Cerebral palsy

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Integrated teaching on CEREBRAL PALSY:

Integrated teaching on CEREBRAL PALSY Hosting department – PEDIATRICS- DR.SUJATHA , PROF & HOD DR.SHIVAPRAKASH SOSALE . C Participating departments ORTHOPEDICS –DR.LOKESH PHYSIOTHERAPHY –MS.SHAMBHAVI

Cerebral palsy :

Cerebral palsy Shivaprakash Sosale , C Associate Professor In Pediatrics, SIMSRC, Bangalore

Definition :

Definition “ Non progressive , STATIC encephalopathy due to insult to the developing brain during antenatal, p renatal or early postnatal period” Disorder of posture and movements Often associated with seizures, mental retardation , visual and hearing impairment Managed with multi disciplinary approach

Epidemiology :

Epidemiology Commonest cause from motor handicap in Indian children. Prevalence ~2% Incidence 3.6 per 1000 Male: female =>1.4:1 80% antenatal factors, 10% intapartum asphyxia PT—15per 100-hemorrhage /PVL IL-6 IN term babies

ETIOLOGY :

ETIOLOGY

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Functional GRADE I-NO LIMITATION OF PHYSICAL ACTIVITY GRADE II- MILD TO MODERATE LIMITATION GRADE III- MODERATE TO SEVERE LIMITATION GRADE IV- NO FUNCTIONAL ABILITY MONOPLEGIA DIPLEGIA (LL>UL) QUADRIPLEGIA HEMIPLEGIA PARAPLEGIA DOUBLE HEMIPLEGIA(UL>LL) SPASTIC HYPOTONIC DYSKINETIC MIXED ATAXIC PRENATAL NATAL POSTNATAL C L AS S I F I CA T I ON

Clinical Classification:

Clinical Classification Spastic- hypertonicity with poor posture control D yskinetic / athetoid - abnormal involuntary movement/slow wormlike writhing Ataxic- wide-based gait Mixed-type/ dystonic - combination of spasticity and athetosis

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Delayed gross motor development A universal manifestation of CP

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Motor syndrome Neuropathology Cause SPASTIC DIPLEGIA (35%) Periventricular leukomalacia Peri ventricular hemorrhage venous infarction Prematurity Ischimia Infection Metabolic SPASTIC QUADRIPLEGIA Multi cystic encephalopathy with cortical atrophy , selective neuronal necrosis Parasagital cerebral injury, cerebral malformations Perinatal /intrauterine infection SPASTIC HEMIPLEGIA Stoke Cerebral injury MCA teritory ( infaction necrosis) Cerebral malformation Genetic – throbophilic disorders Prenatal events like hypoperfusion Hemorrhage DYSKINETIC Basal ganglion Status mormoratus Billirubin deposition Genetic -mitochondrial Perinatal asphyxia Kernicterus ATAXIC, HYPOTONIC Cerebellar lesions Enlarged ventricles Prenatal( genetic)

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Spastic Tone ↑ Clsap -knife Scissoring Learning disorder Seizures Hypotonic Motor delay MR+ Tone↓ with Brisk DTR Severe MR Dyskinetic Movements,stops on sleep, UL>LL hypo hyper Mitochondrial/IEM Ataxic tone ↓ Defective posture In coordination Nystagmus , tremor Dysarthria , no MR CP with ↓reflex Mixed Spasticity+ Choreoathetosis Diplegic PT,LL& Trunk >UL Scissoring gait No MR, Commando crawl No seizure Dystonic Tone Disorder, Posture & action (LPR) Segawa ds , Truncal twisting facial grimacing & Extremity rigidity Choreo-athetoid NNH( Globus Pallidus ) Choreiform monements Dysarthria Hearing defect No MR No seizure Quadriplegic All limbs Double hemiplegia -UL>LL Intelligence low Seizure, Swallow ↓ Contracturs + Hemiplegic Term, UL>LL Persistent fisting and cortical thumb Tip toe walk Cognitive + CEREBRAL PALSY

Warning Signs:

Warning Signs Physical Signs poor head control after 3 months Stiff or rigid arms/legs, arching back, floppy or limp posture Cannot sit up without support by 8 months Uses only one side of the body or only the arms to crawl Behavioral Signs Extreme irritability or crying Failure to smile by 3 months Feeding difficulties Persistent gagging or choking when fed After 6 months of age, tongue pushes soft food out of the mouth.

DIAGNOSIS:

DIAGNOSIS Follow up of high risk newborn EEG-underlying seizure discords Hearing assessment by BERA Assessment of vision Neuro imaging- CT/MRI-location & extent of lesion(in congenital malformation) Genetic evaluation –chromosomes, IEM Tests for inherited thromboembolic disorders-stroke

Management – Multidisciplinary approach :

Management – Multidisciplinary approach Physiotherpahy Orthotic support Muscle relaxants –treat spasticity Dizepam (0.2mg/kg/day) Baclofen (0.2mg/kg/day) Dandroline (2mg/kg/day) Levadopa (small dose)(2mg/kg/day) Artane (0.2mg/day) - trihexyphenidyl Reserpine (0.02mg/kg/day) or tetra benzene(20mg) Botulinum toxin Dorsal Rhizotomy - diplegia Treatment of co-existing Defects-seizure, Movements, Vision, speech Etc. Occupational therapy Psychological support Institutional support

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THANK YOU…

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