Nurul Najihah,Daniel Koshy,Maheshwaran

Multidisciplinary Management of Cerebral Palsy

http://www.nationwidechildrens.org/Document/Get/42099 http://www.hcocinc.com/wp-content/uploadsbigstock_Little_Boy_Sitting_Isolated_6867877.jpg

1.What is Cerebral Palsy ?

2.What causes Cerebral Palsy?

3.What are the types of Cerebral Palsy?

3.What are the signs and symptoms?

4.How many children are affected worldwide?

5.What is the role of doctor, pharmacist and physiotherapist

Questions that public would have in mind

- It refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination

- Classification of cerebral palsy

What is Cerebral Palsy?

http://nyp.org/health/pedneuro-cpalsy.html#top

Spastic

DyskineticAtaxic

Mixed

Rudolph’s Fundamentals of Pediatrics

Templates

What causes Cerebral Palsy?

1. Injuries to the infant’s brain during birth- Birth asphyxia - hypoxia > 4 mins during birth)- APGAR Score (numbered rating that reflects a newborn's physical

health). Good Score is more than 7/10

Reddihough D,Collins K,Others. The epidemiology and cause of cerebral palsy.Australian Journal of Physiotherapy. 2003;49(1);7-14

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(The Etiology)

TemplatesWhat causes Cerebral Palsy?

3. Due to intake of certain toxins by mother during pregnancy (accidentally ingested)

- eg: methyl mercury

4. Infection during perinatal period-Intrauterine infections eg: TORCH Virus (Toxoplasmosis,Rubella,Cytomeglovirus,Herpes)

5. Cerebro vascular accident (CVA) - rapid loss of blood supply to the brain - due to ischemia caused by thrombosis, arterial embolism or hemorrhage

Reddihough D,Collins K,Others. The epidemiology and cause of cerebral palsy.Australian Journal of Physiotherapy. 2003;49(1);7-14

2. Metabolic disorders- Lesch-Nyhan Syndrome - Deficiency of Arginase (causes spastic diplegia)

(Etiology)

What are types of Spastic Cerebral Palsy?

Most common type of overall cerebral palsy, occurring in 90% of all cases according to the Society for Cerebral

Palsy in Europe (SCPE)

http://forkneedlepen.files.wordpress.com/2013/03/typesofcp.gif

• Delayed development milestones– Head control, roll over, sitting, crawling and walking

• Low muscle tone (hypotonia)– Problems with mobility– Poor Muscle control

• Infantile reflexes persist for long time– Sucking and startle reflex

• Failure to speak simple sentence by 24 months • Seizures

What are the signs and symptoms?

https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/signs-and-symptoms-of-cp/http://www.healthcentral.com/adhd/h/hypotonia-fatigue-adhd.html

How many children are affected?

According to an article published by American Academy of Family Physicians, It is the most common childhood physical disability and affects 2 to 2.5 children per 1,000 born in the United States.

There is insufficient statistics for cerebral palsy in Asia and Malaysia

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Role Of Doctor

http://shotofprevention.com/2012/02/24/how-the-doctorparent-relationship-can-impact-immunization-decisions/

1.Doctors carry out physical examination

- complete prenatal and postnatal history of the child

2. Doctors look into the development milestones of the child - Head control,turn-over,sitting,standing

3. Carry out diagnostic tests- x-rays (spine ~ scoliosis ,hip ~ dislocation)- electroencephalogram (EEG) ~ seizures- magnetic resonance imaging (MRI) ~ brain abnormalities - feeding studies - genetic studies

https://www.unitypoint.org/filesimages/rightcallouts/doctor-with-child.jpg

http://nyp.org/health/pedneuro-cpalsy.html#top , http://cshcn.org/sites/default/files/webfm/file/CriticalElementsofCare-CerebralPalsy.pdf,

Role of Doctor(Coordinator)

http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#243683104

4. Determines the type of treatment child requires

- Conservative treatment

Physical – resistive or strength training programs (prevents contracture) 

~ Special braces (orthotic devices) improve mobility and stretch spastic muscles

Occupational - help individuals address new ways to cope with day-to- day activities

Recreation - encourages participation in art and cultural programs, sports, and other events (improve child’s emotional well-being)

