What is cerebral palsy?
- chronic neurological disorder of movement and posture caused by a defect or lesion on immature brain
- varies in severity
What does cerebral mean?
- it means brain
What does palsy means?
- disorder of posture or movement
- lack of movement
What kind of deficit is cerebral palsy?
- primarily a motor deficit
What is mild severity?
- general clumsiness may have a slight limp
What is severe cerebral palsy?
- ambulatory difficulty, inability to speak with spoken words, almost no control of motor function
What are some causes of cerebral palsy?
- prenatal: 30% prenatal
- perinatal: 60% (20 week of gestation to 28 days after birth)
- postnatal: 10%
What are some prenatal causes of cerebral palsy?
- fetal anoxia
- poor nutrition
- chemical toxins
- maternal health problems
What are some perinatal causes of cerebral palsy?
- premature birth
- difficult delivery
- prolonged labour
What are some postnatal causes of cerebral palsy?
- head injury (brain hemorrhages, infections, tumours)
- physical abuse
What do symptoms depend on?
- depends on which area of the brain has been damaged
What are some symptoms of cerebral palsy?
- muscle tightness or spasm
- involuntary movement
- difficulty with gross motor skills such as walking or running, or fine motor skills such as writing and speaking
What are some difficulties associated with cerebral palsy?
- difficulties in feeding, poor bladder and bowel control, breathing problems, and pressure sores
What are some left side brain damage symptoms?
- weak or paralyzed left side
- spatial/perceptual deficits
- behavioural style: quick and impulsive
- memory deficits in performance
What are some right side brain damage symptoms?
- weak or paralyzed right side
- speech/language deficits
- behavioural style: slow, cautious
- memory deficits in language
What are the two main types or classifications of cerebral palsy?
- limb involvement
- muscle tone/movement
What are the types of limb related disabilities in regards to cerebral palsy??
- monoplegia
- diplegia
- hemiplegia
- triplegia
- quadriplegia
What are the types muscle tone/movement disabilities in regards to cerebral palsy??
- spasticity
- athetosis
- ataxia
What is monoplegia?
- only one limb is affected, usually an arm
What is diplegia?
- all four limbs are involved
- both legs are more severely affected than the arms
What is hemiplegia?
- one side of the body is affected
- the arm is usually more involved than the leg (arm is worse)
What is triplegia?
- the limbs are affected, usually both arms and a leg
What is quadriplegia?
- all four limbs are involved
What is spastic cerebral palsy?
- most common (50-60%)
- excessive muscle tone, abnormal tightness and stiffness characterized by hypertonic involuntary muscle contractions
- difficulty relaxing muscles when attempting purposeful movement
What is hyperactive stretch reflex in regards to spastic cerebral palsy?
- spasticity affects flexor muscle groups (think pull motion)
How are the upper limbs effected by hyperactive stretch reflex in regards to spastic cerebral palsy?
- upper limb involvement leads to pronated forearms with flexion at elbows, writs and fingers
How are the lower limbs effected by hyperactive stretch reflex in regards to spastic cerebral palsy?
- spastic lower limbs may be rotated inward, flexed at hip joint, knees flexed and adducted, heels are lifted off of ground
What are contractors/deformities in relation to spastic cerebral palsy?
- typically muscles on one side relax when others contract, but if contractors are present this does not happen
- associated with a hyperactive stretch reflex
What is athetosis cerebral palsy?
- affects 30% of people with CP
- overflow of motor impulses so muscles are characterized by constant, slow, unpredictable and purposeless movement caused by fluctuating muscle tone (hypotonic and/or hypertonic)
What are some effects and aspects of athetosis cerebral palsy?
- fluctuating muscle tone
- problems with visual pursuit and focus (can affect ability to perform hand-eye coordination)
- involuntary & purposeless movement
- fine muscle coordination is difficult
- commonly affects upper extremities and head
- many will use wheelchairs for mobility
- gait is described as unsteady
What is ataxia cerebral palsy?
- affects 10% of people with CP
- damage to cerebellum
- poor balance and trunk control
- uncoordinated movement
- involuntary movement of trunk and extremities
- hypotonic
- walk with wide gate
What is considered mild cerebral palsy?
- can walk, speech somewhat affected
What is considered moderate cerebral palsy?
- difficulty with speech and locomotion
What is considered severe cerebral palsy?
- use of wheelchair, difficult to understand
What are some medical and health concerns linked to cerebral palsy?
- oral dental
- speech (35-75%)
- visual (55-60%)
- sensory deficits
- convulsive disorders (25-50%)
- ID (30-70%)
- hip dislocation, scoliosis, foot deformities
- major reflex problems (80-90%)…
What are pathological reflexes?
- slower and consists of extension of the great toe with fanning of the other toes and often knee and hip flexion
- reflexes interfere with smooth, coordinated movement
What is asymmetrical tonic neck reflex?
- when head is turned to one side, arm on
that side extends while opposite arm flexes - startle reflex
In what ways can people with cerebral palsy have trouble eating?
- Severe gag reflex
- problems with feeding and oral hygiene
- slow eating, spillage, poor (or no) coordination of oral muscles and swallowing mechanisms
- inadequate nutrition
- dehydration
- metabolism of medication
What are some physical activity considerations to keep in mind when working with someone with cerebral palsy?
- relaxed atmosphere
- warm water swimming beneficial
- perform slow, prolonged stretches
- work through full ROM
- encourage independent movement
- make use of functional ability
- stretch daily
- avoid abnormal, involuntary, non-functional muscle patterns
Motor performance of someone with cerebral palsy is compared to a person of what age?
- a child - age 7
What are things to consider when attempting to properly seat someone in their wheel chair?
- must have proper alignment
- hips at 90 and in contact with back of chair
- thighs slightly abducted and in contact with seat
- knees, elbows, ankles at 90 degree flexion
- limit pressure on back of knees
- feet should be flat
- head and neck in midline
