Cerebral Palsy

How will you classify cerebral Palsy?

Anatomical Classification
o Monoplegia
o Paraplegia
o Hemiplegia
o Quadriplegia
o Diplegia - all four limbs are involved, lower more than upper
o Double hemiplegia all four limbs are involved, upper more than
lower
o Triplegia three limbs are involved
Physiological Classification
o Spastic type
o CP with choreoathetoid type of movements
o Ataxic cerebral palsy
o Rigid cerebral palsy
o Atonic cerebral palsy
o Hypotonic cerebral palsy
o Dystonic cerebral palsy
o Athetoid cerebral palsy
o Ballismic cerebral palsy
o Cerebral palsy associated with tremors
o Mixed cerebral palsy
o Unclassified cerebral palsy
Based on site of lesions
o Cerebral cortex
o Subcortical white matter
o Periventricular white matter
o Basal ganglia
o Cerebellum
o Brain sten
o Global lesion

How will you screen and assess children at risk for cerebral palsy?
Children can be screened by assessment of developmental milestones.
Pointers for diagnosis of cerebral palsy

Delayed milestones
Failure to develop protective reflexes (parachute by 9 months)
Changes in tone and posture
Psychomotor retardation
Persistence of primitive reflexes
Presence of pathological reflexes
Postural abnormalities change in tone and posture
Progression of illness not present

Perinatal insult to growing brain

Name few mental assessment scales

Bayleys scale of infant development screening

Weschler intelligence scale
Stanford Binet intelligence scale
Denver development screening test
IQ/DQ tests

Treatment of CP
To alleviate disablility, prevent deformities, achieve maximum
possible functions in terms of communication, mobility, independence, education
and lead a near normal life. Multidisciplinary approach .

Young infant stimulation programme

Behaviour modification
Treatment of comorbid conditions convulsions, reduction of spasms.
Development activation and disability limitation
Physiotherapy
Appropriate school placement
Correction of associated defects refractory errors, squint, hearing loss

Clinical features of Ataxic CP

The site of lesion is cerebellum. Clinical features are hypotonia, intellectual
impairment, intention tremors, decreased or absent reflexes, wide based gait,
cerebellar signs gross incordination, impaired writing skills, dysmetria,
hypotonia, ataxic gait.
What is Dyskinetic CP?
Characterised by abnormal involuntary extrapyramidal movement
patterns along with abnormal tone, posture control and coordination. Abnormal
movement patters (Chorea, Athethosis, Choreoathetosis, dystonia) emerge
between 1 to 3 years. Arms are usually more involved than legs. Predisposing
factors are perinatal hypoxia and kernicterus. There are three phases Hypotonic
phase (at birth), Dystonic phase (by 4 months), stage of involuntary movements
(1-3 years).
Incidence of CP in children with birth asphyxia?
Only 8-10% of cases with CP have history of birth asphyxia.

Name the various newborn reflexes and the age at which they appear
and disappear

Reflex

Age at which appears

Moro
Stepping
Placing
ATNR
Crossed Extensor
Reflex
Symetrical Tonic neck
reflex
Sucking and Rooting

Birth
Birth
Birth
1 month
Few days after birth

Age at which
disappears
2 -3 months
6 weeks
6 weeks
3-5 months
1 month

2 months

6 months

Birth

Palmar grasp
Plantar grasp

Birth
Birth

4 months awake
7 months sleep
6 months
10 months