cerebral palsy (cp) · •cerebral palsy was diagnosed in 12.3% of infants born at between 24 and...
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CEREBRAL PALSY (CP)
S.M.Mazloumi
Associate professor in orthopedics
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CEREBRAL PALSY
Definition
• Cerebral palsy is the result of a brain lesion
• The brain lesion must be fixed and nonpr gressive.
• The abnormality of the brain results in motor
impairment
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Epidemiology
• In recent reports the incidence has been estimated to be between 2.4 and 2.7 per 100O Live births. (low birth weight tiny neonates)
• The risk for cerebral palsy in a child born full-term is approximately 1 in 2000.
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Epidemiology
• Cerebral palsy was diagnosed in 12.3% of infants born at between 24 and 33 weeks of gestation.
• Approximately 50% of children with cerebral palsy have low birth weight, and 28% weight less than 1500 g at birth.
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Epidemiology
• The incidence of cerebral palsy in recent studies of multiple births is
9 to 12 per 1000 in twins
31 to 45 per 1000 in triplets
111 per 1000 in quadruplets.
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Etiology
PRENATAL
• The TORCHES group of infections (toxoplasmosis, rubella, cytomegalovirus, herpes, and syphilis)
• Cocaine, heroin, and marijuana
• Congenital malformations
• Rhesus blood group incompatibility resulting in
kernicterus as a cause of cerebral palsy
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Etiology
PRENATAL
• Prenatal chorioamnionitis and maternal infection have been associated with an
increased risk for premature onset of labor and cerebral palsy in the infant.
• placental abnormalities
• Fetal biophysical profile scores are prenatal noninvasive tests used to monitor the health of the developing fetus.
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Etiology
PERINATAL
• Anoxia as a result of perinatal complications
(A tight nuchal Cord or placental abruption)
• Premature delivery
• Sepsis in the neonatal period
• Extracorporeal membrane oxygenation (ECMO
• Heart surgery before the age of 1 month resulted in cerebral palsy in 25% of infants.
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Etiology
POSTNATAL
• Infections such as meningitis in early childhood can lead to cerebral palsy
• Cardiopulmonary arrest
• Suffocation
• Motor vehicle accidents
• Severe falls, and child abuse
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Classification
• PHYSIOLOGIC
• The most common movement abnormality is Spasticity.
• Hypotonia
• Dystonia
• Athetosis
• Patients with cerebral palsy frequently have a mixed form of movement disorder
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classification GEOGRAPHIC
what part of the body is affected by cerebral
palsy.
•Hemiplegia
•Diplegia
•Triplegia
• Quadriplegia
• total body involvement,
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PHYSICAL EXAMINATION
• Muscle Tone
• Reflexes
Deep tendon reflexes (hyperreflexia & clonus)
• Infantile reflexes (3-6 mouth.)
- startle reflex, or Moro's reflex
- tonic neck reflex
- parachute reflex (5 month. Appears)
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Physical examination
Balance, Sitting, and Gait
Gait Analysis
Cadence. (number of steps per minute),
Scissor gait
crouch gait
Knee flexion contracture and Genu recurvatum
equinus contractures.
toe-walking
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Treatment
NONSURGICAL TREATMENT
• Physical Therapy
• Casting
• Orthoses (AFOs)
dynamic equinus, foot drop,
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Treatment
MEDICAL TREATMENT OF SPASTICITY
• Oral Medication diazepam and baclofen
• Intrathecal Baclofen
• Botulinum Toxin(Botox) Clostridium botulinum and works by blocking the release of
acetylcholine at the neuromuscular junction.
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Treatment
Surgical treatment
• Tenotomies
Adductor muscle tendon
Hamstring muscle tendon
Achill tendon
• Tendon transfer
• Osteotomies