Cerebral Palsy by Dr.jaya Shanker

8/9/2019 Cerebral Palsy by Dr.jaya Shanker

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Cerebral Pal


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Dr. Jaya Shanker Tedla M.P.TC/NDT (Pediatrics NDTA, USA and Adult

"$S, %&'a Theray, D.Ac, M!AP, MND

Assistant Pr&ess&r

Pr&'ra- & Physical Thera

Deart-ent & Medical ehabilitati

C&lle'e & Alied Medical Sc

in' halid Uni0ersity, Ab


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Cerebral alsy(CP# is th'i0en t& 'r&u & dis&rd

abn&r-ality in -&0e-e

&sture caused by ar&'ressi0e in2ury t&

i--ature brain.

D+)!N!T!3N


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!ncidence

45 er 6777

ne1b&rns in

the kin'd&-


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CP +T!3$3*%

"rain in2ury can &ccur in the &ll&1in' e

a.Maternal reas&ns

b.Prenatal

c.Perinatald.P&stnatal


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CP8 +T!3$3*% P+NATA$ P+!3D

T1in 'estati&n

)etal 'r&1th retardati&n

!ncreased urine r&tein e?creti&n Thirdtri-ester bleedin'

$&1 lacental 1ei'ht

Pre-ature lacental searati&n

T3C> inecti&ns

!ntrauterine str&ke

*enetic -al&r-ati&ns


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CP8 +T!3$3*% P+!NATA$ P+!3D

Abn&r-al etal resentati&n

)etal -al&r-ati&ns like c&n'enital heart diseas

!ntra 0entricular hae-&rrha'e

@ery $" inants

Peri0entricular hae-&rrha'ic inarcti&n

Peri0entricular leuk&-alacia

Ne&natal sei=ures

Se0ere an&?ic/ische-ic brain in2ury

!ntraartu- ashy?ia


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CP +T!3$3*%8 P3STNATA$ P+!3D

CNS inecti&ns

>yerbilirubine-ia.

@ascular causes

>ead in2ury

An&?ia

!sche-ia

!nla--ati&n

Sie=ures


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!NT.3DU T!3N

De0el&-ent & the brain

starts in early re'nancy and

c&ntinues until ab&ut a'e

three.

Da-a'e t& the brain durin' this

ti-e -ay result in CP.

Da-a'e t& the brain !ntereres

1ith -essa'es r&- brain t&

b&dy, and b&dy t& brain.


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!NT.3DU T!3N

Mildest CP Sli'ht a1k1ardness & -&0e-

hand c&ntr&l.

M&st se0ere CP -uscle c&ntr&l is al-&stc&-letely l&st s& -&0e-ent and seech

r&&undly aected.


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!NT.3DU T!3N

Deendin' &n 1hich areas & the brain ha0e be

da-a'ed, &ne &r -&re & the &ll&1in' -ay &cc

Muscle ti'htness &r sas- !n0&luntary -&0e-ent and Sei=ures

Diiculty 1ith 'r&ss -&t&r skills such as 1alkin

&r runnin'

Diiculty 1ith ,ine -&t&r skills such as 1ritin' a

seakin' Abn&r-al erceti&n and sensati&n

Diiculties in eedin', &&r bladder and b&1el c

breathin' r&ble-s, and ressure s&res.

$earnin' disabilities

>earin' and @isual i-air-ents


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*&ld standard dia'n&sis &r C

U-bilical c&rd bl&&d analysi ! it sh&1s -etab&lic acid&s

> less than B, hy&?ia, hy

canea and 1ith base e?ces

than 65 --&l


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Tyes & CPSastic

>y&t&nic

Dyst&nic &r Ath

Dyskinetic &r A

Mi?ed


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T&&'rahical classiicati&n

uadril

Dile'

>e-ile

M&n&le

Trile'


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>y(&t&nic P


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>y(&t&nic P

>y&t&nia is di-inished

-uscle t&ne.

>y&t&nia can ran'e r&-

0ery -ild abn&r-alities t&

se0ere &r e0en atal

neur&de'enerati0e &r -uscle

dis&rders.

>y&t&nic CP children are

l&y and l&&k al-&st like a

ra' d&ll.


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N&r-al !n,ant >y(&t&nic !n


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Diiculty in -aintainin'

the &sture.

Preer t& sit leanin'a'ainst s&-ethin' &r lie

&n the l&&r

Sit in a sl&uchin'

&siti&n.

May e?erience

diiculty breathin'.


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Sasticuadrile'ia


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S(astic Cuadri(le'ic P

Diiculty in ushin' a'ainst a surace 1it

uer li-bs.

Diiculty !n r&llin' t& either sides.

Diiculty in usin' the uer e?tre-ities &

that reuires reach , 'ras and release.

P&stural -uscles & trunk are 1eak and &inacti0e.

Th&racic kyh&sis &r sc&li&sis -ay rese

!t causes 1ei'ht &n the diahra'- c&-r

the resirati&n.


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S(astic Cuadri(le'ic P

Ti'htness resent in the

-uscles because & lack &

len'th in the -uscles

li-ited 0ariety & &stures

and -&0e-ent they are able

t& er&r-.

De0el& the c&ntractures

aster because & the &0erty

& -&0e-ent

Sastic


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SasticDile'ia


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S(astic Di(le'ic P

$e's aected -&re than ar-s.

$e's ressed t&'ether and turned

in. Ar-s sli'htly clu-sy.

Tit&e standin'.

)airly '&&d head &sture andc&ntr&l in all &siti&ns.

$&1er b&dy c&ntr&l is &&r.

Tries t& use his head t& initiate

1ei'ht shit


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Sh&1 str&n' uer th&racic

e?tensi&n and 1eak l&1er

th&racic c&ntr&l. $&1er

th&racic e?tensi&n essential &r

Stability in &0erhead reach.

+rect sittin'.

Pr&er sinal ali'n-ent.

Child sends -&re ti-e in

sittin' ( sittin'# because &

ineicient l&1er b&dy

ali'n-ent.

S(astic Di(le'ic P

Spastic Diplegic CP


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Child resents 1ith ti'htness in the

l&1er li-b -uscles.

$e' ti'htness &ten leads t& instabilityin a-bulati&n.

Sciss&rin' 'ait resent.

+?tra -uscle tensi&n usually de0el&s

in the uer b&dy, sh&ulders, and ar-s

due t& c&-ensat&ry stabili=ati&n

-&0e-ents..

Uer b&dy itsel is n&t directly

aected by the c&nditi&n.

Spastic Diplegic CP


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>e-i(le'ic P

Ar-, trunk E le' aected &n &ne side.

Ar- turned in and bent 1ith isted

hand

$e' turned in and bent 1ith ti t&e

standin'.

Sasticity leadin' t& decreased'r&1th & the aected -uscles.

The sh&rtened -uscles cause

r&'ressi0ely, less ran'e & -&0e-ent

and increased stiness in the 2&ints.


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ill sit u but -ay &ten all

t& the side aected by

cerebral alsy. May de0el& sc&li&sis

because & -uscular

1eakness &n he-ile'ic

side. "aby d&es sc&&tin' &r

a-bulati&n.

>e-i(le'ic P

Athet&id Dyst&nia


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Athet&id Dyst&nia

Athet&id


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Athet&id !n0&luntary c&nstant r&tat&ry &r

1rithin' -&0e-ents & the distal

e?tre-ities. "asal 'an'lia in0&l0e-ent.

Any acti0e and intenti&nal -&0e-ents

increases these abn&r-al -&0e-ents

These in0&luntary -&0e-ents are seen

-ainly in head, 2a1, lis, hands E eet

Pr&?i-al area in0&luntary -&0e-ents

are als& seen rarely

Ata ic D skinetic


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Ata?ic Dyskinetic

Ata?ic Dyskinetic


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Ata?ic Dyskinetic

!ntenti&nal tre-&rs

Ata?ic 'ait drunken like 'ait

Scanned seech

Clu-siness in -&0e-ents

Diiculty in ine -&t&r

acti0ities

Able t& 1alk but ha0e

reuent alls

Ma2&r clinical


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Muscle

len'th

Sasticity

Muscle 1eakness

Ma2&r clinical

r&ble-s


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T& tackle -uscle len'th r&ble-s in CP 1e -ay need &ll&

My&ascial release

Maniulati&n and -&bili=ati&n

Passi0e, Acti0e and +ccentric-uscle len'thenin' techniues

P&siti&nal releasetechniues

+lectrical and ther-al

-&dalities

Serial cast

3rth&tic de0

Pr&ri&ceNeur&-uscular )

"&t&?

)uncti&nal ac


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T& tackle sasticity r&ble-s in CP 1e -ay need &ll&

Pr&l&n'ed &siti&nin'

ei'ht bearin' strate'ies

ei'ht shitin' strate'ies

ey &ints & c&ntr&l

>andlin' techniues

Thera suit th

3rth&tic de0


"&t&?, Music th

>ydr&theray, s

trainin' and hi


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T& tackle -uscle 1eakness r&ble-s in CP 1e -ay need &

Acti0e c&ncentric andeccentric stren'th trainin'

)uncti&nal stren'th trainin'

)acilitati&n techniues

)uncti&nal electricalsti-ulati&n()+S#

C&nstraint induced

-&0e-ent theray(C!MT#

>ydr&ther

inesi& ta


Partial b&dy 1su&rted tread-

&b&tic assisted


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T>AN/%3

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Cerebral Palsy by Dr.jaya Shanker

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