Class notes
NRSG 328 Cerebral Palsy Notes
- Course
- NRSG 328
- Institution
- Emory University
This is a comprehensive and detailed note on cerebral palsy for NRSG 328.
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1Cerebral Palsy: a group of permanent movement disorders of the brain caused by abnormal
development of or damage to the parts of the brain that control movement, balance, and posture;
damage is non-progressive.
Motor disorders, disturbances of sensation, perception, communication, cognition, seizures
and behavior are classic findings with CP.
There is a higher incidence in infants weighing 1000 grams to 1499 grams at birth, or infants
born prior to 28 weeks gestation.
o Infants exposed to maternal and perinatal infection have increased risk.
o Additional causes include intracerebral hemorrhage in low-birth-weight infants,
perinatal ischemic stroke, bacterial meningitis, multiple births, and viral encephalitis.
o Head trauma due to MVA, and child abuse (shaken baby syndrome) (from “Cerebral
Palsy: Hope Through Research. National Institute of Neurological Disorders and
Stroke. July 2013, reviewed 2017)
o Malformations (genetic anomalies) of the brain, and anoxia are other major causes
o Anoxia can occur in utero, during the birth process, after birth (classified as CP up to
3 years of age).
o Often the cause is unknown (from “Cerebral Palsy: Hope Through Research. National
Institute of Neurological Disorders and Stroke. July 2013, reviewed/ revised 2017)
Classification:
There are three main CP classifications by motor impairment: spastic, ataxic, and
athetoid/dyskinetic movements:
Spastic – Causes tight, stiff muscles (hypertonic) and movement problems (70%) of cases;
results from damage (lesions) to upper motor neurons in the brain as well as the
corticospinal tract or the motor cortex. This damage impairs the ability of some nerve
receptors in the spine to receive gamma-Aminobutyric acid (leads to hypertonia in the
muscles)
Ataxic – Affects balance and coordination specifically in the arms, legs, and trunk (5-10% of
cases). Ataxic CP is caused by damage to cerebellar structures hence the problems with
muscle movement, coordination, and balance. These children exhibit decreased muscle
tone – the most common manifestation of CP is intention (action tremor) apparent when
carrying out precise movements.
Dyskinetic/athetoid – Causes involuntary (unable to control) muscle movement and is
associated with damage to the basal ganglia (lesions that occur during brain development
due to bilirubin encephalopathy and hypoxic-ischemic brain injury). Clinical diagnosis
occurs within 18 months of birth and is based primarily upon motor function and
neuroimaging techniques. This is a non-spastic extrapyramidal form of CP.
Dyskinetic CP can be divided into two groups:
a. Choreoathetoid – involuntary movements most predominantly found in the face
and extremities
, 2
b. Dystonic – slow, strong contraction which may occur locally or encompass the
whole body.
Also, there is Mixed – Includes a mix of symptoms from the other three types of CP.
In summary, Cerebral palsy:
Is chronic and non-progressive
Is not contagious
Cannot be cured.
Diagnostics:
Birth history
Magnetic resonance imaging (MRI)
Computed tomography (CT) scan
Cranial ultrasound
Treatments include:
Medicines to decrease muscle stiffness i.e. Baclofen!
Physical, occupational or speech therapy
Orthotics (splints or braces)
Evaluation by other specialists in orthopedics, neurosurgery or ophthalmology
Surgery
Options for surgery.
Muscle or tendon lengthening: lengthening the large muscles or tendons in the back of the leg, hip or
sometimes the muscles of the arm or hand.
Selective dorsal rhizotomy (SDR): cutting of some of the roots of nerves as they leave the spine; stopping
the nerves from forcing the muscles to be rigid or tight.
Intrathecal baclofen: ATI question!!!! Implantation of a small pump connected to a catheter that delivers
a continuous infusion of Baclofen (Gablofen, Lioresal) into the spinal tract. Baclofen reduces spasticity (works
on specific cells of the brain). Children must be 40 lbs or greater and have parents who are compliant with
treatment and return visits to the outpatient clinic. Baclofen can also be given po (if child can swallow) or G
or J tube.
Botulinum toxin (botox) and phenol treatment: injection of botox or phenol into the muscles. Botox is a
type of protein, and phenol is an anesthetic. These can help decrease muscle tone and loosen large muscle
groups.
Various Bone, joint, and spinal surgeries
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