclinic.org/diseases-
conditions/cerebral-palsy/symptoms-causes/syc-20353999)
2. Osmosis.org
3. Cdc.gov (https://www.cdc.gov/ncbddd/cp/facts.html).
4. Wikipedia.org (https://en.wikipedia.org/wiki/Cerebral_palsy)
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