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CEREBRAL PALSY

CEREBRAL PALSY. Kate Morton. CEREBRAL PALSY. Disorder of movement and posture Most common cause of motor impairment in children Due to a non-progressive lesion of the motor pathways in the developing brain Clinical manifestations can change as the cerebrum matures

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CEREBRAL PALSY

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  1. CEREBRAL PALSY Kate Morton

  2. CEREBRAL PALSY • Disorder of movement and posture • Most common cause of motor impairment in children • Due to a non-progressive lesion of the motor pathways in the developing brain • Clinical manifestations can change as the cerebrum matures • Most common cause of motor impairment in children • Associated conditions • Learning impairment (60%) • Visual impairment (20%) • Squints (30%) • Hearing loss (20%) • Speech and language disorders • Behaviour disorders • Epilepsy (40%)

  3. ANTENATAL (80%) Cerebral dysgenesis Cerebral malformation Congenital infection INTRAPARTUM (10%) Birth asphyxia/trauma POSTNATAL (10%) Intraventricular haemorrhage/ ischaemia Meningitis/ encephalitis/ encephalopathy Head trauma/ NAI Symptomatic hypoglycaemia Hydrocephalus Hyperbilirubinaemia CAUSES OF CP

  4. PRESENTATION • Abnormal tone and posturing • Feeding difficulties • Delayed motor milestones • Abnormal gait once walking • Developmental delay – language/ social skills • Other signs: • Hand preference under 12m • Persistence of primitive reflexes (should disappear by 12m)

  5. CLINICAL TYPES • Spastic (70%) - damage to UMN pathway • Increased limb tone • Brisk tendon reflexes, extensor plantar response • Different distributions possible – hemiplegia, diplegia, quadriplegia • Ataxic hypotonic (10%) – usually genetic cause • Usually symmetrical • Early hypotonia, poor balance, delayed motor development • Followed by incoordinate movements, intention tremor • Dyskinetic (10%) – damage to basal ganglia or extrapyramidal pathway • Constant involuntary movements • Poor postural control • Floppiness and delayed motor development • Intellect relatively intact

  6. MANAGEMENT • Importance of child health surveillance • MDT approach • Give parents as much information as possible • Medical treatments for muscle spasm– baclofen, dantrolene, diazepam • Surgical – scoliosis, hip reduction, tendon lengthening, osteotomy • Others – mobility aids; botulinus toxin; heat, cold and vibration for spasticity; splinting • Management of associated conditions eg epilepsy, learning disability, dental problems, aspiration pneumonia

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