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    DR Shahid Aslam MRCP (Lon), MRCPCH (UK) Asst Prof&Consultant Paediatrician

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    Rida Fatima
    This document discusses cerebral palsy (CP), a disorder of movement and posture caused by damage to the developing brain. It notes that CP is non-progressive and causes physical disability through impaired muscle tone, strength, coordination or movement. The causes of CP include damage occurring during pregnancy, delivery, or shortly after birth. Common symptoms in infants include delayed development, abnormal muscle tone, lack of ability to bring hands together, and difficulty reaching. Treatment focuses on managing symptoms and associated problems like epilepsy, intellectual disability, and communication issues.

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    DR Shahid Aslam MRCP (Lon), MRCPCH (UK) Asst Prof&Consultant Paediatrician

    Uploaded by

    Rida Fatima
    26 views45 pages
    This document discusses cerebral palsy (CP), a disorder of movement and posture caused by damage to the developing brain. It notes that CP is non-progressive and causes physical disability through impaired muscle tone, strength, coordination or movement. The causes of CP include damage occurring during pregnancy, delivery, or shortly after birth. Common symptoms in infants include delayed development, abnormal muscle tone, lack of ability to bring hands together, and difficulty reaching. Treatment focuses on managing symptoms and associated problems like epilepsy, intellectual disability, and communication issues.

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    This is most common disease among children

    Original Title

    Cerebral Palsy 2

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    This document discusses cerebral palsy (CP), a disorder of movement and posture caused by damage to the developing brain. It notes that CP is non-progressive and causes physical disability through impaired muscle tone, strength, coordination or movement. The causes of CP include damage occurring during pregnancy, delivery, or shortly after birth. Common symptoms in infants include delayed development, abnormal muscle tone, lack of ability to bring hands together, and difficulty reaching. Treatment focuses on managing symptoms and associated problems like epilepsy, intellectual disability, and communication issues.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    26 views45 pages

    DR Shahid Aslam MRCP (Lon), MRCPCH (UK) Asst Prof&Consultant Paediatrician

    Uploaded by

    Rida Fatima
    This document discusses cerebral palsy (CP), a disorder of movement and posture caused by damage to the developing brain. It notes that CP is non-progressive and causes physical disability through impaired muscle tone, strength, coordination or movement. The causes of CP include damage occurring during pregnancy, delivery, or shortly after birth. Common symptoms in infants include delayed development, abnormal muscle tone, lack of ability to bring hands together, and difficulty reaching. Treatment focuses on managing symptoms and associated problems like epilepsy, intellectual disability, and communication issues.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 45

    Dr Shahid Aslam

    MRCP(Lon),MRCPCH(UK)
    Asst Prof&Consultant Paediatrician
     Permanent , non progressive disorder of posture & movement
    causing physical disability .

     Chronic and static impairment of muscle tone ,strength


    coordination or movement.

     Other neurologic deficit/disorder like deafness ,blindness and


    epilepsy usually associated.
     Caused by damage to the motor control centers of the
    developing brain.
     Can occur during pregnancy , during delivery or after
    delivery .
     Life long condition with no cure.
     Non infectious /Non contagious.
     Occurs 2 /1000 live births.
     Known to humans nearly 150yrs.
     Cerebral → Cerebrum

     Palsy → Paralysis / Disorder of movement

     Babies with CP become to attention at 6- 9 months age.

     Symptoms may appear or change with time.


     Damage to developing brain.
     80% Structural problems
     75% Problems during pregnancy
     Exposure to radiation , Intruterine infections(TORCH)
     Complications during delivery( Hypoxia , birth trauma )
     Post natal illness
     Prematurity 40-50%

     Low birth weight 1-1.5Kg

     Multiple births

     Assisted Reproductive Treatment(ART)


    Antenatal factors
    Intrauterine infections(TORCH/Chrioamnionitis)
    Maternal fever
    Congenital defects
    Placental problems
    Diabetic Mother
    Natal factors(During delivery)

    Hypoxia at birth(Asphyxia)
    Instrumental delivery
    Caesarean Section
    Cord prolapse
    Abruptio placentae/Uterine rupture
     Postnatal (After delivery)
    Meconium Aspiration
    Infections in neonate (Meningitis)
    Severe Jaundice(Kernicterus)
    Respiratory distress syndrome (RDS)
    Convulsions (Fits) in babies
    Low blood sugar
     Early Childhood
    Infections(Meningitis/Encephalitis)
    Trauma (Head Injury,MVA)
    Child Abuse/Shaken Baby Syndrome
    Choking
    Near Drowning
    Poisoning
     Symptomlogy is diverse.
     Complete neurologic examination and regular review.

