CEREBRAL PALSY (CP) · •Cerebral palsy was diagnosed in 12.3% of infants born at between 24 and 33 weeks of gestation. • Approximately 50% of children with cerebral palsy have

CEREBRAL PALSY (CP)

S.M.Mazloumi

Associate professor in orthopedics

CEREBRAL PALSY

Definition

• Cerebral palsy is the result of a brain lesion

• The brain lesion must be fixed and nonpr gressive.

• The abnormality of the brain results in motor

impairment

Epidemiology

• In recent reports the incidence has been estimated to be between 2.4 and 2.7 per 100O Live births. (low birth weight tiny neonates)

• The risk for cerebral palsy in a child born full-term is approximately 1 in 2000.

Epidemiology

• Cerebral palsy was diagnosed in 12.3% of infants born at between 24 and 33 weeks of gestation.

• Approximately 50% of children with cerebral palsy have low birth weight, and 28% weight less than 1500 g at birth.

Epidemiology

• The incidence of cerebral palsy in recent studies of multiple births is

9 to 12 per 1000 in twins

31 to 45 per 1000 in triplets

111 per 1000 in quadruplets.

Etiology

PRENATAL

• The TORCHES group of infections (toxoplasmosis, rubella, cytomegalovirus, herpes, and syphilis)

• Cocaine, heroin, and marijuana

• Congenital malformations

• Rhesus blood group incompatibility resulting in

kernicterus as a cause of cerebral palsy

Etiology

PRENATAL

• Prenatal chorioamnionitis and maternal infection have been associated with an

increased risk for premature onset of labor and cerebral palsy in the infant.

• placental abnormalities

• Fetal biophysical profile scores are prenatal noninvasive tests used to monitor the health of the developing fetus.

Etiology

PERINATAL

• Anoxia as a result of perinatal complications

(A tight nuchal Cord or placental abruption)

• Premature delivery

• Sepsis in the neonatal period

• Extracorporeal membrane oxygenation (ECMO

• Heart surgery before the age of 1 month resulted in cerebral palsy in 25% of infants.

Etiology

POSTNATAL

• Infections such as meningitis in early childhood can lead to cerebral palsy

• Cardiopulmonary arrest

• Suffocation

• Motor vehicle accidents

• Severe falls, and child abuse

Classification

• PHYSIOLOGIC

• The most common movement abnormality is Spasticity.

• Hypotonia

• Dystonia

• Athetosis

• Patients with cerebral palsy frequently have a mixed form of movement disorder

classification GEOGRAPHIC

what part of the body is affected by cerebral

palsy.

•Hemiplegia

•Diplegia

•Triplegia

• Quadriplegia

• total body involvement,

PHYSICAL EXAMINATION

• Muscle Tone

• Reflexes

Deep tendon reflexes (hyperreflexia & clonus)

• Infantile reflexes (3-6 mouth.)

- startle reflex, or Moro's reflex

- tonic neck reflex

- parachute reflex (5 month. Appears)

Physical examination

Balance, Sitting, and Gait

Gait Analysis

Cadence. (number of steps per minute),

Scissor gait

crouch gait

Knee flexion contracture and Genu recurvatum

equinus contractures.

toe-walking

Treatment

NONSURGICAL TREATMENT

• Physical Therapy

• Casting

• Orthoses (AFOs)

dynamic equinus, foot drop,

Treatment

MEDICAL TREATMENT OF SPASTICITY

• Oral Medication diazepam and baclofen

• Intrathecal Baclofen

• Botulinum Toxin(Botox) Clostridium botulinum and works by blocking the release of

acetylcholine at the neuromuscular junction.

Treatment

Surgical treatment

• Tenotomies

Adductor muscle tendon

Hamstring muscle tendon

Achill tendon

• Tendon transfer

• Osteotomies