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Presented to: Mrs. Vinay Kumari
Associate Professor (MMCON)
Presented By: Amandeep Kaur
Msc. (N) 2nd year
CEREBRAL PALSY (CP)
In 1860s, known as
"Cerebral Paralysis” or
After an English surgeon
wrote the 1st medical
William John Little
CEREBRAL PALSY (CP)
Cerebral“- Latin Cerebrum;
Affected part of brain
“Palsy " -Gr. para- beyond,
lysis – loosening
Lack of muscle control
CEREBRAL PALSY (CP)
A motor function disorder
caused by permanent, non-progressive brain
present at birth or shortly thereafter.
Non-curable, life-long condition
Damage doesn’t worsen
May be congenital or acquired
CEREBRAL PALSY (CP)
A Heterogenous Group of
– An umbrella term
– Not a single diagnosis
Muscles are unaffected.
Brain is unable to send
the appropriate signals
necessary to instruct
muscles when to
contract and relax.
An insult or injury to the brain
– Fixed, static lesion(s)
– In single or multiple areas
of the motor centers of the
– Early in CNS deviation.
The brain fails to develop correctly.
Can occur before, during or after delivery
Rh incompatibility, illness, severe lack of oxygen
* Unknown in many instances
Severe deprivation of oxygen or blood flow to the
– Hypoxic-ischemic encephalopathy or intrapartal
• Perinatal factors
– at the time of birth to 1month
• Postnatal factors
– In the first 5 mos of life
Difficulty in conceiving or holding a
baby to term
History of fetal deaths/miscarriages
Cigarette smoking >30 sticks per day
Alcoholism and drug addiction
Social status; mother with MR
Mother’s medical condition
High or low BP
Umbilical cord coil
Over sedation of drugs
Trauma i.e. forceps or vacuum
Complications of birth
Trauma, head injury
Lack of oxygen
Stroke in the young
Increased muscle tone, tense and
Have stiff and jerky or awkward
limbs are usually underdeveloped
increased deep tendon reflexes
Most common form 70-80% of all
Types of Spastic CP
According to affected limbs:
* plegia or paresis - meaning paralyzed or weak:
Monoplegia –one limb (extremely rare)
Triplegia –three limbs (extremely rare)
• Both legs with slight
• both legs
May also have
Contractures of hips and
Limbs on only one side
Hemiplegia on right side
Hip and knee contractures
Talipes equinus (“tip-toeing”
- Sole permanently flexed)
Asteriognosis may be present.
(Inability to identify objects by touch)
Characteristic “scissors” positions of lower limbs due to
Dyskinetic movement of
Grimacing, drooling and
Movements may become choreoid
(rapid, irregular, jerky)
(disordered muscle tone, sustained
especially when stressed and during the
Poor balance and lack of
Depth perception usually affected.
Tendency to fall and stumble
Inability to walk straight line.
Least common 5-10% of cases
A common combination is
spastic and athetoid
Spastic muscle tone and involuntary movements.
25% of CP cases, fairly common
DEGREE OF SEVERITY
1. Mild CP- 20% of cases
-Not require self help for assisting their impaired
2. Moderate CP- 50%
- Require self help for assisting their impaired
3. Severe CP- 30%;
-Totally incapacited and bedridden and they always
need care from others.
Inability to perform motor skills as indicated:
Control hand grasp by 3 months
Rolling over by 5 months
Independent sitting by 7 months
Abnormal Developmental Patterns:
Hand preference by 12 months
Excessive arching of back
Abnormal or prolonged parachute response
“W sitting” – knees flexed,
legs extremely rotated
“Bottom shuffling” Scoots along the floor
Walking on tip toe or hopping
Abnormal Developmental Patterns
after 1 year of age:
Mentation and thought processes are not always
Trapped in their bodies with their disabilities
Ability to express their intelligence may be
limited by difficulties in communicating.
Hearing and visual problems
Bladder and bowel control
problems, digestive problems
Skeletal deformities, dental
Mental retardation and
learning disabilities in some
A USEFUL diagnosis is when the specific type,
affected limb, severity and cause, if known, are
Physical evaluation, Interview
MRI, CT Scan EEG
Laboratory and radiologic work up
i.e. Peabody Development Motor Skills, Denver Test
The Peabody Development
6 Subtests include:
The subtests yield a
gross motor quotient
A fine motor quotient
A total motor
Ages covered: from
birth through five years
Denver Test II
Developmental Screening Test
Cover 4 general functions:
Personal social (eg. Smiling),
Fine motor adaptive (eg. Grasping & drawing)
Language (eg. Combining words)
Gross motor (eg. Walking)
Ages covered: from birth to 6 years
a. History Taking
Include all that may predispose an
infant to brain damage or CP
b. Child’s Health History
Often admitted to hospitals for corrective surgeries and
Presence of fever
Feeding and weight loss
Any changes in physical state
P osturing / Poor muscle control and strength
O ropharyngeal problems
S trabismus/ Squint
T one (hyper-, hypotonia)
E volutional maldevelopment
R eflexes (e.g. increaseddeep tendon)
*Abnormalities 4/6 strongly point to CP
Posturing / Poor muscle
control and strength
Test hand strength by lifting the child off the ground while the
child holds the nurses hands.
