Cerebral Palsy and Rehabilitation

There is a hierarchical order in the development of the nervous system:

From simple to complex: First learning to spell, then learning to speak.

From general to specific: First ulnar, then whole-hand grasping, and finally the development of radial grasping ability.

From head to feet (cephalocaudal): Learning to hold the head upright with the development of the nuchal muscle nerves in the first months, then learning to sit and walk, respectively.

From center to extremities (proximal to distal): Learning to use the arm first, then the hand to grasp an object.

• Cerebral Palsy (CP): 

  A general term used to describe a series of symptoms (such as motor skill limitations, speech and learning disorders, and other disorders) that occur due to permanent damage to the baby’s brain in the womb, at birth, and in the months immediately following birth.

   

  Risk Factors:

   

  General: Gestational age <32 weeks / Birth weight <2500 gr

  Maternal causes: Mental retardation, epilepsy, hyperthyroidism, 2 or more stillbirths, sibling with motor deficits.

   

  During pregnancy: Twin pregnancy, fetal growth retardation, increased urinary protein excretion, low placental weight.

  Fetal factors: Fetal malformations, fetal bradycardia, neonatal seizures

  Classification according to tone abnormalities:

   

  Spastic

  Dyskinetic

  Athetoid

  Choreiform-Distal

  Ataxic

  Hypotonic

   

  Classification according to the affected body part:

• Classification according to the body part affected:Diplegia
  Quadriplegia
  Triplegia
  Hemiplegia

  Findings that raise suspicion of CP in the neonatal period:

  – Presence of risk factors
  – Convulsions
  – Micro/macrocephaly, hydrocephalus
  – Hypertonia/hypotonia
  – Developmental reflexes; not obtained-asymmetrical-not lost in time

  Neurological Examination

  Mental status
  Vision – hearing – speech
  Muscle strength and voluntary muscle control
  Reflexes
  Muscle tone
  Involuntary movements

  Orthopedic examination

  Joint range of motion
  Deformity and contracture
  Balance
  Posture while sitting, standing and walking

  Functional Examination

  Sitting
  Walking
  Manual dexterity

• Functional ExaminationSitting examination
  Walking examination
  Classification of ambulation capacity
  Gait analysis

  Pathological Gait in CP

  Jumping gait
  Crouching gait
  Stiff knee gait
  Scissoring gait

  Rehabilitation:

  Physiotherapy: Conventional Exercise Programs, Neurofacilitation Techniques, Functional Therapy
  Occupational Therapy
  Speech and Hearing Therapy
  Vision Rehabilitation
  Dysphagia Rehabilitation
  Oral and Dental Problems

  Conventional Exercise Programs:

  Active and passive exercises for joint range of motion
  Stretching
  Strengthening exercise programs
  Consists of exercise programs that increase cardiovascular capacity.

• Neurofacilitation Methods:Sensory stimuli sent to the CNS create a reflex motor response. In SP, all of these techniques are therapies based on the same principle but apply different stimulus positions and modalities.

  General purpose of all techniques: Normalize muscle tone, develop advanced balance reactions in the body, facilitate normal movement patterns.

  Functional Therapy:

  Priorities are determined for the child and the family.
  Activities are performed repetitively in the natural environment where the child lives.
  Strengthens motor skill learning.
  The child takes an active role.

  “Active motor learning > passive motor learning”

  Device:

  KAFO-metal bar AFO is not used.
  Biomechanical control is provided with variations of plastic AFOs, the smallest possible device is used.
  Mobilization MUST be provided even in children who cannot walk.