1. 3. Define Cerebral Palsy This is a collection of diverse syndromes characterized by disorder of movement and posture cause by a non progressive injury to the immature brain. It causes activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour, by epilepsy, and by secondary musculoskeletal problems.

2. MANIFESTATIONS Floppy infant/ increased tone Delayed motor development Poor sucking Persistent primitive reflex

3. Major risk factors Low birth weight: <2500 g Gestational age: <32 weeks

4. What type and topographical classification of cerebral palsy does our patient have?

5. Classification by Type Spastic – Most common type – Increased in muscle tone – Signs of upper motor neuron lesion (babinsky, hyperactive reflexes) Present in the patient: – Stiffness – Tightness of both Achilles

6. Classification by Type Dyskinetic/Athetoid – Involuntary movements – Impairments in postural stability Present in the patient: – Poor balance (but good sitting balance) Absent in the patient: – Involuntary movements

7. Hypotonic – Most often is the initial presentation of CP spastic and pyramidal type Mixed – Most often spastic plus athetoid type.

8. Classification by Type: There is lack of inhibition of the stretch reflex and is manifested as a) excessive response to rapid stretch of the involved muscles when the tendons are tapped by a reflex hammer during a clinical exam b) one of more “bouncing” contractions (clonus) occurring spontaneously when the muscle is stretched and held by a force c) stereotyped postures assumed as a result of persistent excessive muscle contraction (tone)

9. Classification by Topography Monoplegic – Involvement of both limbs on one side Hemiplegic – Unilateral paresis with upper limbs more severely affected than the lower limbs. Diplegic – Involves lower extremities predominately with only mildly affected upper extremities Triplegia – Involvement of 3 extremities, only one unimpaired Quadriplegia – Involvement of all 4 extremities relatively equally Paraplegia – refers to involvement of the lower extremeities alone with apparently normal upper extremities

10. Classification by Topography: Lower extremities are more affected than the Upper extremities – Toe walking is due to increased tone in the ankle with impaired dorsiflexion. – Scissoring gait is caused by adductor spasm of the rigid lower extremities.

11. Diagnosis: