CEREBRAL PALSY AND ITS TREATMENTS

Mindy GambinoENG 333

OverviewBACKGROUNDTYPES, CAUSES AND SYMPTOMSTREATMENTS

CEREBRAL PALSY

Non curable, non progressive disorder

Affects the ability to moveAffects posture and balance

Types of Cerebral PalsySpasticAthetoidAtaxicMixed

SPASTIC CPTense, contracted musclesMost common

◦Affects 70-80% of all CP patientsStiff, awkward movementsDifficulty shifting positions

SPASTIC CP (Cont.)Three subtypes

1. Diplegia – affects one side2. Hemiplegic – affects both

arms/both legs3. Quadriplegia – affects all limbs

Spastic CP is caused by damage to the motor cortex

ATHETOIDUncontrolled motion in face,

arms, and trunkMovements may increase with

stress and dissipate during sleepInterferes with coordinated

movementsCaused by damage to the

cerebellum

ATAXIC CPPoor balance resulting in

stumbles and fallsCaused by damage to the

cerebellum10% of CP patients have this

form

MIXED CPSpastic, involuntary movementsCombinations of the previously

mentioned typesDamage to both the motor cortex

and cerebellum25% of CP patients have this

form

CAUSES OF CPDevelopmental malformationsNeurological damageBrain damage occurring before,

during or after birth

DEVELOPMENTAL MALFORMATIONSFailure of the brain to develop

correctlyLower than normal number of

brain cellsFetal brain cells not migrating to

correct areas

NEUROLOGICAL DAMAGE

Before , during or after birth

NEUROLOGICAL DAMAGEThree main causes before and

during birth◦ RH incompatibility

Blood conflict between the mother and fetus

◦ Illness of the mother Viral diseases Poor nutrition Diabetes Alcohol or drugs

NEUROLOGICAL DAMAGE (Cont.) Severe Lack of Oxygen

◦ Premature Separation of the placenta from the uterine wall

◦ Breach birth◦ Interference with circulation of the

umbilical cord

NEUROLOGICAL DAMAGE (Cont.)After Birth Causes of CP Accidental Injury Lead Poisoning Illness

◦ Meningitis◦ Encephalitis

SYMPTOMS OF CPUsually noticeable before age

threeTwo main

◦Physical ◦Behavioral

PHYSICAL SYMPTOMS OF CPDifficulty suckingPoor muscle controlPoor coordinationMuscle spasms and seizuresDevelopmental delays in:

◦Crawling◦Sitting◦Walking

BEHAVIORAL SYMPTOMS OF CP

Unusual tensenessIrritabilityLack of concentrationEmotional ProblemsSometimes Down Syndrome

TREATMENT FOR CPOrthopedic SurgeryOrthoticsDrug TherapiesPhysical and Occupational

Therapy

ORTHOPEDIC SURGERYCorrects muscle and bone

deformities caused by spasmsCan be done at any age, usually

from age four

ORTHOPEDIC SURGERY (Cont.)

BenefitsSignificant improvement in

walkingImproved range of motionDecreased deformity

ORTHOPEDIC SURGERY (Cont.)

DrawbacksTime consuming25% chance of infectionChild may temporarily regressCostly - $20,000 or more

ORTHOTICSKnown as bracesReduces plasticityStretches tight muscles and

holds them to prevent contracture

May improve walking

DRUG THERAPIES

Botox injectionsInthrethecal baclofen

BOTOX INJECTIONSInjected into the spastic muscleQuick procedure – 5 minutesUsed on a few muscle groups at a

timeLasts up to three monthsUsed for spastic diplegia or

spastic quadraplegia

INTHRATHECAL BACLOFENPump implanted in the abdomen

to distribute doseDelivered into the spinal fluidRefilled every three monthsDecreases spasms and blocks

abnormal nerve signals

INTHRATHECAL BACLOFENIncreased muscle controlDosage can be adjusted 5-10% risk of infectionRisk of spinal fluid leaksHigh cost - $20-$25,000

SELECTIVE DORSAL RHIZOTOMYNeurosurgical treatmentNerves from brain to leg muscles

are exposed in the spinal cord30-50% of the top of each nerve

is cut offPermanent decrease in spasmsFor children between four and

eight

SELECTIVE DORSAL RHIZOTOMY (Cont.)RisksCould decrease feeling in legsExtensive hospital say4-6 weeks of inpatient

rehabilitationExpensive

SPEECH THERAPYNon invasiveSpecial devices such as a

computer with a voice synthesizer

OCCUPATIONAL THERAPYDevelops skills such as:

◦Feeding◦Brushing teeth◦Dressing

Improves day to day livingBoosts self-esteem

PHYSICAL THERAPYUsed in conjunction with other

treatmentsPrevents muscle weakening

(atrophy)Helps prevent muscle

contractureImproves motor development