Cerebral palsy, Etiology, types, diagnosis, treatment, prevention.


It is a disorder of movement & posture caused by non-progressive injury to the immature brain. 
There is change in muscle tone and posture both at rest and with Voluntary activity

Etiology:-
Arising from permanent brain damage attack before, during or immediately after birth. 
  1. Prenatal factors
  2. Perinatal factors
  3. Post natal factors
Pre - Natal:- 
  • Hereditary (genetic factors). 
  • Prenatal infections including Viral(rubella), Bacterial & parasitic (Toxoplasmosis). 
  • Foetal anoxia caused by hemorrhage from premature separation of placenta or Mal- development of placenta
  • Rh Incompatibility Including Erythroblastosis foetalis , Haemolytic anaemia & hyper bilirubin
  • Metabolic disorders such as Maternal diabetic  & Toxemia of pregnancy
  • Developmental defects which include Mal development of brain, Vascular & skeletal structures. 
Peri Natal factors:-
  • Rupture of the brain blood vessels
  • Compression of brain during prolonged or difficult labor. 
  • Premature separation of the placenta
Post Natal Factors:-
  • Vascular accidents
  • Intracranial hemorrhage
  • Head injury
  • Brain infection including Bacterial/ Viral encephalopathy
  • Toxic conditions such as lead poisoning Types of Cerebral Palsy:-
  1. Spastic - hemiplegia, Diplegia, Quadriplegia
  2. Ataxic
  3. Dyskinetic                                                  Dystonic  - Hypokinesia, hypertonia ,   Choreo Athetoid -Hyperkinesia, hypotonia 
  4. Mixed
Cerebral palsy Associated Disabilities:-
  • Mental retardation
  • Epilepsy
  • Speech disorders
  • Vision & hearing
  • Behaviour abnormalities
  • Learning difficulties
Problems:-
  • Feeding problems ( Failure to suck, gagging , choking, Vomiting, &regurgitation) 
  • Dribbling
  • Constipation
  • Crying, Screaming & sleep disturbance
  • Growth retardation
Associated features:-
  • Eyes - paralysis of gaze, cataracts perceptual & refractive errors. 
  • Ears - partial or complete loss of hearing
  • Speech - Aphasia, dysarthria
  • Sensory deficit - Astereognosis & spatial disorientation
  • Seizures - Spastic usually have generalized focal tonic seizures
  • Intelligence:- about quater of children have Borderline Intelligence while half of them are severely mentally retarded
  • Miscellaneous - Inadequate Thermoregulation and problems of social & emotional adjustment are present. 
Diagnosis:-
Diagnosis of CP should be suspected when there is no normal range of neurological & behavioural development, essentially if abnormalities of posture, involuntary movement and neurological deficit are also present. 

Prevention:-
Prevention of foetal & perinatal insults, good maternal care & freedom from postnatal damage reduces prevalence
Early diagnosis, prompt adequate management plans can reduce the neurological & psychosocial emotional handicaps for the child & his family. 

Management:-
  • The management plan should be holistic & directed to severity, type of Neurological deficits and associated problem
  • Symptomatic treatment is given for seizures
  • Tranquilizers are prescribed for behavior disturbance & relaxants may be used for improving the muscle function
  • Diazepam - Spasticity & Athetosis
  • Dantrolene sodium - Muscle relaxation. 

Occupational therapy:
The beginning is made with simple movement of self help in feeding & dressing with progression to intricate activities like typing

Education:-
The defects of vision, perception speech & learning are managed by adequate special education experiences. 

Orthopaedic support:-
Light weight splints may be used

Social
Family should be given social and emotional support to help it to live with the childs handicap

Rehabilitation and Vocational guidance:-
Parents should help the child to adjust in the social and if possible to become self reliant & Independent by proper Vocational guidance
Severely handicapped may be required to Institutionalized. 

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