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Cerebral Palsy

 

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Types of cerebral palsy

Type Spastic (most common type) Dyskinetic Ataxic Mixed
Cause – mechanisms of neurological dysfunction 1. Pyramidal disturbance (upper motor neurons or UMN)
2. No corticospinal inhibition, so the spinal cord is more influential.		 Extrapyramidal disturbance (lower motor neurons or LMN) Dysfunction in the cerebellum Pyramidal and extrapyramidal mechanisms
Presentation A. Positive Babinski sign.

B. Affected areas of the body.
1. Spastic diplegia – legs affected more than arms
2. Spastic quadriplegia – all limbs, trunk, muscles to mouth, tongue and pharynx are involved
3. Spastic hemiplegia – one side of the body is more involved than the other, arm is more involved than the leg

 One or more of the following symptoms may be observed:

1. Chorea – jerky movement that is random and rapid

2. Athetosis – writhing movements

3. Choreoathetosis – both chorea and athetosis are present

4. Dystonia – postures are distorted, repetitive, twisted movements

 The following symptoms may be observed:

1. Jerky and uncoordinated movements

2. Imbalanced position of trunk and limbs during voluntary movement

3. Difficulty timing movements

4. May or may not have decreased muscle tone

 Multiple patterns of movement

 

Associated Impairments

Impairment Description
Intellectual Disability – affects 30 to 50% of children with cerebral palsy. 1. Impairments in cognitive function, including attention span, memory, comprehension, decision making, problem solving, processing speed, and language.
2. People with more severe cerebral palsy are more likely to have intellectual impairments.
Visual Impairments 1. Ocular – strabismus
2. Central – cortical visual impairment
3. Retinopathy of prematurity
4. Nystagmus – involuntary oscillating eye movements (may be present with ataxia)
5. Homonymous hemianopsia – visual field cut (may be present with hemiplegia)
6.Hyperopia – far sightedness
Hearing, speech and language – affects about 30% of children with cerebral palsy 1. Articulation difficulties
2. Expressive or receptive language problems
3. Reading difficulties
Seizures – affect about 40% of children with cerebral palsy More likely in children with severe intellectual and physical disability
Feeding and growth problems 1. Hypotonia – low muscle tone
2. Weak suck
3. Poor coordination of swallow
4. Tonic bite reflex
5. Hyperactive gag reflex
6. Tongue thrust
7. Gastroesophageal reflux
8. Constipation
Osteopenia 1. Reduced bone density – weak bones
2. Increased risk of fractures

 

Interventions


Intervention Purpose Example Photo/Video
Neurodevelopmental Therapy (NDT) 1. NDT helps the child develop more typical movement patterns.
2. The goal of NDT is to normalize tone and improve movement control during activity.
3. Treatment includes positioning, therapeutic handling, and play.		 An occupational therapist has a child with cerebral palsy reach for toys while on all fours. The occupational therapist provides support and manipulation techniques to position the child for normal movement patterns. Children receive NDT in a clinical setting.
Constraint-induced therapy, also known as forced-use therapy 1. The uninvolved side is constrained to force the use of the involved side.
2. Used with children who have hemiplegic CP.		 An occupational therapist places a padded mitt on a child’s unaffected hand while the child throws a ball with the affected hand. A boy with cerebral palsy has a cast placed2 on his unaffected arm, forcing him to complete activities with his affected arm.
Physical exercise (such as dancing, swimming, playing more physical games) 1. Strengthens muscles and bones
2. Improves motor skills
3. Helps to prevent the development of contractures		 A child with cerebral palsy is included in the regular education phy ed class with support from adults. A child with cerebral palsy has a swimming lesson.
Orthotic devices 1. Ankle-foot orthosis (AFO) stabilizes the foot and allows for stretching of the Achilles tendon.
2. Resting hand splint holds the thumb in abduction and the wrist in neutral or slightly extended to prevent deformity.		 An occupational therapist teaches a child with cerebral palsy how to put on and take off his AFO. A two year old child walks with a posterior walker and new AFOs.
Positioning and seating devices 1. Seating systems designed for the child to prevent contractures and joint deformities as a result of spasticity.
2. Adaptations to regular seating to position the child for functional activities.		 An ambulatory child with cerebral palsy sits at her desk in a static chair with lateral supports and a pommel to promote hip abduction. An adult with cerebral palsy demonstrates his new power wheelchair seating system.
Serial casting 1. Used to reduce or inhibit tone
2. Used for both upper and lower extremitiesb
3. Position spastic muscles so they are lengthened and stretched gently
4. Slowly increases range of motion if a contracture already present
5. Static casts can be used to immobilize for stability during weight-bearing activity 		A child with cerebral palsy undergoes serial casting to lengthen his Achilles tendons in preparation for AFOs. A one year old with cerebral palsy receives serial casting to his right foot.
Adaptive equipment 1. Forearm crutches (Lofstrand)
2. Walkers, posterior walkers
3. Wheelchairs
4. Wheelchair adaptations
-solid seat and back
-trunk supports
-tray
-tilt seat with 10-15 degrees of tilt
-seat cushions
-molded inserts
-power controls
5. Supportive strollers
6. Car seat/car bed		 A young child with cerebral palsy rides the bus to school in an adapted car seat. A child with cerebral palsy learns how to use forearm crutches.
Assistive technology 1. Computers
2. Augmentative communication devices
3. Artificial vision – visual prosthesis
4. iPad with adaptive apps
5. Wii games		 A child with cerebral palsy uses a joystick to move his computer mouse while completing testing required by his teacher. Adults with cerebral palsy demonstrate communication using iPads and augmentative communication devices.

 

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