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Cerebral palsy

Cerebral palsy. By: Missy Kaplan. Outline. Introduction to Cerebral Palsy Epidemiology Etiology Treatment and Prevention Dental Management. What is Cerebral palsy. Affects body’s ability to control muscle movement Results from an injury to the brain during development .

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Cerebral palsy

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  1. Cerebral palsy By: Missy Kaplan

  2. Outline • Introduction to Cerebral Palsy • Epidemiology • Etiology • Treatment and Prevention • Dental Management

  3. What is Cerebral palsy • Affects body’s ability to control muscle movement • Results from an injury to the brain during development. • This can occur prenatally, natally, or postnatally (United Cerebral Palsy, 2011) (Wilkins, 2009)

  4. Types • Spastic • involuntary contractions of muscles causing stiffness • Athetosis • constant, uncontrolled movements. • Ataxic • loss of equilibrium and have difficulty with balance and coordination • Mixed (United Cerebral Palsy, 2011) (Wilkins, 2009)

  5. epidemiology • “an average of 1 in 303 children in the United States have cerebral palsy” • “an estimated 800,000 children and adults in te US are living with cerebral palsy” • Black and White children > Hispanic children • Boys > Girls • Spastic form is the most common accounting for 80% of all cases (Centers for Disease Control and Prevention [CDC], 2011)

  6. Etiology • Injury to the brain Can occur up to age two • Causes • Hypoxia • Bleeding of the brain • Infections of the brain • Head injuries • Severe jaundice • Infections of mother during pregnancy • unknown (PubMed Health, 2011)

  7. RISKS • Low birth weight • Premature infants • Blood type incompatibility • Breech delivery

  8. SYMPTOMS…..besides motor function • Seizure disorders • Spinal deformities • Incontinence • Delayed growth and development • Mental retardation • Drooling • Impaired hearing, vision and speech (National Institute for Neurological Disorders and Stroke [NINDS], 2011)

  9. TYPES OF BRAIN DAMAGE • Periventricular leukomalacia • Damage to the white matter • Cerebral dysgenesis • Abnormal formation of the brain • Intrapartum asphxia • Lack of oxygen to the brain • Intracranial hemorrhage • Blocked or broken blood vessel

  10. DIAGNOSIS • Doctor will monitor…if symptoms get worse…not cerebral palsy • Magnetic resonance imaging (MRI) • Most common • Cranial ultrasound • No fine detail • High risk pregnancies • Computed tomography scan (CT)

  11. Treatment • No cure • Aimed at managing symptoms • Team approach (NINDS, 2011)

  12. Treatment cont. • Therapy!!!! • Physical • Occupational • Recreational • Speech http://www.uthscsa.edu/mission/spring98/horsestr.html (NINDS, 2011)

  13. Treatment Cont. • Medications • Glycopyrolate reduces saliva • Diazepam (Valium) • Baclofen • Dantrolene sodium • Tizanidine Treat stiff, rigid or spastic muscles (NINDS, 2011) (Rxlist, 2011)

  14. surgery • Used when more conservative treatments fail • Orthopedic • Selective dorsal rhizotomy (SDR) • Locate overactive nerve and sever • Spinal cord stimulation • an electrode is implanted at the base of the spinal cord and stimulates the nerve (NINDS, 2011)

  15. http://www.liddlekidz.com/cerebral-palsy-massage-course.html

  16. Oral health • Malocclusion • Facial muscle disturbances • Attrition • Fractured teeth • Dental caries • Periodontal disease (Wilkins, 2009)

  17. Dental management • Do not force limbs • Place patients head in middle of chair • Watch and anticipate movements • Place patients chin down • No sudden movements • Tone down lights • Early appointments • Possible sedation • Nitrous (Waldman, B.H., Borg, P.A., & Perlman, S.P., 2011) (Kaufman, E., Meyer S., Wolnerman, J.S., Gilai, A.N., 1991) (Oklahoma Association of Community Action Agencies, 2008).

  18. Conclusion • The dental office can be a very stressful place and in order to make it less stressful, we need to understand cerebral palsy and know how to manage their dental care.

  19. References • Centers for Disease Control and Prevention. (2011). Cerebral palsy. Retrieved on November 5, 2011 from http://www.cdc.gov/ncbddd/cp/data.html • Kaufman, E., Meyer S., Wolnerman, J.S., Gilai, A.N. (1991). Transient suppression of involuntary movements in cerebral palsy patients during dental treatment. American Dental Society of Anesthesiology. 38: 200-205 • National Institute for Neurological Disorders and Stroke. (2011). Cerebral palsy: hope through research. Retrieved on November 11, 2011 from http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#179283104 • Oklahoma Association of Community Action Agencies. (2008). Oral health care for children with special health care needs. Retrieved on November 11, 2011 from http://www.okacaa.org/8.5%20x%2011%20Oral%20Health%20Care%20for%20Children%20with%20Special%20Health%20Care%20Needs.pdf • PubMed Health. (2011). Cerebral palsy. Retrieved on November 11, 2011 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001734/ • RxList (2011) RxList Inc. Retrieved on November 11, 2011 from http://www.rxlist.com/script/main/hp.asp • United Cerebral Palsy. (2011). Retrieved on November 5, 2011 from http://www.ucp.org/uploads/media_items/cerebral-palsy-fact-sheet.original.pdf • Waldman, B.H., Borg, P.A., & Perlman, S.P. (2011). Periodontal care for patients with special needs. Dimensions of Dental Hygiene. 9(9): 78-80, 83. • Wilkins, E.M. (2009). Clinical practice of the dental hygienist. (10 ed., pp 925-928). Baltimore: Lipincott Williams and Wilkins

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