CEREBRAL PALSY, STROKE, AND TRAUMATIC BRAIN INJURY

Chapter 14

INTRODUCTION Cerebral Palsy, Stroke, and Traumatic

Brain Injury Different causes, similar results: brain

damage Still encouraged to participate in

physical activity

CEREBRAL PALSY Refers to a group of permanent disabling

symptoms resulting from damage to the motor control areas of the brain

Nonprogressive Originates before, during, or shortly after birth Symptoms vary widely, ranging from severe to

mild Other impairments and secondary medical

complications

CAUSES OF CP Pre-natal, Natal, and Post-natal causes Rubella, Rh incompatibility,

prematurity, birth trauma, anoxia, meningitis, poisoning, brain hemorrhages or tumors, and other forms of brain injury

Results from causal pathways rather than any single factor

INCIDENCE Estimated 800,000 children and adults

in the US with CP Only about 10% of those cases are

acquired The number of new cases has

increased by 25% over the last decade 8,000 babies and infants diagnosed

each year 1,200 to 1,500 preschool aged

CLASSIFICATIONS The degree and location of the brain

damage affects the symptoms that are displayed

Because of the variety of symptoms, classification systems have been put in place.1. Topographical2. Neuromotor3. Functional

TOPOGRAPHICAL Based on the body segments affected Typically used by the medical community Classes include:

Monoplegia Diplegia Hemiplegia Paraplegia Triplegia Quadriplegia

NEUROMOTOR American Academy

for CP and Developmental Medicine

Three main types1. Spasticity2. Athetosis3. Ataxia

Characteristics are not distinct

NEUROMOTOR: SPASTICITY Results from damage to motor areas of

the cerebrum Characterized by increased muscle

tone Strong exaggerated muscle

contractions are common Associated with hyperactive stretch

reflex

NEUROMOTOR: ATHETOSIS Caused by damage to the basal ganglia Results in an overflow of motor

impulses to the muscles Also known as dyskinetic CP Muscle tone fluctuates, especially in

muscles that control the head and neck.

Lordotic standing posture Aphasia and articulation difficulties

NEUROMOTOR: ATAXIA Caused by damage to the cerebellum Hypotonicity Usually not diagnosed until child

attempts to walk Wide-based gait is typical Nystagmus is also commonly observed

FUNCTIONAL Used in the field of education Based on ability due to the severity of

the disability Important implications for physical

education and sport

Class

Description

I Severe spasticity or with poor functional range of motion and strength in all extremities

II Severe to moderate spastic or athetoid quadriplegic; poor functional strength in all extremities, and poor trunk control

III Moderate quadriplegic or triplegic; severe hemiplegia; fair to normal strength in one upper extremity

IV Moderate to severe diplegic; good functional strength and minimal control problems in upper extremities and torso

V Moderate to severe diplegic or hemiplegic; moderate to severe involvement in one or both legs; good functional strength; good balance when assistive devices are used

VI Moderate to severe quadriplegic; fluctuating muscle tone producing involuntary movements in trunk and both sets of extremities;

VII Moderate to minimal spastic hemiplegic; good functional ability on nonaffected side

VIII Minimal hemiplegic, monoplegic, diplegic, or quadriplegic; might have minimal coordination problems; good balance

GENERAL EDUCATIONAL CONSIDERATIONS

CP is not a disease. It is not to be treated but managed.

Manage both motor and associated disabilities

In some cases surgery can be done There has been some advanced research

in the use of stem cells Physical therapy is common, especially in

younger patients with CP

FIVE AIMS WHEN WORKING WITH PEOPLE WITH CP

1. Reducing musculoskeletal impairments to improve function and quality of life

2. Enabling children to function optimally given their existing impairments

3. Preventing or limiting development of secondary implications

4. Altering the natural course of the disorder5. Promoting wellness and fitness over the life span

Attention must also be given to the psychological and social development of people with CP.