Dr. J. N. Sharma*
Prof. & Head Deptt. of Pediatrics
Guwahati Medical College
|Cerebral palsy is a persistent disorder of posture and/or movement, due to a non-progressive damage to the developing brain.
The upper age limit of brain insult is not strictly defined.
Arbitrarily fixed at 5 yrs by AAP.
|Cerebral Palsy : Classification|
|A standardized method of blood pressure measurement is the most essential prerequisite of defining HTP. Auscultatory method is the gold standard of all methods with available normative data for sex, age and height. It consists of the following steps in succession:
- Type of motor disorder:
- Anatomical distribution:
Mild, Moderate, severe
Major Risk factors:
Prematurity (75 fold)/VLBW
Exposure to disrupted brain perfusion/oxygenation in fetal, natal, neonatal period
Birth asphyxia (10%)
Apgar score 3 or less a 20 minutes (250 fold increased risk)
Postnatal causes (18%)
Minor Risk Factors:
Mother 40 years or older
Mother 20 years or younger
Father 20 years or younger
First born or 5th or later born
Birth weight < 1.5 kg.
Gestation < 37 weeks
Rh or ABO incompatibility
IU Infection in early pregnancy (German Measles)
CNS infection of the infant
18% of CP is acquired afterbirth (meningitis, head trauma)
High risk newborns
Need regular follow-up and neurodevelopmental examination
From birth onwards
For early detection and intervention
Early Neuromotor behavior
Corrected age for preterm for assessment.
Early Neuromotor Behavior:
Lack of alertness and poverty of movements, poor sleep
Kicks both legs together
Constant fisting and adduction of thumb
Primitive reflexes beyond 6 months
Obligatory ATN reflex
Social smile: 2 months completed
Holds head steady: 4 months completed
Sits alone: 8 months completed
Stands alone: 12 months completed
Abnormal neuromotor behavior
Referral for neurodevelopmental assessment
Infant motor screen
Amiel Tison method
Trivandrum developmental screening chart (TDSC)
Amiel Tison method:
Steps of examination
Examination of the head: sutures, fontanelle and head circumference.
Sensory development: Visual pursuit and acoustic blink reflex.
Assessment of muscle tone:
Is observed when the baby lies undisturbed. Look for constant closure of hands and asymmetry of face or limbs.
Is studied with the infant moving spontaneously in response to a given stimulus e.g., pull to sit. In addition to tone, reflexes viz., stepping and placing reflexes, parachute reflex, knee jerk and ankle clonus are to be examined.
Passive tone is studied by:
Heal to ear angle
Dorsiflexion angle of foot
Early diagnosis and early intervention
Is the corner stone for effective rehabilitation of these children
To help them live a quality life.
|How to Cite URL :|
|Sharma N J D.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=44|