CEREBRAL

PALSY
Rizky Rafiqoh Afdin-G1A217097
Annisa Puja Ikrima-G1A217098

Dosen Pembimbing:
dr. Juli Hartati, Sp.KFR

KEPANITERAAN KLINIK SENIOR

BAGIAN REHABILITASI MEDIK RSUD RADEN MATTAHER
JAMBI
FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN
UNIVERSITAS JAMBI
2019
 Cerebral Palsy

01Penyebab paling umum timbulnya cacat fisik seumur hidup

di sebagian besar negara

02Mempengaruhi sekitar 1 dari 500 neonatus, dengan

prevalensi 17 juta orang di seluruh dunia

Manifestasi klinis cerebral palsy sangat bervariasi pada

03kelainan gerakan,kemampuan dan keterbatasan fungsional
dan bagian tubuh yang terkena.

04There is currently no cure, but progress is being made in

both the prevention and the amelioration of the brain injury

Source: Graham H Kerr, et all. Cerebral Palsy. Orthopaedic Department, The Royal Children’s Hospital. 2016.
 Definisi Cerebral Palsy

Cerebral Palsy

Cerebral palsy (CP) adalah gangguan yang memengaruhi kemampuan seseorang

untuk bergerak dan mempertahankan keseimbangan dan postur. CP adalah
kecacatan motorik yang paling umum di masa kecil. Kelainan gerak dan postur akibat
lesi otak yang immature.

Source: Centers for Disease Control and Prevention- Cerebral Palsy

 EPIDEMIOLOGI

Cerebral palsy adalah kecacatan motorik yang

paling umum terjadi pada anak-anak

Australia dan Eropa, secara historis prevalensi

cerebral palsy mulai dari 1,5 hingga 2,5 per 1.000
kelahiran hidup
Studi terbaru di Amerika Serikat, Taiwan dan Mesir telah
menemukan tingkat prevalensi di atas 3 per 1.000
kelahiran hidup pada orang usia 4-48 tahun.

Source: Graham H Kerr, et all. Cerebral Palsy. Orthopaedic Department, The Royal Children’s Hospital. 2016.
 KEMAMPUAN MOTORIK KASAR
The Gross Motor Function Classification System (GMFCS)
Sistem Klasifikasi Fungsional Motorik Kasar (GMFCS) Oleh CanChild di Kanada

GMFCS level I GMFCS level II GMFCS level III

 Anak-anak  Menaiki tangga sambil
berjalan di  Berjalan menggunakan
rumah, sekolah, di luar memegang ke pengaman.
 Kesulitan berjalan jarak perangkat mobilitas genggam.
rumah.
 Bisa menaiki tangga tanpa jauh tidak seimbang pada  Menggunakan mobilitas roda
pengaman. permukaanyang tidak saat bepergian jarak jauh dan
 Berlari dan melompat, tetapi rata.
dapat mendorong diri sendiri
 Memiliki kemampuan
kecepatan, keseimbangan
minimal untuk berlari dan untuk jarak yang lebih
dan koordinasi terbatas
melompat. pendek.
Source: Graham H Kerr, et all. Cerebral Palsy. Orthopaedic Department, The Royal Children’s Hospital. 2016.
 KEMAMPUAN MOTORIK KASAR

Sistem Klasifikasi Fungsional Motorik Kasar (GMFCS) Oleh CanChild di Kanada

GMFCS level IV GMFCS level V

 Menggunakan metode mobilitas yang  Anak-anak diangkut dengan kursi
memerlukan bantuan fisik.
 Mereka dapat berjalan jarak dekat di roda manual di semua pengaturan.
rumah dengan bantuan fisik atau  Anak-anak terbatas dalam
menggunakan mobilitas bertenaga atau
alat bantu tubuh ketika diposisikan. kemampuan mereka untuk
 Di sekolah, di luar rumah dan di
mempertahankan postur
komunitas anak-anak diangkut dengan
kursi roda manual atau menggunakan antigravitasi kepala dan badan dan
mobilitas bertenaga. mengendalikan gerakan kaki dan
lengan Hospital. 2016.
Source: Graham H Kerr, et all. Cerebral Palsy. Orthopaedic Department, The Royal Children’s
 Types of cerebral palsy Based on Topographical description in
cerebral palsy: unilateral and bilateral cerebral palsy

Based on affected region:

•Monoplegia : affects one limb,
usually an arm
•Hemiplegia : affects one side of the
body including arm, leg, and trunk
•Diplegia : affects either both the legs
or both the arms
•Quadriplegia : affects all four limbs,
and trunk muscle

Source: Graham H Kerr, et all. Cerebral Palsy. Orthopaedic Department, The Royal Children’s Hospital. 2016.
 Types of cerebral palsy Based on Clinical Presentation

