In this lecture we will discuss
Cerebral Palsy and intellectual disability.
So let's start with Cerebral Palsy.
Cerebral Palsy is a non progressive
it changes in its apprearance
It is a disorder of posture and movement
caused in general by an insult to the CNS.
early in development.
So common causes of cerebral palsy include
Children who are less than 28 weeks gestation
have a 100 fold increased risk in
developing cerebral palsy.
This is often through
during the peripartum period.
Patients with low birth rate are
also at increased risk for Cerebral Palsy.
And certainly any child
with traumatic birth
is at risk for cerebral palsy.
Any asphyxia before or during birth
puts a child at risk for cerebral palsy.
If the OB is following the baby
and the child is having late decelerations
that is the kind of picture where
cerebral palsy is an increased risk.
Patients who had infections or inflammations
around birth or in young infancy
are also at risk.
soon after birth, if a child develops for
there is an increased risk.
Any other pregnancy complications
causing things for example like
decreased blood profusions,
will increase the risk of
child for cerebral palsy.
So, cerebral palsy typically
presents with Spasticity
This may not be present at birth
but developed over
the first year of life.
Examples we might see are
scissoring of the legs.
If we see those legs crossing
over, the child is hypertonic.
Patients later develop Ataxia or
inability to control their movements.
these can be in the arms or
They may develop dystonia.
or an increased tone as a result of
their neurologic deficit.
rarely they may have
There are a few different types
of cerebral palsy.
There is Spastic diplegia,
which is where both legs are affected.
Spastic hemiplegia where one side
of the body is affected.
And spastic quadriplegia
which is the worst kind
with all extremities are affected.
Unfortunately for cerebral palsy
there really is no cure for this problem.
Basically, what we try to do is get this
children involved in physical therapy
as early as possible.
Earlier involvement with physical therapy and
and things that can be targetted
towards that child's deficit
will have a much better prognosis.
We enroll all children in early
Early intervention is a program
where children are seen early
by physical therapists, occupational
even speech therapists
to help them improve in terms
of their developmental outcome.
In cases where children get
somtimes botox injections can be
in those spastic areas.
And we do this frequently.
Also patients can receive medications
such as baclofen
which can reduce Spasticity
of their muscles.
So, medications we might use
patients are sometimes placed on long term
although we generally do like to avoid that,
there are some circumstances
where their lives are better
than off them.
Dantroline can be used.
Baclofen can be used
and maybe used in a pump
that is continuously providing
Anticholinergics may be used in
patients with severe Spastic quadriplegia
for preventing drooling. You might put them
on atropine for example.
So that they have less pooling of
and they can manage their oral
It is important to remember
that if a patient has cerebral palsy,
they don't necessarily have
an intellectual disability.
Of course, the patient could have both.
But that is not necessarily
These patients often feel like they
are talked down to
People speak to them
as if there is presumed to be
an intellectual disability.
When we approach one of these patients,
we should approach them
like any other child of that