DR - Vilasinee Ari Hara Kumar

Dr.
Vilasinee Ari Hara Kumar

 Cerebral palsy refers to a disorder of motor function
resulting from a non progressive brain lesion occurring

before the brain is fully mature.
1. What is Cerebral Palsy
2. What causes Cerebral palsy?
3. What are the types of cerebral palsy?
4. What are the signs and symptoms of Cerebral
palsy?
5. What are the role of doctor, pharmacist,
physiotherapist ,and rehabilitations?
 Lesion is static, symptoms often change with time.
 Eg. Hypotonia to hypertonia
 increasing dystonia with age
 Bony deformities
 Contractures
1. Limbs involved - Monoplegia
Diplegia
Triplegia
Quadriplegia
Hemiplegia
2 Tone - Hypotomia
Spasticity
3 Associated Movement Disorders - Dystonia
Chorea
Athetosis
Ataxia
 Delayed Development delay
 Low muscle tone (Hypotonia)
 Infantile reflexes persist for a long time
 Seizures
 Evaluation of muscle tone
 R.O.M.
 Associated movements disorders
 Psycho Social Assessment
1. Spastic
 Passive ROM
 Active ROM
 Spinal mobility
 Use of varied and differential movement pattern
incorporating varied speed and directions
 Equipment to aid with weight bearing movement
and position transitions.
 Promotive muscle Elongation as well as joint
mobility & stability
Athetoid
 Postural tone and balance
 Promoting midline & Symmetrical muscle control
 Small graded movements
Hypotonic
 Antigravity positioning of head
 Trunk control
 Promoting automatic reactions
 Stabilization of joins
Infancy and toddler
 Optimal movement patterns and postures during
daily care activities such as feeding, playing ,
carrying, toileting and movement.
 Adaptive equipments
 Special strollers
 Bath chairs
 Feeding equipments
 Fist, hand or limbs splints
Pre-school-
 Promote skill acquisition for independent function.
 Therapy promotes strength, endurance and
movement patterns.
Mobility issues
wheel chairs
crutches,
walkers,
strollers,
car seats,
school chairs,
splints and orthotics
 Architecture
adaptations
 Home modifications
 Installing wheel chair
lifts
 Classroom
accommodations
 Modified ashworth scale (MAS)
 Measure resistance to passive movements in
upper/lower limbs
 Goniometer measurements PROM / AROM
 Gross motor functional measure
 Assess current level of function and provides goal for
treatment.
 Paediatric evaluations of disability inventory.
 Functional skills in the areas of mobility
 Self care
 Social functions
 Strength measurements by dynamometers
 Neuro developmental training NDT/ Bobath
 Inhitit abnormal muscle tone and primitive reflaxes
 Facilitate normal movement patterns via postioning and
handling techniques that promote sensation of normal
movement
 Emphasis is on acquiring functional skills
 Weight bearing
 Weight shifting
 Normalizing tone
 FES
 Other Therapies
 Strengthening / Stretching
 Serial casting
 Functional Activities
 Dynamic approach repetition of activities by the
patient
 Adaptive equipments
 Sealing system
 Walker
 Canes
 Splinting low temperature thermoplastics
 AIM Spasticity
 Associated movement eg. Dystomia
 CNS acting
 Benzodia zepines Diazepam
 Clonazepam
 Lorazepam
 Tizanidine
 Baclofen
 Peripheral - Dantrolene
 Acts via inhibitory neuro transmitter GABA in spinal
cord
 Effect - relief in painful muscular spasm
- Improvement in sleep
- Long term muscle tone
- Anticonvulsiant property
 Side effect - Habituation
- Sedation
- Secrctions
- Rebound seizures with abrupt
withdranwal
Action on GABA receptor in spinal cord
 Effect Toletrated long term

 Muscle tone / Active Passive
 Side effect - Sedation
- Truncal hypotomia
- Change in bladder habits
 Effect - Aplha 2 adrenergic effects
- Anti hypertensive
- Treat movement disorder & eg tics

 works directly on the sarcoplasmic reticulum of
muscle and is effective in decreasing muscle tone
 Side effect - Muscle weakness
- GI upset, fatigue
- Hepato Toxicity
 In patients with
spasticity of cerebral
origin
 Continuous infusion of
baclofen in intrathecal
space
 Maintain mobility & Stability of joints
 Surgery at hip when subluxation or abduction less
them 300
 Improves function
 prevent worsening of
contractures
 Prevents recurrence of
deformities after surgical

correction
 Treatment for CP with focus on prevention of CP as
well as effective and permanent at the level of brain.
Treatment occurs most effectively with a
multidisciplinary approach to assessment and
treatment.
1. The commonest etiologies for cerebral palsy include all of
the following except,
I. Prematurity
II. Cerebral hypoxemia
III. Vitamin C deficiency
IV. Hyperbilirubinemia
2. Which of the following is not a Pre-natal cause of C.P.,
I. Prolonged and difficult labor
II. Premature rupture of membranes
III. CNS infection (encephalitis, meningitis)
IV. Multiple pregnancies

3. Which of the following scale is used for assessment of
spasticity-
I. GCS
II. MAS ( Modified Ashworth scale)
III. AS (Ashworth scale)
IV. AIS (American Spinal Injury Association (ASIA)

Impairment Scale )
4. Which of the following is not a centrally acting anti spastic
medication,
I. Diazepam
II. Tizanidine
III. Dantrolene
IV. Baclofen
5. Among the following which is not used for spasticity
management in C.P.,
I. Stretching Exercises.
II. Bracing.
III. Baclofen
IV. Anti spasmodic drugs.

DR - Vilasinee Ari Hara Kumar

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DR - Vilasinee Ari Hara Kumar

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Dr.

Vilasinee Ari Hara Kumar

resulting from a non progressive brain lesion occurring

 Effect Toletrated long term

- Treat movement disorder & eg tics

 Side effect - Muscle weakness

deformities after surgical

II. Cerebral hypoxemia

III. Vitamin C deficiency

I. Prolonged and difficult labor

II. Premature rupture of membranes

III. CNS infection (encephalitis, meningitis)

IV. Multiple pregnancies

II. MAS ( Modified Ashworth scale)

III. AS (Ashworth scale)

IV. AIS (American Spinal Injury Association (ASIA)

IV. Anti spasmodic drugs.

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