1. Cerebral Palsy
Handicap International Sri Lanka Henk Willemsen

2. Goals of Presentation Provide you with knowledge about:
What is cerebral palsy and how to recognize
2 most common types of cerebral palsy
Parts of the body affected

3. What Is Cerebral Palsy?
Result of damage to an area of the brain that controls the muscles
Not a disease because it is not transmitted and it does not progress
Will last all the life; The child with cerebral palsy will become an adult with cerebral palsy.
CP is the most common neuroimpairment in childhood after MR.
Average; 2 per 1000 births in industrialized countries.
The damaged parts of the brain cannot be repaired, but often the child
can learn to use the undamaged parts to do what she wants. The child
with cerebral palsy will become an adult with cerebral palsy. Searching
for cures may bring disappointment. Instead help the child to learn to
become an adult who can live with her disability and be as independent
as possible.

4. What Causes Cerebral Palsy?
Injury of the brain, before, during, or shortly
after birth ( under age one) Possible causes;
Infections
Intoxications
Lack of air during delivery
Injuries from difficult delivery
Baby born before 9 months and low weight
Causes before birth:
Infections of the mother while she is pregnant, for instance: German measles, rubella, herpes, syphilis.
Maternal intoxications; alcohol, heroine, anti-epileptic medicine, cigarette
Rh incompatibility (differences between the blood of the mother and the child)
Inherited: rare, but there is a “familial spastic paraplegia”
Causes around the time of birth and after:
Lack of oxygen,
Preterm birth and LBW
Obstetric problems (difficult labour, breech birth)
Postnatal infections
No cause can be found in about 30 % of the children.

5. How to recognize Cerebral palsy
Early Signs
At birth a baby with cerebral palsy often is floppy
Slow and abnormal development; slow to hold up his head, to sit, to move around, poor balance
Developmentally delayed: Slow to roll over, sit up, crawl, smile, or walk. At birth a baby with cp is often floppy.

6. How to recognize Cerebral Palsy
He may not use his hands, or only uses the same one hand all the time
Difficulties in handling; taking care of the young child; her body may stiffen or being very floppy

7. How to recognize Cerebral Palsy
Abnormal muscle tension
Unusual positions

8. Associated Problems Difficulty to talk and eat.
Mental Retardation and learning problems (50 –75 %)
Fits
Growth Problems
Problems of the eyes (25 %) or Hearing (25 %)
Incidence of MR and epilepsy in cp:
IQ < 50: Athetoid: 30 %, Diplegia: 33 %, Hemiplegia: 39 %, Quadriplegia: 64 %
Seizure Disorder: Athetoid: 27 %, Diplegia: 31 %, Hemiplegia: 67 %, Quadriplegia: 56 %
Gibbs (1963)

9. Types of Cerebral Palsy
Spastic - lack of possibility to relax muscles
Athetoid – lack possibility to control muscle movements
Mixed Patterns
Cerebral palsy is often different in every child. Experts have worked out different ways of describing. It`s helpful to recognise 3 main ways that cerebral palsy can appear. However, it often appears in some sort of combination.
Spastic CP is the most common type off CP; 75 % of all children with CP. Spastic diplegia is the most common type of spastic CP. Symptoms are influenced by posture and movement,can be absent in rest.
Athetosis accounts for 20 % of all cases of CP.
Ataxia represents less than 10 % of cases of CP.

10. Spasticity Most common type
High muscle tension, stiff and slow movements
Moves in patterns; no isolated movements
Position of the head causes abnormal positions of the whole body
Afraid of moving
Contractures
Spasticity = Resistance against passive movement velocity dependent, an increase in speed results in an increase in resistance. Clasp-knife.

12. Athetoid = Without position
Total, twisted, slow or sudden quick movements
Sometimes looks like they move for no reason, restless
Difficulty to keep sitting or standing
Position of the head causes abnormal positions of the whole body
Athetoid: Total body involved. Restless, also when not moving, increases when movement is initiated (often leads to movement of other muscle groups) or when trying to keep a posture. Slow , twisting movements, most explicit in face and distal part of extremities.
Asymmetric in posture and movement, mixed muscle tone.

14. Affected Body Parts
Hemiplegia - one arm and one leg on the same side of the body are affected
Diplegia - both legs are affected
Quadriplegia -all arms and legs affected
Plegic means paralysis. Given the fact that there is not a complete neutralized muscle-activity, this expression is in fact not correct.

15. Spastic Hemiplegia
Asymmetric, Affected side is shortened and limited in use, Often doesn't use affected side because it can solve most problems with healthy side.
Typical posture: walks on tiptoe or outside of the foot , inside rotation hip, the elbow, wrist and fingers bent
Spastic Diplegia
Arms; gross function is good, minor coordination problems of fingers on fine skills
Legs; spastic. Typical pattern legs;
Hips bent forward or turned inside
Knees; hold together, never straight
Feet tiptoe
Rub bellies, crawling is difficult (hare hopping), TV-sitting position, sacral sitting
In general no big speech- language problems
Quadriplegia
Athetosis, Spasticity or combined
Like Diplegia but total body involvement; arms and legs affected
Head and trunk control often very limited
Balance when standing usually nihil
Often asymmetrical

16. Questions Can a person with CP marry and have children?
What medical or surgical treatment is there?
Will a child with CP be able to walk?
Is CP transmitted?
What can we do?

17. Look at my strengths, …………… not at my weaknesses!