Cerebral Palsy

By Jimprey S. Valdez RN
Definition
 a group of disabilities caused by injury or insult to the
brain either before or during birth, or in early infancy.
 is the most common permanent disability of
childhood.
Cerebral refers to the cerebrum, which is
the affected area of the brain (although the disorder
most likely involves connections between the cortex
and other parts of the brain such as the cerebellum,
and palsy refers to disorder of movement.
Definition
CP is caused by damage to the motor control
centers of the developing brain and can occur
during pregnancy (about 75 percent), during
childbirth (about 5 percent) or after birth
(about 15 percent) up to about age three.It is
a non-progressive disorder, meaning the
brain damage does not worsen, but secondary
orthopedic difficulties are common. For
example, onset of arthritis and osteoporosis
can occur much sooner in adults
with cerebral palsy.
Classification of Cerebral Palsy:
1. Spastic Cerebral Palsy – is the most common type and may
involve one or both sides of the body.
Clinical hallmarks include hypertonicity with poor control of
posture, balance, and coordinated movement, and impairment of
fine and gross motor skills. Active attempts at motion increase the
abnormal postures and lead to overflow of movement to other
parts of the body.
Common types of spastic cerebral palsy include:
Hemiparesis is when one side of the body is affected
Quadriparesis (tetraparesis) is when all four extremities are
affected.
Diplegia is when similar body parts are affected, such as both arms.
2. Dyskinetic/Athethoid Cerebral Palsy –
involves abnormal involuntary movements that
disappear during sleep and increase with stress.
Major manifestations are athetosis (wormlike
movement), dyskinetic movement of mouth, drooling
and dysarthria.
Movements may become choreoid (irregular, jerky)
and dystonic (disordered muscle tone), especially
when stressed and during the adolescent years.
. Ataxic Cerebral Palsy – is manifested by a wide-
based gait, rapid repetitive movements performed
poorly, and disintegration of movements of the upper
extremities when the child reaches for objects.
4. The Mixed/dystonic Cerebral Palsy – is
manifested by a combination of the characteristics of
spastic and athetoid CP.
Classification of Cerebral Palsy:
Etiology:
Cerebral Palsy common results from existing prenatal
brain abnormalities.
Prematurity is the single most important determinant
of Cerebral Palsy.
Other prenatal or perinatal risk factors include: asphyxia,
ischemia, perinatal trauma, congenital and perinatal
infections, and perinatal metabolic problems such as
hyperbilirubinemia and hypoglycemia.
Infection, trauma and tumors can cause Cerebral Palsy in
early infancy.
Some cases (about 24%) of CP remain unexplained.
Pathophysiology:
Disabilities usually result from injury to the
cerebellum, the basal ganglia or the motor
cortex.
It is difficult to establish the precise
location of neurologic lesions because
there is no typical pathologic picture. In
some cases, the brain has gross
malformations; in others, vascular
occlusion, atrophy, loss of neurons and
degeneration may be evident.
Cerebral Palsy is nonprogressive but may
become more apparent as the child grows
older.
Clinical Manifestations:
The most common clinical manifestation in all types of CP is
delayed gross motor development (delay in all motor
accomplishments; delay becomes more profound as the child
grows)
Additional manifestations include:
1. Abnormal motor performance (e.g. early dominant hand
preference, abnormal and asymmetrical crawl, poor sucking,
feeding problems or persistent tongue thrust)
2. Alterations of muscle tone (e.g. increased or decrease
resistance to passive movements, child feels stiff when
handling or dressing, difficulty in diapering or opisthotonos)
Clinical Manifestations:
3. Abnormal postures (e.g. scissoring legs or persistent
infantile posturing)
4. Reflex abnormalities (e.g. persistent primitive reflexes,
such as tonic neck of hyperreflexia)
Disabilities associated with Cerebral Palsy include 
mental retardation, seizures, attention deficit
disorder and sensory impairment.
Severe cases may be observed at birth, mild and moderate
cases usually are not detected until the child is 1 to 2 years
old. Failure to achieve milestones may be the first sign.
Diagnosis of Cerebral Palsy is based on the
following:
Prenatal, birth and postnatal history
Neurologic examination
Assessment of muscle tone, behavior and abilities
Other disorders, such as metabolic disorders,
degenerative disorders and early slow-growing brain
tumors are ruled out.
Nursing Management:
Prevent physical injury by providing the child with a safe
environment, appropriate toys, and protective gear
(helmet, kneepads) if needed.
Prevent physical deformity by ensuring correct use of
prescribed braces and other devices and by performing
ROM exercises.
Promote mobility by encouraging the child to perform age-
and condition-appropriate motor activities.
Promote adequate fluid and nutritional intake.
Foster relaxation and general health by providing rest
periods.
Administer prescribed medications which may include
Nursing Management:
 Encourage self-care by urging the child to participate in activities of daily living (ADLs) (e.g. using
utensils and implements that are appropriate for the child’s age and condition).
 Facilitated communication
 Talk to the child deliberately ad slowly, using pictures to reinforce speech when needed.
 Encourage early speech therapy to prevent poor or maladaptive communication habits.
 Provide means of articulate speech such as sign language or a picture board.
 Technology such as computer use may help children with severe articulation problems.
 As necessary, seek referrals for corrective lenses and hearing devices to decrease sensory deprivation
related to vision and hearing losses.
 Help promote a positive self-image in the child:
 Praise his accomplishments
 Set realistic and attainable goals
 Encourage and appealing physical appearance
 Encourage his involvement with age and condition- appropriate peer group activities.
 Promote optimal family functioning
 Encourage family members to express anxieties, frustrations and concerns and to explore
support networks.
 Provide emotional support and help with problem solving as necessary.
 Refer the family to support organizations such as the United Cerebral Palsy Association.
Nursing Management:
repare the child and family for procedures, treatments, appliances and surgeries if needed.
Assist in multidisciplinary therapeutic measures designed to establish locomotion,
communication and self-help, gain optimal appearance and integration of motor functions;
correct associated defects as effectively as possible and provide educational opportunities
based on the individual’s needs and capabilities. Therapeutic measures include:
Braces to help prevent or reduce deformities, increase energy of gait, and control alignment.
Motorized devices to permit self-propulsion.
Orthopedic surgery to correct deformities and decrease spasticity (medications are not helpful
for spasticity).
Medications to control possible seizure activity or attention deficit disorder.
Speech therapy and physical therapy.
Inform parents but their child will need considerable help and patience in accomplishing
each new task.
Encourage them not to focus solely on the child’s inability to accomplish certain tasks.
Urge them to relax and demonstrate patience.
Explain the importance of providing positive feedback.
TThank You!