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DEFINITION
IT IS A NEUROMOTAR DISORDER RESULTING FROM NON-PROGRESSIVE DAMAGE TO THE DEVELOPING
BRAIN.
CAUSES
• PRENATAL
• SMOKING/ALCOHOLISM
• DIABETIS/HYPERTENSION
• FALL
• CONSANGINIOUS MARRAIGES
• RH INCOMPATIBILITY
• PERINATAL
• FORCEPS DELIVERY
• BREECH PRESENTATION
• PREMATURE DELIVERY
• POSTNATAL
• JAUNDICE
• SPASTIC
• ATHETHOID
• ATAXIC
• FLACCID
• MIXED
• TOPOGRAPHICAL CLASSIFICATION
• QUADRIPLEGIC
• HEMIPLEGIC
• PARAPLEGIC
• MONOPLEGIC
• DIPLEGIC
CLINICAL TYPES
SPASTIC CEREBRAL PALSY:
These kids may have normal IQ and can be sent to normal schools
ATAXIC CEREBRAL PALSY
Coordination is lost
CLINICAL FEATURES
ABNORMAL TONE
ABNORMAL REFLEXES
SENSORY DISTURBANCES
CONTRACTURES &DEFORMITIES
RESPRATORY&ORO-MOTAR DYSFUNCTION
DYSMORPHIC FEATURES
MENTAL RETARDATION
MULTIPLE ASSOCIATED DEFICITS
MENTAL RETARDATION
CONVULSIONS
VISUAL DEFICITS
HEARING DEFECTS
PERCEPTUAL PROBLEMS
LEARNING DISABILITIES
FEEDING PROBLEM
DYSMORPHIC FEATURES
FRONTAL BOSSING
IRREGULAR DENTITION
As the age at which diagnosis is made goes on increasing ,secondary complications of developmental
delay come into picture.
The neonate is seen by the therapist earliest in NICU where baby is admitted for medical complications
When neonate is referred to physiotherapist before starting the therapeutic intervention assessment of
the infant has to be carried out.
ASSESMENT OF C.P
Assessment starts with history .Detailed history of prenatal/peri natal & postnatal risk factors has to be
obtained from either from mother or from medical records
APGAR SCORE
It is a quantitative method for assessing infants respiratory ,circulatory , & neurological status
immediately after the birth
SCORING OF APGAR
SNEEZE
5 COLOUR OF BABY BLUE/PALE BODY PINK COMPLETELY
&EXTREMITIES PINK
BLUE
SCORE EFFECT
8-10 NORMAL
As in new born ,extremities are always blue immediately after birth ,ideal score is never 10 at 1 min but
9
Therefore a pre term infant should de identified from normal term infant
Illingworth scale differentiate a pre term baby [risk baby] from full term baby.
6 POSTURE OF PRONE: flat pelvis & knees at the PRONE: pelvis high
BABY side of abdomen knees drawn up
under abdomen
Acute flexion at hips
SUPINE: Limbs are
SUPINE: lower limbs externally strongly flexed
rotated & abducted .head aligned to
Head turned to side trunk
VOJTA’S REACTIONS
These are useful for diagnosis of brain damage in infants
Dr.Vojta ,a German Pediatric Neurologist standardized 7 postural reflexes along with Neurological &
behavioral assessment technique to diagnose the development of cerebral palsy in the neonate
VOJTA’S REACTIONS
1]TRACTION
2]LANDAU
3]AXILLARY SUSPENSION
4] VOJTA’S SIDE TILT REACTION
5]COLLI’S HORIZONTAL SUSPENSION
6]PIEPER &ISBERT’S REACTION
7]COLLI’S VERTICAL SUSPENSION REACTION
VOJTA’S RECTIONS
These reactions develop in which are dependent on the age of infant from 0-12 months
It is scaled as follows
6 Pieper & Isbert’s The infant is held by its thighs Head hangs in the center
vertical suspension & lifted suddenly head down
Upper limb –MORO
in vertical position
RESPONSE
Head spine &upper limb is
observed No response in spine
REFLEX MATURATION
A REFLEX IS A STERO TYPED RESPONSE TO A STIMULUS
-TREATMENT PLANNING
NEONATAL REFLEXES
1 Doll’s eye reflex Birth-10 days Baby head is Eyes lag behind
turned to one
side
6 Placing of upper Birth -6 months Brush the dorsum Flexion of upper limb
extremity of one of baby’s with placement of hand
hand against edge on the table
of the table
7 Placing of lower Birth – 1 ½ Brush the dorsum Flexion of the lower limb
extremity months of the foot with placement of foot
against the under on the table top
edge of the table
3 Crossed Birth-2 months One leg in flexion & The flexed leg extends
extensor other in extension. Give
pressure on the ball of
the foot of extended leg
without allowing flexion
of the same leg
BRAIN –STEM REFLEXES
CORTICAL REACTIONS
Equilibrium:
Is tested on equilibrium board in all the functional positions or by pushing the baby from static posture.
Prone 6months
Supine 8 months
Kneeling 15 months
To enable the baby to have some kind of locomotion &interact with environment
AIMS OF PHYSIOTHERAPY
DEVELOPING RAPPORT WITH PARENTS & BABY
SENSORY INTEGRATION
PLANS OF PHYSIOTHERAPY
Developing rapport: developing rapport with the kid is very important as any goal will be
difficult to achieve without the cooperation of the baby. The baby has to be motivated well
enough to gain the confidence .The goals set for the baby must be challenging at the same time
achievable
Explain the role of mother & teach the home exercises so that it can be carried at home as
treatment of cerebral palsy is whole day management
Remember always the therapy should be play therapy .Try to include games or play items into
the therapy or else the kid will not show interest in the treatment
MANAGEMENT OF ABNORMAL TONE
HYPERTONICITY
• SLOW PASSIVE MOVEMENTS
• SUSTAINED STRETCH
• CRYOTHERAPY
• VIBRATIONS
HYPOTONICITY
• WEIGHT BEARING
• JOINT COMPRESSIONS
• RHYTHMIC STABILIZATION
• VIBRATIONS
• CRYOTHERAPY
• TAPPING
In cerebral palsy ,because of delay or absence of normal movements ,muscles are usually in
shortened state
Equilibrium reactions are necessary before the next mile stone is achieved
SENSORY INTEGRATION
Perception includes whole of sensorimotor experience. Sensory integration is ability to organize
the sensory inputs for use.
Various functional activities incorporating different objects /sizes /colours/textures can be used
in therapy
Eg:beading ,putting different size objects into respective holes, getting the object under the
chair,sandplay.putti-clay,colouring squares circles, obstacle walking
PLANS OF PHYSIOTHERAPY
Oromotar function depends on well controlled head &neck flexion which is dependent upon the
active use of supra&infra hyoid muscles that have the primary action on jaw ,tongue &hyoid
movements.
Drooling
THERAPY:
Develop good neck control[wedge exercises]