Download Cerebral Palsyg

16-10-2014
CEREBRAL PALSY
Prof. V.P.Sharma
M.S.,(Ortho), DNB(PMR), .FACS, FICS, FIMSA, MAMS, PG (Spine-Aus.)
Professor
Deptt. of Physical Medicine & Rehabilitation
K.G. Medical University, Lucknow
CEREBRAL PALSY
• C.P. refers to a disorder of motor function
resulting from a non progressive brain lesion
occurring before the brain is fully mature.
C.P. refers exclusive to the motor dysfunction
May also have – Cognitive dysfunction
seizures
or
•
Lesion is static, symptoms often change with time.
•
Eg. Hypotonia to hypertonia
•
increasing dystonia with age
•
Bony deformities
•
Contractures
Classification
1.
Limbs involved
-
Monoplegia
Diplegia
Triplegia
Quadriplegia
Hemiplegia
2
Tone
-
Hypotomia
Spasticity
3
Associated Movement Disorders Dystonia
Chorea
Athetosis
Ataxia
Assessment of spasticity
•
•
•
•
Evaluation of muscle tone
R.O.M.
Associated movements disorders
Psycho Social Assessment
Physical and occupational therapy
1. Spastic
–
–
–
–
Passive ROM
Active ROM
Spinal mobility
Use of varied and differential movement pattern
incorporating varied speed and directions
– Equipment to aid with weight bearing movement
and position transitions.
– Promotive muscle Elongation as well as joint
mobility & stability
Athetoid
• Postural tone and balance
• Promoting midline & Symmetrical muscle control
• Small graded movements
Hypotonic
•
•
•
•
Antigravity positioning of head
Trunk control
Promoting automatic reactions
Stabilization of joins
Treatment According to age
Infancy and toddler
• Optimal movement patterns and postures during daily
care activities such as feeding, playing , carrying,
toileting and movement.
• Adaptive equipments
• Special strollers
• Bath chairs
• Feeding equipments
• Fist, hand or limbs splints
Pre-school•
Promote skill acquisition for independent function.
•
Therapy
promotes
movement patterns.
strength,
endurance
and
Mobility issues wheel
chairs crutches,
walkers, strollers, car
seats school chairs,
splints and orthotics
Schooling
•
•
•
•
Architecture
adaptations
Home modifications
Installing wheel chair
lifts
Classroom
accommodations
Ambulation
Sports
Formal Evaluation tools
• Modified ashworth scale (MAS)
• Measure resistance to passive movements in
upper/lower limbs
• Goniometer measurements PROM / AROM
• Gross motor functional measure
• Assess current level of function and provides goal for
treatment.
• Paediatric evaluations of disability inventory.
• Functional skills in the areas of mobility
• Self care
• Social functions
• Strength measurements by dynamometers
Facilitation of movement patterns
• Neuro developmental training NDT/ Bobath
• Inhitit abnormal muscle tone and primitive reflaxes
• Facilitate normal movement patterns via postioning and
handling techniques that promote sensation of normal
movement
• Emphasis is on acquiring functional skills
•
Weight bearing
•
Weight shifting
•
Normalizing tone
Electrical stimulation
•
•
•
•
•
•
•
•
•
•
•
FES
Other Therapies
Strengthening / Stretching
Serial casting
Functional Activities
Dynamic approach repetition of activities by the
patient
Adaptive equipments
Sealing system
Walker
Canes
Splinting low temperature thermoplastics
Oral Pharmacotherapy
•
•
•
•
•
•
•
•
•
AIM
Spasticity
Associated movement eg. Dystomia
CNS acting
Benzodia zepines
Diazepam
Clonazepam
Lorazepam
Tizanidine
Baclofen
PeripheralDantrolene
Benzodiazepines
• Acts via inhibitory neuro transmitter GABA in spinal
cord
• Effect
relief in painful muscular spasm
Improvement in sleep
Long term muscle tone
Anticonvulsiant property
• Side effect
Habituation
Sedation
Secrctions
Rebound seizures with abrupt
withdranwal
Baclofen
Action on GABA receptor in spinal cord
• Effect
Toletrated long term
• Muscle tone / Active Passive
• Side effect
Sedation
Truncal hypotomia
Change in bladder habits
Clonidine quanfacine Tizanidine
• Effect
-
Aplha 2 adrenergic effects
-
Anti hypertensive
-
Treat movement disorder & eg tics
Dantrolene
• works directly on the sarcoplasmic reticulum of
muscle and is effective in decreasing muscle tone
• Side effect
-
Muscle weakness
-
GI upset, fatigue
-
Hepato Toxicity
Intrathecal Baclofen
• In patients with
spasticity of cerebral
origin
• Continuous infusion of
baclofen in intrathecal
space
Surgery
• Maintain mobility & Stability of joints
– Surgery at hip when subluxation or abduction less
them 300
Bracing
• Improves function
– prevent
worsening
of
contractures
– Prevents recurrence of
deformities after surgical
correction
Future Direction
• Treatment for CP with focus on prevention of CP as
well as effective and permanent at the level of brain.
Treatment
occurs
multidisciplinary
treatment.
most
approach
effectively
to
with
assessment
a
and
1. The commonest etiologies for cerebral palsy include all
of the following except,
I.
Prematurity
II.
Cerebral hypoxemia
III. Vitamin C deficiency
IV. Hyperbilirubinemia
2. Which of the following is not a Pre-natal cause of C.P.,
I.
Prolonged and difficult labor
II. Premature rupture of membranes
III. CNS infection (encephalitis, meningitis)
IV. Multiple pregnancies
3. Which of the following scale is used for assessment of
spasticity-
I.
GCS
II. MAS
III. AS
IV. AIS
4. Which of the following is not a centrally acting anti
spastic medication,
I.
Diazepam
II. Tizanidine
III. Dantrolene
IV. Baclofen
5. Among the following which is not used for spasticity
management in C.P.,
I.
Stretching Exercises.
II.
Bracing.
III. Baclofen
IV. Anti spasmodic drugs.