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DEFINITION:
-A neurological disorder cause by a
non-progressive
brain
injury
or
malformation that occurs while the
childs brain is under development. It
primarily affects body movement and
muscle coordination.
P-ermanent
-asphyxia
-intraventricular hemorrhage
-preeclampsia
-respiratory
prematurity
M-anageable
EPIDEMIOLOGY:
-CHORIOAMNIONIEIS
POSTNATAL
-anoxia
-toxin exposure
-traumatic head injury
-viral or bacterial meningitis
BASIC MEDICAL SCIENCES:
AREAS OF THE BRAIN
AFFECTED:
-infections
-inflammation
-PREMATURITY
COMMON)
(MOST
PRENATAL
S-yphillis
T-oxoplasmosis
meat)
of
MATERNAL RISKS:
GENERAL CAUSES:
disorders
(uncooked
o H-erpes Zuster
Perinatal
o Bridge birth(butt first)
o Lack of oxygen in the
brain
Postnatal
o Falls
o Trauma
PATHOPHYSIOLOGY: (diagram)
1. hypoxia
2. intracerebral hemorrhage
3. Hyperbilirubinemia
Grading for Severity of Pathology
Grade I - isolated subependymal
hemorrhage
Grade II - bleeding into the ventricle
without dilation
Grade III - bleeding into the ventricle
with dilation
Grade IV - intraventricular hemorrhage
with ext to the surrounding mater
parenchyma
-
Prenatal
o Maternal History
o S-yphillis
o T-oxoplasmosis
(uncooked meat)
o O-thers (chicken pox)
o R-ubella
(german
measles)
o C-ytomegalovirus
Tone Abnormalities
o Either
decreased,
increased or fluctuating
movements
o Fluctuating tone shifts in
varying degrees from
hypotonic to hypertonic
o Hypo(dyskinesia)
o Hyper(spastic/rigid)
Reflexes Abnormalities
o Retained
primitive
infantile reflexes
o delay in the acquisition of
righting and equilibrium
reactions occur
o hypotonia (areflexia)
Postural abnormalities
o hypertonicity in the lower
extremities=often
lies
supine with the hips
internally rotated and
adducted and the ankles
plantar flexed
o hypotonicity=
typically
lies
with
the
hips
abducted, flexed, and
externally
rotated
because of low muscle
tone, weakness in the
affected muscles, and the
influence of gravity
Delayed
motor
development(universal sign
for CP)
o delay in the childs ability
to sit independently
o often not recognized until
the child fails to achieve
these
early
motor
milestones.
Atypical motor performance
o Child may demonstrate a
variety
of
motor
abnormalities such as
asymmetrical
hand use
unusual
crawling
method or gait
uncoordinated
reach
difficulty sucking
chewing
swallowing
CLASSIFICATIONS:
-
Topographical
distribution
(body part/ motor function
classification system)
o Mono-one limb
o Diplegia-severely involve
LE, less affectation of UE
o Hemi-one side of the
body
o Para-only LE (cognitively
okay)
o Tri-three
extremities
involved
o Tetrafour
(3
parts
severely affected, one
part less)
Classification according to
Movements disorders:
o Spastic
o Athetoid
o Ataxic
Spastic
Hypertonicity
Most common (70-80% of the
cases of CP)
Result of Upper Motor Neuron
Involvement
Retained primitive reflexes in
affected areas of the body
Impact on motor function:
o Mild impairmentdoes
not
interfere
with
functional limits
o Severe Inability to reach
and grasp
Contractures
leading
to
deformity are common
Categorized Anatomically:
Spastic Hemiplegia
o One entire side of the
body including neck,
head and trunk.
o UE is usually affected
o Early signs dragging
one side of body
Spastic Diplegia
o Both LE,
o mild
coordination,
tremors or less severe
in UE
o Bunny hop- rely on
the arms for support
Dystonia
-Abnormality in muscle tone
Athetosis
Most
common
type
of
dyskinesia or dystonia
Slow,
Writhing
involuntary
movements
Involuntary and uncontrolled
movements
10-20% of the cases of CP
Basal Ganglia involvement
Choreiform
Gross
motor
classification system
function
o
o
LAB TESTS:
-
SPECIAL TESTS:
Reflex Testing
M Moro reflex
A ATNR
S STNR
S Stepping reflex
P Parachute reflex
E Extensor thrust
N Neck righting on body
MEDICAL/PHARMACOLLOGICAL
MANAGEMENT:
- Oral medications used to reduce
spasticity in severe cases with
mixed results such as:
o diazepam (Valium)
o dantrolene (Dantrium)
o baclofen have been.