     9 months
     18 months
     24 or 30 months


     Delayed developmental milestones
    Spasticity/Joint contractures
    Spasms/ involuntary movements
    Unsteady gait
    Scissor walking
    Tip toe walking
     In a Baby Younger Than 6 Months of Age
    Head lags when you pick him up while lying on back
    He feels stiff
    He feels floppy
    When held cradled in your arms, he seems to overextend his
    back and neck.
    When you pick him up, his legs get stiff and they cross or
    scissor.
     In a Baby Older Than 6 Months of Age

     Doesn’t roll over in either direction

     Cannot bring hands together

     Difficulty bringing hands to mouth

     Reaches out with only one hand while keeping the other fisted
     Speech & Language Problems
    Due to involvement of pharyngeal/palatal muscles
    Oral articulation problems
    Poor respiratory control

    Hearing & Visual impairment


    Communication difficulty
    Intellectual disability
     Infant has difficulty /inability in sucking/swallowing/
    chewing.

     Unable to hold bottles/utensils.

     Fine motor functions are more affected that gross motor.


     Associated features
    Epilepsy 30%
    Visual problems 40%
    Learning difficulties 50%
    Communication problems 60%

    Feeding /Eating issues


    Fecal/Urine incontinence
    Behavioral issues
     3 Types

    Spastic 70%

    Ataxic 10-15%

    Athetoid/Dyskinetic 5-10%
     Spastic CP
    Most common form.
    Spasticity of limbs( tight muscles)

    Monoplegia one limb


    Hemiplegia Arm+leg on same side
    Paraplegia Both legs affected
    Quadriplegia All four limbs affected
     Spastic (pyramidal) cerebral palsy
     Signs of upper motor neuron involvement hyperreflexia,
    clonus, extensor Babinski response, persistent primitive
    reflexes, and overflow reflexes (crossed adductor).

     Child's tendency to keep the elbow in a flexed position or the


    hips flexed and adducted with the knees flexed and in valgus,
    and the ankles in equinus, resulting in toe walking
     Upper motor neuron(UMN) signs
    GABA

    Hypertonia
    Hypereflxia
    Clonus
     Inability to walk
     Unsteady gait
    Arthritis
     Tendinitis
     Contractures
     Short stature
     Limb length discrepancy
     Thin bones
     Ataxic
    Cerebellum involved
    Hypotonia
    Tremors
    Unsteady gait
    Fine coordinated movements are affected
    Athetoid/Dyskinetic
    Extrapyramidal system/Pyramidal tract/Basal ganglia

    Kernicterus in newborns commonest cause.

    Mixed muscle tone


    Impaired fine motor control(pencil holding)
    Involuntary movements
     Associated problems
    Seizures 30- 50%
    Mental retardation 50%
    Language&speech delay
    Hearing involvement
    Visual problems
    Impaired sensory perception
     History of gross motor developmental delay.
     Abnormal muscle tone: The most frequent symptom.
     Definite hand preference before age 1 year.
     Asymmetrical crawling or failure to crawl
     Growth disturbance: Especially failure to thrive
     Increased reflexes: Sign of an upper motor neuron lesion; and
    persistence of primitive reflexes
     Underdevelopment or absence of postural or protective
    reflexes
     Observe gait pattern and each joint in the lower and upper
    extremity should be assessed for signs of cerebral palsy.
     Hip: Excessive flexion, adduction, scissoring of the legs is
    common in spastic cerebral palsy
     Knee: Flexion and extension
     Foot: Toe walking is common in cerebral palsy
    Imaging studies

     Cranial ultrasonography; structural abnormalities


    hemorrhage , hypoxic-ischemic injury
     Computed tomography(CT) congenital malformations,
    intracranial hemorrhage, craniosynostosis.
     Magnetic resonance imaging (MRI)
    modality of choice.
    Clinical diagnosis
     No definitive laboratory tests.
     Thyroid function studies
     Lactate and pyruvate levels: Abnormalities of energy
    metabolism ( mitochondrial cytopathy)
     Ammonia levels: Elevated ammonia levels may indicate
    liver dysfunction or urea cycle defect
     Organic and amino acids: May reveal inherited metabolic
    disorders
     Electroencephalography Important in the diagnosis of seizure
    disorders

     Electromyography and nerve conduction studies: Helpful


    when a muscle or nerve disorder is suspected
    Thanks

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