Spastic cerebral Dyskinetic

palsy Cerebral Palsy
01
02
includes athetoid, choreoathetoid, and
dystonic cerebral palsies
 have problems controlling the
 Spastic CP affects about 80% of people with CP movement of their hands, arms, feet,
 Increased muscle tone and legs, making it difficult to sit and
 Their muscles are stiff and can be awkward walk
 The movements are uncontrollable
and can be slow and writhing or rapid
and jerky
 Sometimes the face and tongue are
affected and the person has a hard
time sucking, swallowing, and
talking.
 A person with dyskinetic CP has
muscle tone that can change
 Types of cerebral palsy Based on Clinical Presentation

Ataxic Cerebral Mixed

Palsy 03 Cerebral Palsy
04
 People with ataxic CP have  Some people have symptoms of more
problems with balance and than one type of CP.
coordination  The most common type of mixed CP
 Unsteady when they walk is spastic-dyskinetic CP.
 They might have a hard time with
quick movements or movements
that need a lot of control, like
writing. 
 They might have a hard time
controlling their hands or arms
when they reach for something.
 TIPE MOTORIK

Source: Worldcpday. org

 Classification based on muscle tone

Hypertonic cerebral palsy

Hypertonic atau hypertonia mengacu pada tonus

otot yang abnormal tinggi, yang menciptakan
kekakuan dan rigiditas otot. Cerebral palsy
spastik ditandai dengan hipertonus.

Hypotonic cerebral palsy

Hipotonik atau hipotonia mengacu pada
tonus otot rendah yang abnormal. Gejala
hipotonia termasuk kelemahan. Bentuk
cerebral palsy non-spastik (ataksik,
diskinetik, dan cerebral palsy athetoid)
ditandai oleh hipotonia.
 Risks of CP During Pregnancy
 Bacterial and viral infections
 Maternal blood clotting
 German measles (rubella)
 Maternal bleeding in later weeks of pregnancy
 Exposure to toxins (mercury from raw fish,
undercooked/raw meat, cat feces)
 Maternal thyroid problems
 Incompatible blood type between mother and
fetus
 Maternal seizures
Source: cerebralpalsyguide.com
Risks of CP During Birth
 Loss of oxygen to the infant brain
 Breech birth (baby being delivered feet or
rear end first)
 Premature birth (a child is born before start
of 37th week of pregnancy)
 Low birth weight (less than 5 pounds, 7.5
ounces)
 Inability of placenta to provide nutrients and
oxygen
 The use of vacuum extractors of forceps
 Risks Of CP After Birth

 Severe jaundice
 Infections
 Vascular problems shortly after
birth
 Lack of oxygen (asphyxiation)
 Head trauma

Source: cerebralpalsyguide.com
 Screening and Diagnosis of Cerebral Palsy

Developmental Developmental Developmental and Medical

Monitoring
WHO:     Parents, grandparents, other
caregivers
WHAT:   Look for developmental
milestones
WHEN:   From birth to 5 years
WHY:      To help you
•celebrate your child’s development
•talk about your child’s progress with
doctors and childcare providers
•learn what to expect next
•identify any concerns early
HOW:     With easy cdc milestones
Screening
WHO:     Healthcare provider, early childhood
teacher, or other trained provider
WHAT:   Look for developmental milestones
WHEN:   At 9, 18, and 24 or 30 months, or
whenever there is a concern
WHY:      To find out
•if your child needs more help with development,
because it is not always obvious to doctors,
childcare providers, or parents
•if a developmental evaluation is recommended
HOW:     With a formal, validated screening tool
Evaluations
WHO:     Developmental pediatrician, child
psychologist, or other trained provider
WHAT:   Identify and diagnose
developmental delays and conditions
WHEN:   Whenever there is a concern
WHY:      To find out
•if your child needs specific treatment
•if your child qualifies for early intervention
HOW:     With a detailed examination,
formal assessment tools, observation, and
checklists from parents and other caregivers,
often in combination, depending on the area
of concern

Source: Centers for Disease Control and Prevention- Cerebral Palsy

CDC’s Developmental Milestones
DENVER
 Structural changes observed in muscle of children with
cerebral palsy compared with typically developing children

Source: Graham H Kerr, et all. Cerebral Palsy. Orthopaedic Department, The Royal Children’s Hospital. 2016.
 Movement disorders in cerebral palsy

Source: Graham H Kerr, et all. Cerebral Palsy. Orthopaedic Department, The Royal Children’s Hospital. 2016.
LANGKAH-LANGKAH MENEGAKKAN DIAGNOSIS CEREBRAL PALSY
DIAGNOSIS

 Tanda awal Cerebral palsy biasanya tampak pada usia < 3

tahun, dan orang tua sering mencurigai ketika kemampuan
perkembangan motorik tidak normal.