Observe for presence of limb deformity, as decreased use of
extremity leads to shortening.
Upon extension of extremities on vertical suspension of the
If infant back bend backwards like
and arch may indicate CP is severe
Hypertonia - rigid, tense
Hypotonia – floppy or
Evolutional mal development
Delays in motor skills
such as rolling over, sitting, crawling, and
Size for age.
Persistence of primitive reflexes or parachute
reflex fail to develop
Present at birth, normally disappears after 3 or
4 months (some say 6months)
Startle response; Startle reflex; Embrace reflex
Asymmetric tonic neck reflex
-- head to one side, arm & leg on that side extended,
opposite limbs flexed.
persistent asymmetric tonic reflex.
When the dorsal (back) side of the hand or foot is placed on the
edge of a surface, such as a table, the infant will lift the
extremity and place it on the flat surface.
When the infant is held in a horizontal prone position, the infant will lift head
and extend the neck and trunk. When the neck is passively flexed, the entire
body will flex. This reflex is present by 6 months and hypotonicity (low
tone) indicates motor system deficits.
When held around the waist in a horizontal prone position and then lowering
the infant slowly, head first to the surface. By age 6 to 8 months the infant
should respond by extending the arms and hands to break the “fall”. If this
response is asymmetrical it indicates an unilateral motor abnormality.
Eg. Increased/ exaggerated deep tendon
A. General management
- Proper nutrition and personal care
Botox, Intrathecal, Baclofen
- control muscle spasms and seizures,
-Delivered directly to the spinal fluid
-Using a pump to avoid brain effects
Glycopyrrolate -control drooling
Pamidronate -may help with osteoporosis.
-To loosen joints,
-Relieve muscle tightness,
- Straightening of different twists or
unusual curvatures of leg muscles
- Improve the ability to sit, stand, and walk.
Selective posterior rhizotomy
Is used to improve
stiffness) in cerebral
palsy. In some cases
nerves need to be severed
to decrease muscle
tension of inappropriate
A major operation, takes approximately four hours to
The sensory nerve fibers in the spinal cord, usually
between the bottom of the rib cage and the top of the
hips are divided
The nerve fibers are then stimulated and the responses
of the leg muscles are observed.
Those that have an abnormal or excessive response
Those with a normal response are left intact.
Intensive rehabilitation is required after the surgery,
usually up to six weeks, followed by physical therapy
on an ongoing basis.
D. Physical Aids
Orthosis, braces and splints
- Keep limbs in correct alignment
- Prevent deformities.
-Enable better posture
Walkers, special scooters, wheelchairs
- make it easier to move about.
E. Special Education
- To meet the child's special needs
- Improve learning.
- Vocational training can help prepare young
adults for jobs
F. Rehabilitation Services-
Speech and occupational therapies may improve
the ability to speak, and perform activities of
daily living and to do some suitable works to
have their own income.
G. Family Services
- Professional support helps a patient and
family cope with cerebral palsy.
- Counselors help parents learn how to
- Caring for a child with cerebral palsy can
be very stressful.
- Some families find support groups helpful.
H. Other Treatment
- Therapeutic electrical stimulation,
- Hyperbaric therapy
- Massage Therapy might help
II. Physical Therapy
'The ultimate long-term goal is realistic independence.
To get there we have to have some short-term goals.
Those being a working communication system,
education to his potential, computer skills and, above
- Vertical head control and
control of head and trunk.
B. Standing and walking
- Establish an equal distribution of
weight on each foot, train to use steps or inclines
C. Prone Development
D. Supine Development
-Head control on supine and positions
The impact of Kinesio taping technique on
children with cerebral palsy.
Cerebral palsy (CP) is the most common movement disorder in
children that is associated with life-long disability and multiple
impairments. The clinical manifestations of CP vary among
children. CP is accompanied by a wide range of problems and
has a broad spectrum. Children with CP demonstrate poor fine
and dross motor function due to psychomotor disturbances.
