Cerebral Palsy 'Cerebral' – refers to the brain. 'Palsy' – can mean weakness or paralysis. It is defined as a disorders resulting cerebral dysfunction due to nonprogressive brain damage cause physical disability in human development Etiology and Risk Factors for CP Congenital genetic, inflammatory, Meningitis infectious, traumatic metabolic. The injury to the developing brain may be prenatal, natal or postnatal. 75% - 80% of the cases are due to Prenatal infections are most dangerous in the first few weeks after conception. German measles (rubella) and cytomegalovirus (CMV) during pregnancy are known causes of cerebral palsy. Less than 10% being due to significant birth trauma Hypoxia, Cystic periventricular leukomalacia (CPVL) is a risk factor with 60%-100% of patients with CPVL developing CP. Associated Deficits problems Problems with hearing Mental retardation (MR) is common in CP in up to 60% Visual impairments and disorders of ocular motility are common (28%) in children with CP. Epilepsy is common in children with CP. Intellectual or learning disability Perceptual difficulties – problems such as judging the size and shape of objects are termed perceptual difficulties Bone disease – some children with cerebral palsy are not able to be as active as children without disabilities and have some degree of osteoporosis. Fractures can occur with very minor injuries Scoliosis – an abnormal curvature in the spine, common in up to 30 percent of children with cerebral palsy Shortened Achilles tendon – a shortened tendon that causes issues with walking and standing Hand and wrist deformities – abnormal flexing in the hand and wrist that prevents development of fine motor skills DIAGNOSIS neurological examination CT Scan, MRI To find out, hemorrhage, cyst, Apgar scores have sometimes been used as one factor to predict whether or not an individual will develop CP Physiotherapy Treatment Approaches for Cerebral Palsy Exercise 1. Stretching Exercise 2.Postural exercise 3. Balance exercise 4. Aqua therapy 5.Muscle Strengthening Exercises 6.Co ordination exercise 7.Gait training 8. Weight bearing in the lower limb through use of Tilt-tables 9.Body Weight Supported Treadmill Training 10.ROM exercise 11. Tone normalization exercise 12. Functional Exercises The topographic classification of CP 1. Monoplegia is one single limb being affected. 2. Hemiplegia – the leg and arm on one side of the body are affected. hemiplegiae is 20% – 30% Seizures occur in more than 50%. Leafspring AFO Design: dynamic dorsiflexion assist Flaccid foot drop General indications: hemiplegia 3. Diplegia – is the commonest form (30% – 40%), 4. Quadriplegia – both arms and both legs, and the trunk, are affected 10% – 15% associated with acute hypoxic asphyxia. 5. Triplegia: three limbs affected usually both LL & one UL CP is classified based on the type of neuromuscular deficit 1. Spastic CP is the commonest and accounts for 70% of all cases• Stiff and difficult movement (scissor gait) adductor spasm Spastic types exhibit pyramidal, hypertonia, and positive Babinski contractures are common in spastic CP Physiotherapy Treatment Physical therapy can reduce the muscle tension and jerky movements associated with spastic cerebral palsy. Exercises such as stretching can even relieve stiffness over time. 2. dyskinetic – 10% to 15% is characterized by extra pyramidal involvement in which rigidity present Babinski are absent This refers to the type of cerebral palsy with abnormal involuntary movements. It is divided into two types of movement problems, called dystonia and athetosis. 3. Dystonia – this is the term used for sustained muscle contractions that frequently cause twisting or repetitive movements, or abnormal postures. 4. Athetosis – this is the word used for the uncontrolled extra movements that occur particularly in the arms, hands and feet, and around the mouth. The lack of control, is often most noticeable children with athetoid cerebral palsy often feel floppy Effected part of brain: Basal Ganglia Physiotherapy Treatment Athetoid – People with athetoid cerebral palsy use physical therapy to increase muscle tone and gain more control over their movements 5. Ataxic is less than 5% of cases Disturbed depth perception • Effected part of brain: cerebellum. Ataxic (or ataxia) is the word used for unsteady shaky movements or tremor. Children with ataxia also have problems with balance Effected part of brain: cerebellum Physiotherapy Treatment There are exercises that can improve balance problems faced by those with ataxic cerebral palsy. 6. Mixed • There can exist a combination of these types of CP 7. Flaccid /hypotonic those children who are hypotonic there is no cognitive impairment. problems with drooling and swallowing difficulties are seen. 30% of children with CP have a mixed pattern of involvement; they are uncommon in the extra pyramidal group. Hypotonic CP is characterized by generalized muscular hypotonia the persists beyond 2 to 3 yrs of age Physiotherapy Treatment physical therapy to increase muscle tone and gain more control over their movements The Gross Motor Function Classification System (GMFCS) (GMFCS) is a method of describing the range of gross motor function in children with cerebral palsy. The GMFCS describes five 'levels' of motor function GMFCS Level Description Level I Walks without limitations and climbs stairs without limitations. Speed, balance and co-ordination are reduced Level II Walks with limitations, climbs stairs holding on to a rail. Experiences limitations walking on uneven surfaces Level III Walks indoors or outdoors using a hand held mobility device and climbs stairs holding onto a railing. May require a self-propelled wheelchair when travelling longer distances, outdoors or on uneven terrain Level IV Self-mobility with great limitations and may use powered mobility Level V Physical impairments restrict voluntary control of movement and have no means of independent mobility. Transported in a manual wheel chair Assisted devices For exercise 1 ball 2 parallel bar 3stepper 4. Roll and spring 5. Wall bar stands For ALDS 1 wheelchairs 2 walker crutches canes 3. Bath chairs Orthosis. Goals OF orthosis To provide a BOS To improve the efficiency of gait To correct and prevent deformity To improve the efficiency of gait in selected cases Prescription Criteria Diagnosis Physical examination Gait pathology assessment Common AFO Options for CP · Rigid AFO · Anterior ground reaction AFO · Leaf spring AFO · Dynamic ankle foot orthosis (DAFO) · Supra-malleolar orthosis (SMO) Electrical Stimulation The goal of the electrical stimulation is to increase muscle strength and motor function Neuromuscular Electrical Stimulation (NMES) involves application of transcutaneous electrical current that results in muscle contraction. Splinting “Splints and casts are external devices designed to apply, distribute or remove forces to or from the body in a controlled manner to perform one or both basic functions of control of body motion and alteration or prevention in the shape of body tissue CP POSTIOING In sitting: Place a soft pillow on child left and right arm and also place a soft pillow on children head and neck to support an upright position In supine lying In supine lying position place pillow on children ribs to give support to child In prone lying In prone lying position place pillow on children chest to give support to child In side lying position In side lying position place pillow on children back also place pillow on children right leg by bending the right leg and straight the left leg In standing position Transition from sitting to standing In standing position place children back to wall give support to child and place hand on child knees to prevent from fall Eating/ Feeding position Place your child in your laps gives support his / her back then feed your child Therapeutic technique Pulling the shoulder blades forward as you lift him up.  Press firmly on the muscles on each side of the backbone and slowly bring your hand from her neck toward her hips.  You can also do taping & stimulation of para-vertebral muscle