Post on 22-Jun-2015
description
Nutritional & hormonal imbalance in cerebral palsy
Dr. Varidmala JainAssociate Prof, SHIAT, Allahabad
Email- varidmala@rediffmail.comjjain999@gmail.com
www.samvednatrust.com, www.trishlaortho.comFb:samvednatrust.cerebralpalsy
Youtube:jjain999
Introduction
• Most of the time children with cerebral palsy suffer from some or other nutritional problems—
• Deficiencies
• Imbalances
• Hormonal problems leading to nutritional deficiencies & growth retardation
Common Nutritional deficiency & hormonal disorder
• Protein-energy Malnutrion
• Vit D, Calcium, Phosphorus, Magnesium
• Vit B12
• Vit C
• Iron & folic acid
• Thyroid
• Growth hormone
Protein energy malnutrition
Etiology-• Frequent infection and / or hospitalisation• Feeding, eating, drinking and swallowing (FEDS)
problems• Modified consistency of diet (e.g. soft, minced &
moist, or puréed)• Reliance on others for feeding• High nutritional needs• Poor appetite due to constipation or reflux
Contd.
• More spasticity more energy expenditure
• Ambulatory spastic CP –medium energy expenditure.
• Athetoid CP - higher energy expenditure
• Wheel chair bound/non ambulatory - lower energy expenditure
• Factors for estimating energy needs: age, activity level, growth rate and muscle tone.
Overweight
• Because of reduced physical activity & increase intake of fat & fast food.
• Common in Quadriplegic non walker GMFCS 4/5
• Difficulty to mobilize & transfer.• Wt gain itself detrimental to person’s physical
activity and it becomes vicious cycle. • Proper nutritional advice & increase physical
activity
Contd.
• Good balanced diet • With high protein and fibers• Fats – less in obese but extra in severely
undernourished• Thumb rule is it should contain good mixture of
fruits, green vegetables, cereals, pulses and eggs or fish
• Plenty of fluids.
Vit D Deficiency
• Limited exposure to the sunlight • Poor nutritional intake • Anticonvulsant medications • Rickets of Prematurity• Vit D deficiency can be one of the cause of loss
of seizure control • Osteomalacia in adolescent & rickets in younger
children • Symptom- Bone pain, proximal muscular
weakness, failure to thrive, stress fracture
Treatment
• Calcium rich food & supplement
• Vitamin D supplement
• Exposure to sunlight
• Avoidance of trauma
• Standing, walking, out door activity, swimming & regular physical therapy
Vit C
• Pain, limping & swelling
• Progressive leg weakness
• Subcutaneous bleeding
• Bleeding gums and loosening of teeth
• Fatigue, failure to gain weight, loss of appetite, and irritability
• Anemia
• Vit C supplements
Vit B12, iron & folic acid deficiency
• Faulty dietary habit & poor intake
• Worm infestation
• Anemia, peripheral neuropathy
• Supplement
Hypothyroidism
• Hypothyroidism can be the cause of floppy baby D/D hypotonic CP
• Hypothyroidism are very common in severely affected CP Child & adult
• Mother with hypothyroidism are more prone to deliver cerebral palsy child
• Hypothyroidism can cause wt gain & anemia
• Regular checkup in doubtful cases
Growth hormone deficiency
• Commonly in severely affected cases
• Can cause stunted growth..
• Face appears younger than children of the same age.
• They may also have a chubby body build.
• Late Puberty
• Growth hormone assay & supplement
Contd.
• These problems are result of---1. Feeding, Eating, Drinking and Swallowing
Difficulties (FEDS)
2. Oro-motor Difficulties:
3. Self-Feeding:
4. Sensory Difficulties:
5. Gastro-esophageal Reflux:
6. Constipation
7. Tooth Decay
Feeding, Eating, Drinking & Swallowing Difficulties (FEDS)
• One third of growing children with CP are poorly nourished due to FEDS
• Increase meal time
• Swallowing difficulty leads to choking & safety hazards – repeated pneumonia
Oro-motor Difficulties:
• It include tongue thrust, poor lip closure & inadequate tongue movements.
• causes food and drink to spill from the mouth, resulting in loss of calories and hydration.
Tt- • A modified consistency diet may be required for
safe feeding.• Oro pharyngeal exercises • Oral / Tube feeding / Gastrostomy tube
Self-Feeding:
• Some children may have difficulties using standard utensils such as spoons, forks and cups.
• They may require adaptive utensils to promote safety and independence
• Adjusting seating
• More time given for self feeding
• Small but frequent interval meal
Sensory Difficulties:
• Overly sensitive to touch in & around the mouth and face.
• Sensory modification like light stroke, massage will help out in this problem
Gastro-esophageal Reflux:
• Gastro-esophageal reflux or regurgitation of acid and or food contents from the stomach back up into the esophagus.
• Thickening of food along with small feed
• Seating arrangement during feed to prevent regurgitation
• Antacids
Constipation
• Caused by poor oral fluid intake, poor fiber intake, poor muscle tone, inactivity & certain medications.
• Intake of high fiber foods
• Increase in fluid intake
• Continuation of physical therapy
• Maintenance of ambulation at least standing & supported walking
• Stool softener / Suppository
Tooth Decay
• Causes are faulty diet, feeding difficulties, medication or Gastro-esophageal reflux.
• Tooth grinding can be common. • Tooth decay increases discomfort during
eating and drinking. • It is best to avoid excess sugary foods and
drinks, and to clean teeth twice daily. • Milk and water are the most tooth friendly drinks.
Message • Poor growth of children with CP occur
because of malnutrition, abnormal endocrine function, decreased weight bearing that have other negative health consequences that pose a significant burden to families and to society
• Proper understanding of problem & their solution can prevent child undergoing into another problem.
•Thanks