Early rehabilitation programs are essential for children with CP
and should be appropriate for the age and functional condition
of the patients.
Kinesio taping (KT) technique is a relatively new
technique applied in rehabilitation programs of CP.
The author reviews the effects of KT techniques on
improving motor skills in children with CP. In this study,
we used keywords "cerebral palsy, Kinesio Tape, KT and
Taping" in the national and international electronic
databases between 1999 and 2016. Out of the 43 articles
obtained, 21 studies met the inclusion criteria.
Findings:- There are several different applications about KT
technique in children with CP. Review of the literature
demonstrated that the impact of this technique on gross and fine
motor function and dynamic activities is more effective than
postural and static activities. Also this technique has more
effectiveness in the child at higher developmental and motor
The majority of consistent findings showed that KT technique as
part of a multimodal therapy program can be effective in the
rehabilitation of children with CP to improve motor function and
dynamic activities especially in higher developmental and motor
a. Risk for injury r/t spasms, uncontrolled movements and seizures.
b. Impaired Physical mobility r/t spasms and muscle weakness.
c. Changes in growth and development r/t neuromuscular disorders.
d. Impaired verbal communication r/t difficulty in articulation.
e. Risk for aspiration r/t neuromuscular disorders.
f. Changes in thought processes r/t cerebral injury, learning disabilities.
g. Self-care Deficit r/t muscle spasms, increased activity, cognitive
h. Deficient Knowledge r/t home care and therapeutic needs.
a. Children will always be safe and free from injury.
b. Children will have a maximum movement ability and not
c. Children will explore how to learn and participate with other
children in doing some activities.
d. Children will express their needs and develop a body weight
within normal limits.
e. Children do not have aspirations.
f. The child will demonstrate an appropriate level of learning
g. Parents / family demonstrate understanding of the needs of
child care that is characterized by taking an active role in
a. The increasing need for security and prevent injury
1. Avoid children from harmful objects, for example can be
2. Watch the children during activity.
3. Give the kids a break when tired.
4. Use safety equipment when necessary.
5. The provision of anti-seizure in the event of a seizure, When a
seizure; install a safety device in the mouth so that the tongue
is not bitten.
6. Do suction, if necessary.
b. Improve the physical mobility
1. Examine the movement of the joints and muscle tone.
2. Do physical therapy and repositioning every 2 hours.
3. Evaluation of the needs of special equipment for eating,
writing and reading and activities.
4. Teach the use of a walker, how to sit, crawl in young
children, walking, and others.
5. Teach how to reach for objects, how to move the limbs,
6. Provide a rest period.
c. Improve communication
1. Examine the response to communication.
2. Use the cards / pictures / whiteboards to facilitate
3. Involve the family in training a child to communicate.
4. Refer to a speech therapist.
5. Teach and assess non-verbal meaning.
6. Trained in the use of the lips, mouth and tongue.
d. Improve the nutritional status needs
1. Examine the diet of children.
2. Weigh weight every day.
3. Provide adequate nutrition and food preferences, lots of
protein, minerals and vitamins.
4. Give extra foods that contain lots of calories.
5. Help your child meet their daily needs with the ability
e. Prevent the occurrence of aspiration
1. Do immediately when there is suction secretions.
2. Provide an upright position or semi-sitting while eating
3. Examine the pattern of breathing
f. Increase the need for intellectual
1. Review the child's level of understanding.
2. Teach in understanding conversations with verbal or non
3. Teach writing using whiteboards or other devices that
can be used according to the ability of parents and
4. Teaching reading and writing according to his needs
g. Meet the daily needs
1. Examine the level of children's ability to meet daily
2. Assist in meeting the needs; eating and drinking,
elimination, personal hygiene, dress, play activities.
3. Involve families and for children who are cooperative in
meeting their daily needs.
h. Enhance the knowledge and the role of parents in
meeting child care needs
1. Examine the level of parental knowledge.
2. Teach parents to express their feelings about the child's condition.
3. Teach parents in meeting child care needs.
4. Teach about the conditions experienced by children and are related
to physical therapy and exercise needs.
5. Emphasize that parents and families have an important role in
helping meet the needs.
6. Explain the importance of play and socialization needs of others.
i. Prevent to impaired skin integrity
1. Examine the area that is attached ancillary equipment.
2. Use a skin lotion to prevent dry skin.
3. Do the massage in a depressed area.
4. Provide a comfortable position and provide support with
5. Ensure that ancillary equipment or dressing
appropriately and fixed.
1. “CEREBRAL PALSY” on SlideShare [Internet]. [cited 2017 May 2].
2. Moro reflex - Google Search [Internet]. [cited 2017 May 2]. Available from: