1. C EREBRAL PALSY By: Missy Kaplan

2. O UTLINE Introduction to Cerebral Palsy Epidemiology Etiology Treatment and Prevention Dental Management

3. W HAT IS C EREBRAL PALSY Affects body’s ability to control muscle movement Results from an injury to the brain during development. This can occur prenatally, natally, or postnatally (United Cerebral Palsy, 2011) (Wilkins, 2009)

4. T YPES Spastic involuntary contractions of muscles causing stiffness Athetosis constant, uncontrolled movements. Ataxic loss of equilibrium and have difficulty with balance and coordination Mixed (United Cerebral Palsy, 2011) (Wilkins, 2009)

5. EPIDEMIOLOGY “an average of 1 in 303 children in the United States have cerebral palsy” “an estimated 800,000 children and adults in te US are living with cerebral palsy” Black and White children > Hispanic children Boys > Girls Spastic form is the most common accounting for 80% of all cases (Centers for Disease Control and Prevention [CDC], 2011)

6. E TIOLOGY Injury to the brain Can occur up to age two Causes Hypoxia Bleeding of the brain Infections of the brain Head injuries Severe jaundice Infections of mother during pregnancy unknown (PubMed Health, 2011)

7. RISKS Low birth weight Premature infants Blood type incompatibility Breech delivery

8. SYMPTOMS….. BESIDES MOTOR FUNCTION Seizure disorders Spinal deformities Incontinence Delayed growth and development Mental retardation Drooling Impaired hearing, vision and speech (National Institute for Neurological Disorders and Stroke [NINDS], 2011)

9. TYPES OF BRAIN DAMAGE Periventricular leukomalacia Damage to the white matter Cerebral dysgenesis Abnormal formation of the brain Intrapartum asphxia Lack of oxygen to the brain Intracranial hemorrhage Blocked or broken blood vessel

10. DIAGNOSIS Doctor will monitor…if symptoms get worse…not cerebral palsy Magnetic resonance imaging (MRI) Most common Cranial ultrasound No fine detail High risk pregnancies Computed tomography scan (CT)

11. T REATMENT No cure Aimed at managing symptoms Team approach (NINDS, 2011)

12. T REATMENT CONT. Therapy!!!! Physical Occupational Recreational Speech (NINDS, 2011) http://www.uthscsa.edu/mission/spring98/ horsestr.html

13. T REATMENT C ONT. Medications Glycopyrolate reduces saliva Diazepam (Valium) Baclofen Dantrolene sodium Tizanidine Treat stiff, rigid or spastic muscles (NINDS, 2011) (Rxlist, 2011)

14. SURGERY Used when more conservative treatments fail Orthopedic Selective dorsal rhizotomy (SDR) Locate overactive nerve and sever Spinal cord stimulation an electrode is implanted at the base of the spinal cord and stimulates the nerve (NINDS, 2011)

15. http://www.liddlekidz.com/cerebral-palsy-massage-course.html

16. O RAL HEALTH Malocclusion Facial muscle disturbances Attrition Fractured teeth Dental caries Periodontal disease (Wilkins, 2009)

17. D ENTAL MANAGEMENT Do not force limbs Place patients head in middle of chair Watch and anticipate movements Place patients chin down No sudden movements Tone down lights Early appointments Possible sedation Nitrous (Waldman, B.H., Borg, P.A., & Perlman, S.P., 2011) (Kaufman, E., Meyer S., Wolnerman, J.S., Gilai, A.N., 1991) (Oklahoma Association of Community Action Agencies, 2008).

18. C ONCLUSION The dental office can be a very stressful place and in order to make it less stressful, we need to understand cerebral palsy and know how to manage their dental care.

19. R EFERENCES Centers for Disease Control and Prevention. (2011). Cerebral palsy. Retrieved on November 5, 2011 from http://www.cdc.gov/ncbddd/cp/data.html Kaufman, E., Meyer S., Wolnerman, J.S., Gilai, A.N. (1991). Transient suppression of involuntary movements in cerebral palsy patients during dental treatment. American Dental Society of Anesthesiology. 38: 200-205 National Institute for Neurological Disorders and Stroke. (2011). Cerebral palsy: hope through research. Retrieved on November 11, 2011 from http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#179283 104 Oklahoma Association of Community Action Agencies. (2008). Oral health care for children with special health care needs. Retrieved on November 11, 2011 from http://www.okacaa.org/8.5%20x%2011%20Oral%20Health%20Care%20for%20Childr en%20with%20Special%20Health%20Care%20Needs.pdf PubMed Health. (2011). Cerebral palsy. Retrieved on November 11, 2011 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001734/ RxList (2011) RxList Inc. Retrieved on November 11, 2011 from http://www.rxlist.com/script/main/hp.asp United Cerebral Palsy. (2011). Retrieved on November 5, 2011 from http://www.ucp.org/uploads/media_items/cerebral-palsy-fact-sheet.original.pdf Waldman, B.H., Borg, P.A., & Perlman, S.P. (2011). Periodontal care for patients with special needs. Dimensions of Dental Hygiene. 9(9): 78-80, 83. Wilkins, E.M. (2009). Clinical practice of the dental hygienist. (10 ed., pp 925-928). Baltimore: Lipincott Williams and Wilkins