CEREBRAL PALSYBy: Missy Kaplan

OUTLINE Introduction to Cerebral Palsy

Epidemiology

Etiology

Treatment and Prevention

Dental Management

WHAT IS CEREBRAL PALSY

Affects body’s ability to control muscle movement

Results from an injury to the brain during development. This can occur prenatally, natally, or postnatally

(United Cerebral Palsy, 2011) (Wilkins, 2009)

TYPES Spastic

involuntary contractions of muscles causing stiffness

Athetosis constant, uncontrolled

movements. Ataxic

loss of equilibrium and have difficulty with balance and coordination

Mixed(United Cerebral Palsy, 2011) (Wilkins, 2009)

EPIDEMIOLOGY “an average of 1 in 303 children in the

United States have cerebral palsy”

“an estimated 800,000 children and adults in te US are living with cerebral palsy”

Black and White children > Hispanic children

Boys > Girls

Spastic form is the most common accounting for 80% of all cases

(Centers for Disease Control and Prevention [CDC], 2011)

ETIOLOGY

Injury to the brainCan occur up to age two

CausesHypoxiaBleeding of the brainInfections of the brainHead injuriesSevere jaundiceInfections of mother during pregnancyunknown

(PubMed Health, 2011)

RISKS

Low birth weight

Premature infants

Blood type incompatibility

Breech delivery

SYMPTOMS…..BESIDES MOTOR FUNCTION Seizure disorders

Spinal deformities

Incontinence

Delayed growth and development

Mental retardation

Drooling

Impaired hearing, vision and speech

(National Institute for Neurological Disorders and Stroke [NINDS], 2011)

TYPES OF BRAIN DAMAGE

Periventricular leukomalacia Damage to the white matter

Cerebral dysgenesis Abnormal formation of the brain

Intrapartum asphxia Lack of oxygen to the brain

Intracranial hemorrhage Blocked or broken blood vessel

DIAGNOSIS

Doctor will monitor…if symptoms get worse…not cerebral palsy

Magnetic resonance imaging (MRI) Most common

Cranial ultrasound No fine detail High risk pregnancies

Computed tomography scan (CT)

TREATMENT

No cure

Aimed at managing symptoms

Team approach

(NINDS, 2011)

TREATMENT CONT.

Therapy!!!!Physical

Occupational

Recreational

Speech

(NINDS, 2011)

http://www.uthscsa.edu/mission/spring98/horsestr.html

TREATMENT CONT.

MedicationsGlycopyrolate reduces saliva

Diazepam (Valium)BaclofenDantrolene sodiumTizanidine

Treat stiff, rigid or spastic muscles

(NINDS, 2011) (Rxlist, 2011)

SURGERY

Used when more conservative treatments fail

Orthopedic Selective dorsal rhizotomy (SDR)

Locate overactive nerve and sever Spinal cord stimulation

an electrode is implanted at the base of the spinal cord and stimulates the nerve

(NINDS, 2011)

http://www.liddlekidz.com/cerebral-palsy-massage-course.html

ORAL HEALTH Malocclusion

Facial muscle disturbances

Attrition

Fractured teeth

Dental caries

Periodontal disease

(Wilkins, 2009)

DENTAL MANAGEMENT

Do not force limbs Place patients head in middle of chair Watch and anticipate movements Place patients chin down No sudden movements Tone down lights Early appointments Possible sedation

Nitrous

(Waldman, B.H., Borg, P.A., & Perlman, S.P., 2011)(Kaufman, E., Meyer S., Wolnerman, J.S., Gilai, A.N., 1991)(Oklahoma Association of Community Action Agencies, 2008).

CONCLUSION

The dental office can be a very stressful place and in order to make it less stressful, we need to understand cerebral palsy and know how to manage their dental care.

REFERENCES Centers for Disease Control and Prevention. (2011). Cerebral palsy. Retrieved

on November 5, 2011 from http://www.cdc.gov/ncbddd/cp/data.html Kaufman, E., Meyer S., Wolnerman, J.S., Gilai, A.N. (1991). Transient

suppression of involuntary movements in cerebral palsy patients during dental treatment. American Dental Society of Anesthesiology. 38: 200-205

National Institute for Neurological Disorders and Stroke. (2011). Cerebral palsy: hope through research. Retrieved on November 11, 2011 from http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#179283104

Oklahoma Association of Community Action Agencies. (2008). Oral health care for children with special health care needs. Retrieved on November 11, 2011 from http://www.okacaa.org/8.5%20x%2011%20Oral%20Health%20Care%20for%20Children%20with%20Special%20Health%20Care%20Needs.pdf

PubMed Health. (2011). Cerebral palsy. Retrieved on November 11, 2011 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001734/

RxList (2011) RxList Inc. Retrieved on November 11, 2011 from http://www.rxlist.com/script/main/hp.asp

United Cerebral Palsy. (2011). Retrieved on November 5, 2011 from http://www.ucp.org/uploads/media_items/cerebral-palsy-fact-sheet.original.pdf

Waldman, B.H., Borg, P.A., & Perlman, S.P. (2011). Periodontal care for patients with special needs. Dimensions of Dental Hygiene. 9(9): 78-80, 83.

Wilkins, E.M. (2009). Clinical practice of the dental hygienist. (10 ed., pp 925-928). Baltimore: Lipincott Williams and Wilkins