-
SURGICAL MANAGEMENT:
1. Gastroenterology Surgery
a. Nasogastric tube tube
placed through the nose
to introduce food to the
stomach
b. Gastrostomy tube tube
inserted
through
the
abdominal wall to the
stomach
allowing
uninterrupted feeding
2. Hearing Surgery
a. Hearing aids amplify
sounds
without
distortions
b. Radio aids the use of
microphone
and
transmitters
Developmental
-
Acquisitional
-
Rehab
-
OT EVALUATION:
o
o
o
o
o
o
o
o
o
o
OT ASSESSMENT:
o
OCCUPATIONS
AND
ACTIVITIES AFFECTED:
Self-care:
-Child
usually
has
difficulty
performing
basic activities of daily
living such as eating
independently, dressing,
toileting, grooming and
hygiene, and lacks the
ability to be mobile.
-Child
usually
needs
assistance to develop and
achieve
independent
living status.
Productivity:
-Childs play skills may be
delayed due to lack of
exploratory
play
behaviour.
-Child
may
need
assistance in adapting
the working environment
to his or her own abilities.
Child
may
have
difficulty with schoolwork
such as learning how to
read and how to write.
Leisure
-Child
may
need
assistance in exploring leisure
options
-Child
may
need
assistance in adapting
the leisure environment
to his or her own abilities
Cognitive
-Child may have learning
disabilities related to perceptual
disorders
-Child may have difficulty
in learning due to mental
retardation
Psychosocial
-Child
may
become
depressed and express feelings
of
hopelessness
and
helplessness
-Child may have poor
self-image and low selfesteem
-Child
may
have
inadequate coping skills and
become easily frustrated
-Child may have limited
opportunities for self-expression
-Child may have difficulty
developing social relations
OT INTERVENTION
Self-care
-Promote oral motor skills
to facilitate feeding
-Suggest clothing
adaptations
that
may
facilitate
independent dressing
positions that
during dressing
-Suggest various
promotes stability
-Suggest
adaptive
equipment
that
may
facilitate
activities
of
daily
living
such
as
bolsters, wedges, aids for
standing and side lying,
adapted
chairs,
mobility aids.
and
Productivity
-Increase
opportunities
for play development.
Adapted
toys
and
computer aided games
and toys may expand the
childs play environment.
-Encourage
parents,
caregivers or teachers to
assign
responsibilities
and duties for child to
perform
-Explore
vocational
interests and career options
-Encourage development
of independent living skills
Leisure
-Explore leisure interests
-Develop leisure skills by
providing
opportunities
to
participate in activities.
Cognitive
-Increase
attending
behavior and attention
span.
-Instruct the child to
instruct others regarding
need for assistance.
-Use of computers may
facilitate learning tasks
and improve the persons
ability to function.
Psychosocial
-Provide
a
safe
environment in which the
person can experience
movement without fear.
-Provide opportunities for
socialization.
-Assist in development of
functional communication
and language skills.
-Help the family identify
community resources.
-Facilitate
improvement
of self-image`
-Encourage development
of social skills.
that
o Passive elongation
o Limb dissociation
o Positioning
o Orthotics
o Reflex-inhibiting patters.
These methods are
administered in three stages:
o First stage:
To use handling
techniques to give the
sensation
of
what
normal
tone
and
movement feel like
o Second stage:
Adaptive devices
o Use of a jelly bean switch
which is a single switch
to those patients who
can only perform
movement such as press
and release to a switch.
o Use of zipper pull to
compensate for difficulty
in stabilizing the hand.
Orthotics
o Use of splint such as
AFO, KAFO, resting hand
splint, dynamic splint,
wrist cock-up splint, antispasticity and deformity
splint to improve
function and reduce or
prevent deformity.
Environmental modification
o Provide grab bars in
private bathroom to
facilitate safety of the
patient.
Wheelchair modification
o Detachable leg rests to
facilitate w/c transfers
o Arm trough for upper
extremity to facilitate w/c
proper positioning
Adapted procedures
o Propel w/c using sound
arm and leg to substitute
for loss of lower
extremity ROM
Safety education
Roles of OT
The roles of an occupational
therapist in treating a client with
Cerebral Palsy are the following:
-
Improving infant-caregiver
interaction, family support for
coping, and home modifications