- Disorder of movement and posture due to defect in the immature brain
- Underlying brain pathology is non-progressive
- Often presents at birth or in early childhood
- Caused by:
- Birth trauma or asphyxia
- Disease or injury in early life
- Essentially is a motor disorder
- Affects voluntary movements
- May also have other handicaps including:
- Blindness
- Sensory abnormalities
- Speech defects
- Mental deficits
Clinical features
- Motor defects takes several forms in either isolation or combination
- Spasticity
- Loss of coordination
- Rigidity
- Hypotonic muscles
- Developmental milestones are often delayed
- Paralysis can be variable in extent
- Arm and leg on one side - hemiparesis
- One limb - monoparesis
- Both legs - paraparesis
- All 4 limbs - quadriparesis
- Spasticity is of an upper motor neuron type
- Flexor muscles are often more spastic than extensors
- Reflexes are exaggerated
- Stretch reflexes are abnormally sensitive
- Deformity develops early due to muscle imbalance
- Several patterns of deformity are seen
- Flexion of elbow wrist and fingers
- Flexion and adduction of hips and knees
Management
- The handicaps are variable and complex
- Patients should be managed by a multidisciplinary team including:
- Paediatricians
- Orthopaedic surgeons
- Physiotherapists
- Psychologists
- Speech therapists
- Social workers
- Mainstay of treatment is physiotherapy
- Physiotherapy aims are to:
- Assist in assessment
- Prevent or attempt to correct musculo-skeletal deformity
- Train the child in posture and movement
- Provide suitable sensory stimulation
Surgery
- Surgery aims to:
- Correct any established deformity
- Soft tissue surgery - tendons, joint capsules, skin
- Bone correction
- Restore muscle balance and diminish spasticity
- Tendon lengthening
- Tendon transfers
- Partial denervation
- Splintage
- Surgery is most valuable in the lower limb
- Timing of surgery is important
Bibliography
Bax M. Diagnostic assessment of children with cerebral palsy.
Lancet Neurol 2004: 3: 395.
Keogh J M. Badawi N. The origins of cerebral palsy.
Curr Opin Neurol 2006; 19: 129-134.
Koman L A. Smith B P. Shilt J S. Cerebral palsy.
Lancet 2004; 363: 1619-1631.
Krigger K W. Cerebral palsy: an overview. Am Fam
Physician 2006; 73: 91-100.
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