 Untuk menetapkan diagnosis Cerebral palsy diperlukan

beberapa kali pemeriksaan, harus dipastikan bahwa proses
gangguan otak tersebut tidak progresif
DIAGNOSIS
 Kriteria Levine dapat digunakan dalam membuat diagnosis Cerebral
palsy usia > 1 tahun:
 Kelainan pola gerak dan postur
 Kelainan pola gerak oral
 Strabismus
 Kelainan tonus otot
 Kelainan evolusi reaksi postural dan tahap perkembangan
 Kelainan refleks tendon, refleks primitif, dan refleks plantar

 Diagnosis Cerebral palsy ditegakkan jika minimum terdapat 4

abnormalitas dari 6 kriteria di atas. Bila hanya memenuhi satu kriteria
belum dapat dikatakan CP, namun dikatakan kecurigaan CP.
 PEMERIKSAAN FISIK NEUROLOGIS

A Status Mental

B Penglihatan dan Pendengaran

C Kekuatan otot dan kontrol motorik

D Refleksdan Tonus Otot dan Gerakan Involunter

 Pemeriksaan Muskuloskeletal

Penilaian tulang
Range Of Motion belakang

01 02

Pelvic Obliquity &

Penilaian Hip,
Perbedaaan Panjang
Tungkai 04 03 lutut dan kaki
 Pemeriksaan Fungsional

3
Mobilitas

1
2

Duduk Keseimbangan
 Manual Ability Classification System (MACS)
•MACS Level I: Children handle objects with ease.
•MACS Level II: Children largely handle objects
successfully, but with compromised speed or
quality.
•MACS Level III: Children experience difficulty
handling objects and often require help.
•MACS Level IV: Children can handle certain
objects (with difficulty), but require extensive help
from others.
•MACS Level V: Children have extremely limited
ability to perform manual activities.
Communication Function Classification System (CFCS)
•CFCS Level I: The person can effectively send and
receive communicative information with unfamiliar
and familiar partners.
•CFCS Level II: The person effectively, but slowly,
sends and receives communication information with
both unfamiliar and familiar partners. 
•CFCS Level III: The person is usually able to
effectively send and receive communication
information with familiar partners, but may struggle to
communicate with unfamiliar partners.
•CFCS Level IV: The person inconsistently sends and
receives communication information with familiar
partners, and rarely can communicate with unfamiliar
partners.
•CFCS Level V: The person rarely communicates
effectively, even with familiar people.
 PEMERIKSAAN PENUNJANG

Radiologis
Ultrasonography (USG) kranial
Computed Tomography (CT) Otak
Magnetic Resonance Imaging (MRI) Kranial
Electroencephalography (EEG)
Diagnosa Banding
 PENATALAKSANAAN
CEREBRAL PALSY

Physical therapy and rehabilitation

•Occupational therapy. This type of
therapy helps a child learn to do everyday
activities such as dressing and going to
school.
•Recreational therapy. Participating in
art programs, cultural activities, and
sports can help improve a child’s physical
and intellectual skills.
•Speech and language therapy. A speech
therapist can help a child learn to speak
more clearly, help with swallowing
problems, and teach new ways to
communicate, such as by using sign
language or a special communication
device.
Orthotic devices
Pemberian bracing pada penderita
Cerebral palsy bertujuan untuk
mengurangi beban aksial, menjaga
stabilitas, memperbaiki postur tubuh,
pencegahan dan koreksi deformitas serta
memposisikan anggota gerak dalam posisi
yang lebih fungsional.
AFO untuk mencegah plantarfleksi
meningkatkan stabilitas saat berdiri dan
berjalan, menempatkan kaki pada posisi
yang tepat dan menjaga clearance saat fase
swing sehingga mengurangi penggunaan
energi dan meningkatkan panjang langkah
dan kecepatan berjalan
Assistive devices and technologies

These include special computer-based

communication machines, Velcro-
fastened shoes, or crutches, which can
help make daily life easier.
 Vojta

Bobaths
Pengelolaan Medis
 Medikasi untuk mengurangi spastisitas
digunakan pada anak-anak,
 Baclofen (Lioresal) dan Dantrolen
(Dantrium)
 Penilaian kembali spastisitas pada anak
CP yang sedang tumbuh setiap 6 bulan
sekali
 >> botox
SURGERY
 Preventing CP

Before Pregnancy

Be as healthy as possible before pregnancy, Vaksinasi

During Pregnancy

Pelajari cara memiliki kehamilan yang sehat, ANC, cuci tangan,

Hubungi dokter jika sakit, demam, atau memiliki tanda-tanda
infeksi lain selama kehamilan
After the Baby is
Born
Pelajari cara menjaga bayi tetap sehat dan aman setelah lahir, harus
diperiksa untuk penyakit kuning di rumah sakit dan lagi dalam waktu 48
jam setelah meninggalkan rumah sakit, divaksinasi, cegah cedera
 PROGNOSIS
Jumlah orang dewasa dengan cerebral palsy meningkat
karena meningkatnya kelangsungan hidup bayi berat lahir
rendah dan peningkatan umur populasi. Mobilitas orang
dewasa dan kemampuan untuk melakukan aktivitas
kehidupan sehari-hari harus dipantau secara rutin seiring
bertambahnya usia pasien.
THANK YOU