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Presentation on theme: "CEREBRAL PALSY Prof. V.P.Sharma"— Presentation transcript:

1 CEREBRAL PALSY Prof. V.P.Sharma 16-10-2014
M.S.,(Ortho), DNB(PMR), .FACS, FICS, FIMSA, MAMS, PG (Spine-Aus.) Professor Deptt. of Physical Medicine & Rehabilitation K.G. Medical University, Lucknow

2 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 or seizures

3 Lesion is static, symptoms often change with time.
Eg. Hypotonia to hypertonia increasing dystonia with age Bony deformities Contractures

4 Classification 1. Limbs involved - Monoplegia Diplegia Triplegia
Quadriplegia Hemiplegia 2 Tone - Hypotomia Spasticity

5 Associated Movement Disorders - Dystonia Chorea
Athetosis Ataxia

6 Assessment of spasticity
Evaluation of muscle tone R.O.M. Associated movements disorders Psycho Social Assessment

7 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

8 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

9 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


11 Pre-school- Promote skill acquisition for independent function. Therapy promotes strength, endurance and movement patterns.

12 Mobility issues wheel chairs crutches, walkers, strollers, car seats school chairs, splints and orthotics

13 Schooling Architecture adaptations Home modifications
Installing wheel chair lifts Classroom accommodations


15 Ambulation

16 Sports


18 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

19 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

20 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

21 Oral Pharmacotherapy AIM Spasticity Associated movement eg. Dystomia
CNS acting Benzodia zepines Diazepam Clonazepam Lorazepam Tizanidine Baclofen Peripheral - Dantrolene

22 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

23 Action on GABA receptor in spinal cord
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

24 Clonidine quanfacine Tizanidine
Effect - Aplha 2 adrenergic effects Anti hypertensive Treat movement disorder & eg tics

25 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

26 Intrathecal Baclofen In patients with spasticity of cerebral origin
Continuous infusion of baclofen in intrathecal space

27 Surgery Maintain mobility & Stability of joints
Surgery at hip when subluxation or abduction less them 300

28 Bracing Improves function prevent worsening of contractures
Prevents recurrence of deformities after surgical correction

29 Future Direction Treatment for CP with focus on prevention of CP as well as effective and permanent at the level of brain. Treatment occurs most effectively with a multidisciplinary approach to assessment and treatment.

30 1. The commonest etiologies for cerebral palsy include all of the following except,
Prematurity Cerebral hypoxemia Vitamin C deficiency Hyperbilirubinemia

31 2. Which of the following is not a Pre-natal cause of C.P.,
Prolonged and difficult labor Premature rupture of membranes CNS infection (encephalitis, meningitis) Multiple pregnancies

32 3. Which of the following scale is used for assessment of spasticity-

33 4. Which of the following is not a centrally acting anti spastic medication,
Diazepam Tizanidine Dantrolene Baclofen

34 5. Among the following which is not used for spasticity management in C.P.,
Stretching Exercises. Bracing. Baclofen Anti spasmodic drugs.

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