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Cerebral Palsy

Cerebral Palsy. Lewis, pp. 1716-1724. Etiology/Pathophysiology. Non-progressive neuromuscular disorder Caused by perinatal trauma/hemorrhage or anoxia to areas of brain or prenatal brain abnormalities

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Cerebral Palsy

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  1. Cerebral Palsy Lewis, pp. 1716-1724

  2. Etiology/Pathophysiology • Non-progressive neuromuscular disorder • Caused by perinatal trauma/hemorrhage or anoxia to areas of brain or prenatal brain abnormalities • Characterized by early onset and impaired movement and posture. May be accompanied by developmental delays, and intellectual impairment (about 50% have some degree) • Variety of manifestations in brain, but are not common to all cases—atrophy, lesions, vascular occlusions, infarctions, hemorrhages

  3. Risk Factors • LBW preterm birth • Periventricular leukomalacia (studies have shown low levels of white matter in brain—MRI can show lesion) • In utero exposure to maternal infection • Severe newborn hypoglycemia • Postnatal infections and trauma

  4. Types (1717, Box 55-1) • Spastic (most common)—hypertonia; poor posture, balance, coordination; impaired fine and gross motor skills • Dyskinetic—involuntary, writhing and jerking movements; drooling; poor articulation • Ataxic—wide-based gait; rapid, repetitive, poorly performed movements • Mixed/dystonic—combination of spastic and dyskinetic

  5. Early Motor Signsof CP • Poor head control after age 3 mos • Stiff or rigid limbs • Arching back/pushing away • Floppy tone • Unable to sit without support at age 8 mos • Clenched fists after age 3 mos • Persistent tonic neck and Moro reflexes • Hand preference in first 2 years

  6. Early Behavioral Signs of CP • Excessive irritability • No smiling by age 3 mos • Feeding difficulties • Persistent tongue thrusting • Frequent gagging or choking with feeds

  7. Interventions for CP • Goal is early recognition and promotion of optimum development through: • Meeting needs for locomotion, communication, self-help skills • Correct defects ASAP to gain optimal appearance and function • Provide optimal educational and socialization experiences

  8. Interventions • Most children need wide variety of support services—PT, OT, speech, medical, dental • Considerable help may be needed in ADLs and training for self-help. • Ortho needs include orthotics, motor devices, adaptive devices, surgery to correct tendon deformities or control spasticity and contractures

  9. Medications • Muscle relaxers to decrease spasticity include po forms of Dantrium, Baclofen, and Valium, and Botox injections. • A Baclofen pump infused intrathecally has been approved. • Antiseizure meds for those who need them (Tegretol, Depakote) • Ritalin for those who have ADHD • Pain meds

  10. Technology • Technical devices to improve functioning and promote independence: • Voice activated computer technology • Toys controlled with head device when head and trunk are in alignment • Computerized toys and games to improve hand-eye coordination

  11. Educational and Social Needs • Mainstreaming is encouraged. Many children have normal intelligence but are unable to demonstrate it on standardized tests. • Vocational training for those who are unable to do formal education • Encourage recreational activities and appropriate sports activities such as Special Olympics • Refer family to United Cerebral Palsy organization (www.ucp.org)

  12. Nursing Responsibilities • Encourage early intervention and multidisciplinary approach • Encourage frequent rest periods • Promote optimal nutrition (oral vs. gastrostomy, manual jaw control) • Good oral hygiene • Safety precautions if fall risk • Immunizations • Encourage normalization • Support family • Realize hospitalization may be a form of respite care

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