Neuromotor Problem In cerebral palsy

Cerebral palsy is not a disease but it is a group of neuromotor problem comprising of physical disability associated with medical problem

Whole Problem seen in child with Cerebral Palsy-

Developmental milestone : delayed gross motor, fine motor etc…

Mobility: poor postural control, in coordination, poor balance, involuntary movement etc…

Cognition : Attention, concentration, memory etc.

Self care: Dependent/ partial dependent in basic ADL (feeding, dressing etc…)

Social: communication, social behavior (verbal& non-verbal)

Academic: Maintaining posture, hand function etc

Motor Disabilities :-

  • Hyper-tonicity – spasticity, rigidity and athetosis (involuntary movement) along with its consequences like contracture, torsional deformity and joint dislocation
  • Paralysis (weakness) of the propulsive and antigravity muscles
  • Abnormal movements and postures and Persistence of primitive reflexes
  • Difficulty in coordinated and alternative movements
  • Difficulty in keeping the body in antigravity postures

Sensory Disability— loss of cortical sensation likes two point discrimination, stereo gnosis fine tactile sensation and joint position sense.

Associated Handicap: Associated problem define ultimate outcome in management of cerebral palsy . 1. Speech problem – 82%, 2. Mental Retardation – 30%,3 . Deafness-15%, 4. Visual defect-34%, 5. Perceptual problem-14%, 6.Convulsive disorders (25%)

Other associated problem

  • Mental retardation 8. Dental defects 9. Chest congestion 10. Sleeping disorder 11.Poor immunity 12.Growth retardation 13. social and emotional problems 14. Spinal defects 15. Bladder and bowel problems 16. Feeding problems 17. Constipation 18.Obesity 19. Malnourishment 20. learning disability

Effect of physical disability on different vital body system in relation with aging —

Effect of physical disability on musculoskeletal system

  • muscles become more tighter, Decrease in flexibility, limited muscle strength, endurance & restricted movement , More Energy expenditure ,Difficult to perform tasks & take longer time, frequent Fatigue & Muscle Sore

incremental factor–

  • Anti epileptic drugs, sun exposure, poor intake lead to Vit D deficiency (osteomalacia)
  • Less Wt. bearing & poor muscle lead to osteoporosis
  • Abnormal muscle tone lead to deformity & torsion of bone-Patella alta, hip dysplasia, spondylosis, cervical stenosis & Progression of Scoliosis curve
  • Early degenerative arthritis –mechanical malalignment between joint surfaces & excessive joint compression.
  • Post-impairment syndrome- a combination of pain, fatigue & weakness
  • Overuse syndromes (repetitive motion injuries)

End result

  • Loss of stamina, loss of physical functioning, Obesity, More need of support during standing & walking, Fracture with trivial trauma, Nerve entrapments, Myelopathy

Effect of disability on general health

  • More risk of Diabetes , Obesity or malnutrition, Hypertension & coronary artery disease, Problem in bladder control like Urinary retention, incontinence, Recurrent chest infection & restrictive lung disease , Pressure sores

Effect of disability on GI system

  • Earlier onset of disturbance in gastrointestinal functions, Combination of mouth breathing, poor hygiene, tooth grinding, mal-occlusion & abnormalities in tooth enamel, Cavities & periodontal diseaseProblem in Chewing, swallowing , Feeding & nutritional issues, Heartburn, hemorrhoids, Gastro-esophageal reflux, Frequent vomiting, poor general nutrition, retarded physical growth & aspiration & Constipation

Effect of disability on psychological state

  • Early memory loss, Sleep deprivation, Fluctuating emotional status, The rate of depression is three to four times higher, loss of Self-esteem, Self neglect

Effect of disability on Reproductive health

  • Difficult counseling of women with cerebral palsy, Pregnancy, Problem in menstrual cycle, Menopausal symptom, Need of sex, STD, birth control, Body image

Impact of disability on social issue

  • Lower level of education, Higher level of poverty, higher level of unemployment, Less disposable income, Self care, Lesser social activities and communication problem due to ambulatory & speech problem, Social abuse, drug & alcohal abuse

case of hemiplegic spastic cerebral palsy treated by SEMLS by OSSCS concept