Cerebral Palsy

1
Cerebral Palsy

• Lewis, pp. 1716-1724

2
Etiology/Pathophysiology

• Non-progressive neuromuscular disorder
• Caused by perinatal trauma/hemorrhage or anoxia
  to areas of brain or prenatal brain abnormalities
  
• Characterized by early onset and impaired
  movement and posture. May be accompanied by
  developmental delays, and intellectual impairment
  (about 50 have some degree)
• Variety of manifestations in brain, but are not
  common to all casesatrophy, lesions, vascular
  occlusions, infarctions, hemorrhages

3
Risk Factors

• LBW preterm birth
• Periventricular leukomalacia (studies have shown
  low levels of white matter in brainMRI can show
  lesion)
• In utero exposure to maternal infection
• Severe newborn hypoglycemia
• Postnatal infections and trauma

4
Types (1717, Box 55-1)

• Spastic (most common)hypertonia poor posture,
  balance, coordination impaired fine and gross
  motor skills
• Dyskineticinvoluntary, writhing and jerking
  movements drooling poor articulation
• Ataxicwide-based gait rapid, repetitive, poorly
  performed movements
• Mixed/dystoniccombination of spastic and
  dyskinetic

5
Early Motor Signs of CP

• Poor head control after age 3 mos
• Stiff or rigid limbs
• Arching back/pushing away
• Floppy tone
• Unable to sit without support at age 8 mos
• Clenched fists after age 3 mos
• Persistent tonic neck and Moro reflexes
• Hand preference in first 2 years

6
Early Behavioral Signs of CP

• Excessive irritability
• No smiling by age 3 mos
• Feeding difficulties
• Persistent tongue thrusting
• Frequent gagging or choking with feeds

7
Interventions for CP

• Goal is early recognition and promotion of
  optimum development through
• Meeting needs for locomotion, communication,
  self-help skills
• Correct defects ASAP to gain optimal appearance
  and function
• Provide optimal educational and socialization
  experiences

8
Interventions

• Most children need wide variety of support
  servicesPT, OT, speech, medical, dental
• Considerable help may be needed in ADLs and
  training for self-help.
• Ortho needs include orthotics, motor devices,
  adaptive devices, surgery to correct tendon
  deformities or control spasticity and
  contractures

9
Medications

• Muscle relaxers to decrease spasticity include po
  forms of Dantrium, Baclofen, and Valium, and
  Botox injections.
• A Baclofen pump infused intrathecally has been
  approved.
• Antiseizure meds for those who need them
  (Tegretol, Depakote)
• Ritalin for those who have ADHD
• Pain meds

10
Technology

• Technical devices to improve functioning and
  promote independence
• Voice activated computer technology
• Toys controlled with head device when head and
  trunk are in alignment
• Computerized toys and games to improve hand-eye
  coordination

11
Educational and Social Needs

• Mainstreaming is encouraged. Many children have
  normal intelligence but are unable to demonstrate
  it on standardized tests.
• Vocational training for those who are unable to
  do formal education
• Encourage recreational activities and appropriate
  sports activities such as Special Olympics
• Refer family to United Cerebral Palsy
  organization (www.ucp.org)

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Nursing Responsibilities

• Encourage early intervention and
  multidisciplinary approach
• Encourage frequent rest periods
• Promote optimal nutrition (oral vs. gastrostomy,
  manual jaw control)
• Good oral hygiene
• Safety precautions if fall risk
• Immunizations
• Encourage normalization
• Support family
• Realize hospitalization may be a form of respite
  care