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MIXED CEREBRAL

PALSY

DEFINITION:
Mixed CP occurs when two or more types of

CP are present in the same person.


The most common type of mixed CP would be
Athetoid/Spastic-diplegic or Athetoid/Spastichemiplegic. The least common type of mixed CP would be
Athetoid/Ataxic. However, any mix of types and subtypes
discussed above may occur. It is even possible to have a
mix of all three types .

INCIDENCE:
Statistics say that mixed CP accounts for 10% of all cases

of cerebral palsy, but the actual percentage may be


more. The incidence of mixed cerebral palsy has been
rising due to better diagnostic techniques.

ETIOLOGY:
Injuries to both the pyramidal and extrapyramidal areas of

the brain.
They have damage to both the motor cortex and the
cerebellum, which are the two areas of the brain damaged
in the other types of cerebral palsy.

CLINICAL FEATURES:
Children with mixed cerebral palsy usually have both

the tight muscle tone of spastic cerebral palsy and the


involuntary movements of athetoid cerebral palsy.
Spasticity is usually the more obvious type, with the
involuntary athetoid movements increasing when the child
is between nine months and three years old. It usually
takes months or years to notice the presence of mixed
cerebral palsy more obvious.

The most common combination of mixed cerebral palsy

involves both spasticity and athetoid movements, but


other combinations are also possible. The least common
mix is athetoid and ataxic, however any mix of types may
occur. It is possible to have a mix of all three types of
cerebral palsy: spastic, athetoid and ataxic.

Spastic & Athetoid-Mixed CP


Since spastic C.P. causes one or more muscle groups to become tight,

patience experience severe movement limitations. As a result, children


with this disability have stiff and jerky movements often having trouble
changing positions and find it difficult to hold and let go of objects.
Patients suffering from mixed C.P. often exhibit the involuntary

movements of athetoid C.P. as well as the tight muscle tone of spastic


C.P. The spasticity is often more dominant, while the involuntary athetoid
movements increase as the child begins to grow, usually between nine
months and three years. It can take years until the symptoms of mixed
C.P. are noticed

ATHETOID-MIXED CP
Mixed cerebral palsy with athetoid characteristics are

caused by damage to the cerebellum or basal ganglia.


These areas of the brain are responsible for processing the
signals that enable smooth, coordinated movements as
well as maintaining body posture. Injury to these areas
may cause a child to develop involuntary, purposeless
movements, especially in the face, arms, and trunk.

The involuntary movements caused by mixed cerebral palsy often


interfere with speaking, feeding, reaching, grasping, and other skills
requiring coordinated movements.
. Involuntary grimacing and tongue thrusting may lead to
swallowing problems, drooling, and slurred speech
The movements often increase during periods of emotional stress
and disappear during sleep.
Have low muscle tone and have problems maintaining posture for
sitting and walking.

MANAGEMENT:
THERAPIES:
Physical therapy
Occupational therapy
Speech/language pathology
Accupuncture
Aquatic therapy
Biofeedback
Hippotherapy
Hyperbaric oxygen therapy

Massage therapy
Music therapy
Neurofeedback
Recreation therapies
ORTHOTICS & SPLINTS
MEDICATIONS
Diazepam,baclofen,dentrolene-control spasticity
Anticholinergic drugs-benztropine(help reduce abnormal movement)
Injections
Alcohol washes
Botox.

THANKYOU

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