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3. Define Cerebral Palsy

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.

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3. Define Cerebral Palsy

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  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) Spastic Cerebral Palsy

  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. Diplegic Cerebral Palsy

  11. Diagnosis: Spastic Diplegic Cerebral Palsy

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