DEFINITION
It is a non progressive neurological disorder of movement ,posture and tone due to a non progressive pathological process in the brain caused by an insult to the developing brain

 

Depending on the site and extent of involvement ,it may be associated with

• visual disturbances
• seizures
• mental retardation

Etiology

Both prenatal and perinatal factors are considered.

1. prematurity

2. kernicterus

3. structurally abnormal brain

4. birth asphyxia

5.encephalitis

6.meningitis

Classification

1. spastic CP
2. Extra pyramidal CP
3. Cerebellar or ataxic CP
4. Mixed CP

Spastic C P

Again classified into

1. Diplegic C P
2. Hemiplegic C P
3. Quadriplegic C P

Diplegic C P

commonest form of C P in preterm

symptoms

1. spastic lower limbs with increased tendon jerks and extensor plantar  response
2. scissoring of legs
3. visual disturbances

Hemiplegic C P

There is paresis of one side of body with upper motor neuron type of spasticity increased reflexes and extensor plantar response

Quadriplegic C P

1. spasticity in all the four limbs with pseudo bulbar palsy
2. severe mental retardation
3. epilepsy

Extra pyramidal C P

Distonia and choreoathetosis in various propotions

1. Defective coordination of movements
2. defective regulation of muscle tone,resulting in the inability to execute the intended movements

Ataxic C P

Manifest only in second year of life,before that the child may remain floppy without other cerebellar signs

 

Investigations

1. CT
2. MRI
3. TORCH screening for associated symptoms

Treatments

Treatment of associated defects and optimum utilization of available motor functions become important

Treatment of associated deficits

• seizures can be controlled with anticonvulsants
• early stimulation aimed at functional development of various modalities is a must
• physiotherapy
• prevention of contractures -splinting  may prevent this
• avoid\make use of abnormally persisting reflexes
• reflex stimulation
• training in motor activities
• education
• Orthopedic & neurosurgical measures

1.    arthrodesis of the wrist,ankle etc may be considered if it adds to the functional recovery
2. in established contracture , muscle lengthening to decrease the adduction of hip,flexion of knee etc..
3. surgical transfer of tendons to the muscles of desired function and release of tendo achilles contracture
4. peripheral nerve section (obturator nerve) may help to reduce adductor spasm
5. a more advanced surgery is selective motor fasiculotomy where selected fasicule of a nerve that causes undesirable hyper tones is cut off after identifying them by stimulation studies
6. surgical implants of electrodes in   selected areas over the dura of spinal cord can be used for spinal stimultaion

 

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