Cerebral Palsy (CP)

00:01 In this lecture we will discuss Cerebral Palsy and intellectual disability.

00:07 So let's start with Cerebral Palsy.

00:10 Cerebral Palsy is a non progressive problem but it changes in its apprearance over time.

00:17 It is a disorder of posture and movement caused in general by an insult to the CNS.

00:23 early in development.

00:25 So common causes of cerebral palsy include pre-term delivery.

00:31 Children who are less than 28 weeks gestation at birth have a 100 fold increased risk in developing cerebral palsy.

00:39 This is often through CNS damage during the peripartum period.

00:45 Patients with low birth rate are also at increased risk for Cerebral Palsy.

00:50 And certainly any child with traumatic birth is at risk for cerebral palsy.

00:55 Any asphyxia before or during birth puts a child at risk for cerebral palsy.

01:01 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.

01:11 Patients who had infections or inflammations around birth or in young infancy are also at risk.

01:17 So soon after birth, if a child develops for example, bacterial meningitis there is an increased risk.

01:25 Any other pregnancy complications causing things for example like decreased blood profusions, So example, preeclampsia will increase the risk of child for cerebral palsy.

01:37 So, cerebral palsy typically presents with Spasticity This may not be present at birth but developed over the first year of life.

01:47 Examples we might see are scissoring of the legs.

01:51 If we see those legs crossing over, the child is hypertonic.

01:55 Patients later develop Ataxia or inability to control their movements.

01:59 these can be in the arms or the legs.

02:02 They may develop dystonia.

02:04 or an increased tone as a result of their neurologic deficit.

02:09 And rarely they may have frank Choreoathethosis There are a few different types of cerebral palsy.

02:18 There is Spastic diplegia, which is where both legs are affected.

02:24 Spastic hemiplegia where one side of the body is affected.

02:28 And spastic quadriplegia which is the worst kind with all extremities are affected.

02:35 Unfortunately for cerebral palsy there really is no cure for this problem.

02:40 Basically, what we try to do is get this children involved in physical therapy as early as possible.

02:47 Earlier involvement with physical therapy and stretching exercises and things that can be targetted towards that child's deficit will have a much better prognosis.

02:58 We enroll all children in early intervention.

03:02 Early intervention is a program where children are seen early by physical therapists, occupational therapists, even speech therapists to help them improve in terms of their developmental outcome.

03:16 In cases where children get significant contractions, somtimes botox injections can be used in those spastic areas. And we do this frequently.

03:27 Also patients can receive medications such as baclofen which can reduce Spasticity of their muscles.

03:35 So, medications we might use patients are sometimes placed on long term benzodiazepines although we generally do like to avoid that, there are some circumstances where their lives are better on benzodiazepines than off them.

03:51 Dantroline can be used.

03:53 Baclofen can be used and maybe used in a pump that is continuously providing the medication.

04:00 And Anticholinergics may be used in patients with severe Spastic quadriplegia for preventing drooling. You might put them on atropine for example.

04:10 Or glycopyrrelate So that they have less pooling of secretions and they can manage their oral function better.

04:19 It is important to remember that if a patient has cerebral palsy, they don't necessarily have an intellectual disability.

04:28 Of course, the patient could have both.

04:30 But that is not necessarily the case.

04:33 These patients often feel like they are talked down to People speak to them particularly loudly as if there is presumed to be an intellectual disability.

04:42 When we approach one of these patients, we should approach them like any other child of that particular age.