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CEREBRAL PALSY TREATMENT

Cerebral palsy is a disorder which occurs in children which largely effect muscular movements and coordination. It is not caused by complications during the process of birth or perinatal difficulties. It is the result of some injury to the brain that occurred during pregnancy which leads to cp and predisposes the infants to a difficult delivery.



Biochemical Response to Asphyxia


Cerebral blood flow is sensitive to


  • PaO2(Inversely related with CBF).
  • PaCo2(Hypercarbia increase CBF and Hypocarbia decreases CBF)

  • Acid base status(Acidosis increases CBD and Alkalosis decreases CBF)


    Early markers of CP


  • SLOW head growth.
  • Poor head control
  • Eye – roving eyes, poor hand regard, persistent squint.
  • Ear – lack of auditory response.
  • Irritability, seizures, poor suck, poor quality of sleep.
  • Extreme sensitivity to light
  • Cortical thumb beyond 8 weeks
  • Handedness before 2 yrs
  • Paucity of limb movements
  • Scissoring of lower limbs
  • Toe walking
  • Abnormal tone
  • Persistence of primitive reflexes or failure to acquire postural reflexes
  • Stereotypic abnormal movements
  • Lack of alertness

  • CP DIAGNOSIS


  • Initial complaint is failure to meet early developmental milestones.
  • No evidence of progressive disease.
  • No loss of milestones acquired previously


  • Criteria


  • Delayed Milestones
  • Persistence of primitive reflexes
  • Pathological reflexes
  • Failure to develop protective reflexes


  • Differential Diagnosis


  • In the early infancy when the child is in hypotonic phase, neuromuscular conditions like myopathies may cause diagnostic confusion.
  • Children with mental retardation may have hypotonia but do not have abnormal motor patterns or postures.
  • Neurodegenerative conditions which have onset in early infancy such as Tay-Sach disease, Crabbe’s disease, and Metachromatic Leucodystrophy can mimic CP to a good extent.
  • The progressive course of these conditions can be ascertained on the basis of history, and relevant investigation can confirm the diagnosis.
  • Dopa-responsive dystonia and organic aciduria like glutaric aciduria may look like dystonic CP.

  • Disabling Conditions be Evaluated on Multiple Axes


  • Pathophysiology (underlying disease).
  • Impairment (clinically observable abnormality).
  • Functional limitations (effect on task performance).
  • Disability (effect on daily living) and.
  • Societal limitations (effect on lifetime opportunities).
  • Since CP is a changing disorder it is evident that some limitations may not be evident early in life but might manifest in the schooling age or later.
  • The hemiplegic type of CP has the best prognosis for walking with 95% walking by 3 years compared to 40% of other groups.
  • Age of sitting is a good guide to prognosticate about walking. A child who is able to sit unsupported at 2 years will eventually be able to walk.
  • On the contrary, a child whose sitting is delayed beyond 3 years has remote prospects for functional outdoor walking

  • Gross Motor Function Classification System For Assessing Severity Of CP


  • Level I - Walks without restrictions : limitations in more advanced gross motor skills.
  • Level II - Walk without assistive devices: Limitations of walking outdoors and in the community
  • Level III - Walk with assistive mobility devices : limitations in walking outdoors and in the community.
  • Level IV - Self mobility with limitations : Children are transported on use power mobility outdoor and in the community.
  • Level V - Self mobility is severely limited even with the use of assistive technology.

  • Causes of most of CP unknown, but the majority seems to be prenatal in etiology(such as congenital malformations and genetic causes).


    Most children with CP did not sustain intrapartum asphyxia(only about 10-24 %).


    However ,intrapartum asphyxia does occur and is an important mechanism of brain injury and CP.


    Role of Neuroimaging


    Neuroimaging (MRI preferred to CT) is recommended in children with cerebral palsy in order to establish structural brain abnormality which may further help in finding the etiology and giving a prognosis


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