Cerebral Palsy-GWC and DCF 2010

8/8/2019 Cerebral Palsy-GWC and DCF 2010

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By Jimprey S. Valdez RN


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Definitiony a group of disabilities caused by injury or insult to the

brain either before or during birth, or in early infancy.

y is the most common permanent disability ofchildhood.

y Cerebralrefers to the cerebrum, which isthe affected area of the brain (although the disorder

most likely involves connections between the cortexand other parts of the brain such as the cerebellum,and palsy refers to disorder of movement.


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Definitiony CP is caused by damage to the motor control

centers of the developing brain and can occurduring pregnancy (about 75 percent), during

childbirth (about 5 percent) or after birth(about 15 percent) up to about age three.It isa non-progressive disorder, meaning thebrain damage does not worsen, but secondary

orthopedic difficulties are common. Forexample, onset of arthritis and osteoporosiscan occur much sooner in adults

with cerebral palsy.


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Classification of Cerebral Palsy:y 1. Spastic Cerebral Palsy is the most common type and

may involve one or both sides of the body.y Clinical hallmarks include hypertonicity with poor control

of posture, balance, and coordinated movement, andimpairment of fine and gross motor skills. Active attemptsat motion increase the abnormal postures and lead tooverflow of movement to other parts of the body.

y Common types of spastic cerebral palsy include:y

Hemiparesis is when one side of the body is affectedy Quadriparesis (tetraparesis) is when all four extremities are

affected.y Diplegia is when similar body parts are affected, such as

both arms.


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y 2. Dyskinetic/Athethoid Cerebral Palsyinvolves abnormal involuntary movements that

disappear during sleep and increase with stress.y Major manifestations are athetosis (wormlike

movement), dyskinetic movement of mouth, droolingand dysarthria.

yMovements may become choreoid (irregular, jerky)and dystonic (disordered muscle tone), especially

when stressed and during the adolescent years.


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y . Ataxic Cerebral Palsy is manifested by a wide-based gait, rapid repetitive movements performed

poorly, and disintegration of movements of the upperextremities when the child reaches for objects.


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y 4. The Mixed/dystonic Cerebral Palsy ismanifested by a combination of the characteristics of

spastic and athetoidCP

.


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Classification of Cerebral Palsy:


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Etiology:y Cerebral Palsycommon results from existing prenatal

brain abnormalities.

y Prematurity is the single most important determinantofCerebral Palsy.

y Other prenatal or perinatal risk factors include: asphyxia,ischemia, perinatal trauma, congenital and perinatalinfections, and perinatal metabolic problems such ashyperbilirubinemia and hypoglycemia.

y Infection, trauma and tumors can cause Cerebral Palsyinearly infancy.

y Some cases (about 24%) ofCP remain unexplained.


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Pathophysiology:y Disabilities usually result from injuryto the cerebellum, the basal ganglia orthe motor cortex.

y It is difficult to establish the precise

location of neurologic lesions becausethere is no typical pathologic picture.In some cases, the brain has grossmalformations; in others, vascularocclusion, atrophy, loss of neurons

and degeneration may be evident.y Cerebral Palsyis nonprogressive but

may become more apparent as thechild grows older.


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Clinical Manifestations:y The most common clinical manifestation in all types

ofCP is delayed gross motor development (delay in allmotor accomplishments; delay becomes more profound as

the child grows)y Additional manifestations include:

y 1. Abnormal motor performance (e.g. early dominant handpreference, abnormal and asymmetrical crawl, poorsucking, feeding problems or persistent tongue thrust)

y 2. Alterations of muscle tone (e.g. increased or decreaseresistance to passive movements, child feels stiff whenhandling or dressing, difficulty in diapering oropisthotonos)


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Clinical Manifestations:y 3. Abnormal postures (e.g. scissoring legs or persistent

infantile posturing)

y

4. Reflex abnormalities (e.g. persistent primitive reflexes,such as tonic neck of hyperreflexia)

y Disabilities associated with Cerebral Palsyinclude mentalretardation, seizures, attention deficit disorder and sensoryimpairment.

y Severe cases may be observed at birth, mild and moderatecases usually are not detected until the child is 1 to 2 yearsold. Failure to achieve milestones may be the first sign.


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Diagnosis of Cerebral Palsy is

based on the following:y Prenatal, birth and postnatal history

y Neurologic examination

yAssessment of muscle tone, behavior and abilitiesy Other disorders, such as metabolic disorders,

degenerative disorders and early slow-growing braintumors are ruled out.


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Nursing Management:y Prevent physical injury by providing the child with a safe

environment, appropriate toys, and protective gear(helmet, kneepads) if needed.

y Prevent physical deformity by ensuring correct use ofprescribed braces and other devices and by performingROM exercises.

y Promote mobility by encouraging the child to perform age-

and condition-appropriate motor activities.y Promote adequate fluid and nutritional intake.

y Foster relaxation and general health by providing restperiods.

y Administer prescribed medications which may include


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Nursing Management:y Encourage self-care by urging the child to participate in activities of daily living (ADLs) (e.g. using

utensils and implements that are appropriate for the childs age and condition).

y Facilitated communication

y Talk to the child deliberately ad slowly, using pictures to reinforce speech when needed.

y

Encourage early speech therapy to prevent poor or maladaptive communication habits.y Provide means of articulate speech such as sign language or a picture board.

y Technology such as computer use may help children with severe articulation problems.

y As necessary, seek referrals for corrective lenses and hearing devices to decrease sensory deprivationrelated to vision and hearing losses.

y Help promote a positive self-image in the child:

y Praise his accomplishments

y Set realistic and attainable goalsy Encourage and appealing physical appearance

y Encourage his involvement with age and condition- appropriate peer group activities.

y Promote optimal family functioning

y Encourage family members to express anxieties, frustrations and concerns and to exploresupport networks.

y Provide emotional support and help with problem solving as necessary.

y Refer the family to support organizations such as the United Cerebral Palsy Association.


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Nursing Management:y repare the child and family for procedures, treatments, appliances and surgeries if

needed.y Assist in multidisciplinary therapeutic measures designed to establish locomotion,

communication and self-help, gain optimal appearance and integration of motorfunctions; correct associated defects as effectively as possible and provide educational

opportunities based on the individuals needs and capabilities. Therapeutic measuresinclude:y Braces to help prevent or reduce deformities, increase energy of gait, and control

alignment.y Motorized devices to permit self-propulsion.y Orthopedicsurgery to correct deformities and decrease spasticity (medications are not

helpful for spasticity).y Medications to control possible seizure activity or attention deficit disorder.

y Speech therapy and physical therapy.y Inform parents but their child will need considerable help and patience in accomplishing

each new task.y Encourage them not to focus solely on the childs inability to accomplish certain tasks.y Urge them to relax and demonstrate patience.y Explain the importance of providing positive feedback.


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TThank You!

Cerebral Palsy-GWC and DCF 2010

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