Cerebral palsy refers to a group of neurological disorders characterized by motor dysfunction due to non progressive brain damage to the developing brain.

Cause

The cause of cerebral palsy are many and they are grouped under three headings: Prenatal, perinatal and postnatal.

Prenatal causes( from conception until setting in of labor pain)

• Maternal viral infections such as TORCH infections ( Toxoplasmosis, Rubella, cytomegalovirus, varicella or Herpes simplex)
• Metabolic disorder in the mother such as diabetes, heart ailments, hyperthyroidism,severe asthma or anemia.
• Poor prenatal care
• Rh incompatibility between partners
• Abdominal injury, smoking or drinking during pregnancy
• Early or late primi mothers

Perinatal causes(shortly before birth and up to a month after birth)

• Asphyxia due to mechanical respiratory obstruction
• Drugs causing anoxiaadministered during labor
• Trauma to the head during labor, big head babies
• Uterine hemorrhage
• Foreceps application
• Poor possition of infants like breach delivery
• Prematurity and complications at birth, respiratory distress, very low birth weight
• Anatomical abnormality in uterus or vaginal canal
• Eclampsia
• Anoxia due to various problems like umbilical cord round the neck or placenta previa

Developmental Causes

• Macrocephaly
• Microcephaly

Acquired Postnatal causes

• Trauma to the head with the injury of brain
• Infection of the central nervous system such as meningitis, encephalitis, tuberculosis and brain absces
• Thrombosis or hemorrhage which causes vascular insufficiency
• Anoxia due to drowning, murder attemptlike suffocation by pillows or carbon monoxide poisoning
• Malignancy like tumor or cyst
• Hydrocephalus

Classification

Topographical classification include

Quadriplegia – involvement of four limb

Diplegia –involvement of four limbs with legs more affected than the arm/ double hemiplegia same as above but with arms affected more than legs

Paraplegia – involvement of both leg

Triplegia – involvement of three limbs

Hemiplegia – one side of the body is affected

Monoplegia – one limb is affected

Clinical  Classification

Clinical classification include

• Spastic cerebral palsy
• Ataxic cerebral Palsy
• Athetoid  cerebral palsy

Spastic cerebral palsy –The characteristics of spastic cp  are hypertonicity

 Of clasp knife variety with increased tendon reflex  and occasional clonus.

Changes in posture may occur with excitement, emotional outburst, fear or anxiety which increase muscle tension. Reflexes like ATNR or STNR may be present.

Ataxic cerebral Palsy–The disturbance of balance and coordination are the Hallmark of  the ataxic type. The Child reaches out to objects but is unable to achieve its objective due to Overshooting or under reaching.  stability of the head on trunk and body on pelvic is poor. This result child appearing clumsy. There may also be intentional tremor which prevent fine motor movements. Nystagmus, visual and perceptual problems also be present.

Athetoid cerebral palsy–This form is characterized bybizarre and uncontrolled involuntary movement which are purposeless, jerky or tremor like rotatory pattern around the body. Athetoid dance is a common feature of Athetoid cp in which they continueosly withdraw their feet upward almost as if they were dancing. Intelligence is frequently good and the children perform well academically.

Common features in cerebral Palsy

All cerebral palsyied children are slow in motor development because of retarded or abnormal development of postural balance mechanism or reflexes.

Appearance of certain abnormal reflexes

Inability to maintain balance and posture

Children with Athetoid cp are more intelligent

Perception of space is more affected in spastic cp

There may be loss of sensation in one side of the body in child with hemiplegia

Spinal deformities together with ribcage abnormalities can lead to poor respiration

Seizures are more common in spastic cp when compared to other cp

Neonatal Reflexes

 Patients with cerebral palsy  often exhibit neonatal reflex are listed below:

      Tonic neck reflexes- ATNR & STNR

Crossed extensor response

Moro reflex

Galant reflex

Labyrinthine righting reaction

Parachute reaction

         Placing reaction

         Neonatal standing and stepping

Aim of Rehabilitation

• To develop some form of Locomotion and independent mobility that may include wheelchair, electronic wheelchairs
• To develop Independence in daily activities of drinking, eating, bathing, dressing, toileting and general self-care
• To play and develop  leisure and recreational activities
• To develop forms of communication