Cerebral Palsy (CP)

  1. General information
    1. Neuromuscular disorder resulting from damage to or altered structure of the part of the brain responsible for controlling motor function
    2. Incidence: 1.5-5 in 1,000 live births
    3. May be caused by a variety of factors resulting in damage to the CNS; possible causes include
      1. Prenatally: genetic, altered neurologic development, or trauma or anoxia to mother (toxemia, rubella, accidents)
      2. Perinatally: during the birth process (drugs at delivery, precipitate delivery, fetal distress, breech deliveries with delay)
      3. Postnatally: kernicterus or head trauma (child falls out of crib or is hit by a car)
  2. Medical management
    1. Drug therapy
      1. Antianxiety agents
      2. Skeletal muscle relaxants
      3. Local nerve blocks
    2. Physical/occupational therapy
    3. Speech/audiology therapy
    4. Surgery: muscle- and tendon-releasing procedures
  3. Assessment findings: disease itself does not progress once established; progressive complications, however, cause changes in signs and symptoms
    1. Spasticity: exaggerated hyperactive reflexes (increased muscle tone, increase in stretch reflex, scissoring of legs, poorly coordinated body movements for voluntary activities)
      1. Occurs with pyramidal tract lesion
      2. Found in 40% of all CP
      3. Results in contractures
      4. Also affects ability to speak: altered quality and articulation
      5. Loud noise or sudden movement causes reaction with increased spasm
      6. No parachute reflex to protect self when falling
    2. Athetosis: constant involuntary, purposeless, slow, writhing motions
      1. Occurs with extrapyramidal tract (basal ganglia) lesion
      2. Found in 40% of all CP
      3. Athetosis disappears during sleep, therefore contractures do not develop
      4. Movements increase with increase in physical or emotional stress
      5. Also affects facial muscles
    3. Ataxia: disturbance in equilibrium; diminished righting reflex (lack of balance, poor coordination, dizziness, hypotonia)
      1. Occurs with extrapyramidal tract (cerebellar) lesion
      2. Found in 10% of all CP
      3. Muscles and reflexes are normal
    4. Tremor: repetitive rhythmic involuntary contractions of flexor and extensor muscles
      1. Occurs with extrapyramidal tract (basal ganglia) lesion
      2. Found in 5% of all CP
      3. Interferes with performance of precise movements
      4. Often a mild disability
    5. Rigidity: resistance to flexion and extension resulting from simultaneous contraction of both agonist and antagonist muscle groups
      1. Occurs with extrapyramidal tract (basal ganglia) lesion
      2. Found in 5% of all CP
      3. Diminished or absent reflexes
      4. Potential for severe contractures
    6. Associated problems
      1. Mental retardation: the majority of CP clients are of normal or higher than average intelligence, but are unable to demonstrate it on standardized tests; 18%-50% have some form of mental retardation
      2. Hearing loss in 13% of CP clients
      3. Defective speech in 75% of CP clients
      4. Dental anomalies (from muscle contractures)
      5. Orthopedic problems from contractures or inability to mobilize
      6. Visual disabilities in 28% due to poor muscle control
      7. Disturbances of body image, touch, perception
      8. Feelings of worthlessness
  4. Nursing interventions
    1. Obtain a careful pregnancy, birth, and childhood history.
    2. Observe the child's behavior in various situations.
    3. Assist with activities of daily living (ADL), help child to learn as many self-care activities as possible; CP clients cannot do any task unless they are consciously aware of each step in the task; careful teaching and demonstration is essential.
    4. Provide a safe environment (safety helmet, padded crib).
    5. Provide physical therapy to prevent contractures and assist in mobility (braces if necessary).
    6. Provide client teaching and discharge planning concerning
      1. Nature of disease: CP is a nonfatal, noncurable disorder
      2. Need for continued physical, occupational, and speech therapy
      3. Care of orthopedic devices
      4. Provision for child's return to school
      5. Availability of support groups/community agencies.