Speech and Language Therapy, Treatment for problems with eating and drooling

Oral Medications (eg: Baclofen)

Role of Doctor

http://soap.org/abstracts-uploads-spring-2011/1010711131105Xray_Baclofen_pump.jpg

Role of Doctor

- Invasive treatment

Botulinum Toxin (anti-spasticity management)

Selective Dorsal Rhizotomy

Insertion of intrathecal baclofen pump

~ helps in ambulation of child

5. Delegates job to physiotherapist and pharmacist for further treatment and counseling

Role Of Pharmacist

http://img.dailymail.co.uk/i/pix/2007/12_01/pharmacyREX0212_468x331.jpg

1. Educating parents about the medications given to their child

- side effects of medication- effectiveness- Purpose of medication

Role of Pharmacist

http://uspharmacist.com/content/d/featured%20articles/c/10170

2. Advise and collaborate with doctors on the suitable medication and dosage needed for cerebral palsy patients

- suitable dosage, not to overdose or under dose patient

Role of Pharmacist

http://www.everydayhealtenh.com/drugs/baclofen

3. Support the doctor by providing the adverse effects that occur to the patients because of the medication

Role of Pharmacist

http://uspharmacist.com/content/d/featured%20articles/c/10170

http://www.pharmacynews.com.au/news/latest-news/new-prescribing-initiatives-to-be-investigated

- Information reaches the pharmacist about the adverse effects of medication

which is then passed on to the doctor

4. Obtain past medical records containing medications taken by the patient and interpret for the doctor

- complications - determine whether to change dosage - effectiveness of the medicines - toxicity

Role of Pharmacist

http://uspharmacist.com/content/d/featured%20articles/c/10170

http://www.jacksongeneral.com/for-visitors---medical-records.php

Role Of Physiotherapist

http://www.pretoria-south-africa.com/elarduspark-faerie-glen-physiotherapist.html

TemplatesRole of Physiotherapist

1.Rehabilitation of physical impairments (Conservative Treatment)

- second line of treatment - main intervention for spasticity and dystonia - maximize functional control of the body - increase motor function - improve posture of cerebral palsy patients

http://www.csp.org.uk/your-health/conditions/cerebral-palsy http://www.tasputraperkim.org.my/images/serv_physio.jpg

2. Give advice regarding walking aids and equipment with the help of occupational therapist

- improve the patient’s co-ordination and body balance

- to allow children to go to school - preform daily activities - To enhance the ability of self-care

Role of Physiotherapist

http://www.tasputraperkim.org.my/images/serv_physio.jpg

3. Teaching parents physical therapy that have to be carried out at home on daily basis - to maintain effectiveness of Botulinum Toxin A injection

- encorage normal postures and movement (legs, arms,head control)

Role of Physiotherapist

http://www.childbirthinjuries.com/Cerebral-Palsy/Treatment/Physiotherapy http://www.ctn-simcoeyork.ca/aboutctn/newsandupdates.php?article=80

Summary

Cerebral Palsy is a neurological disorder

No Known Cure

Mobility of child can be greatly enhanced with correct diagnosis and treatment

Doctors advise on available treatment (conservative and invasive)

Physiotherapist offer physical treatment

Pharmacist advise on medications

Summary

Doctor

Pharmacist Physiotherapist

“Treatment of children with cerebral palsy is a multidisciplinary approach that is highly dependant upon a team of medical professionals”

TemplatesReference List

1) Bejing Puhua International Hospital. Bejing Puhua International Hospital. [Online] [Viewed 5 Dec 2013]. Available from: http://www.puhuahospital.com/?gclid=CJux66LqorsCFUcB4godUUQASQ#!cerebral-palsy/c1tc6  2) Cerebralpalsy.org.au. Signs and Symptoms of Cerebral Palsy | Cerebral Palsy Alliance. [Article], [Viewed 5 Dec 2013]. Available from: https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/signs-and-symptoms-of-cp/. 3) Csp.org.uk. What is physiotherapy? | The Chartered Society of Physiotherapy. [Article], [Viewed 5 Dec 2013]. Available from: http://www.csp.org.uk/your-health/what-physiotherapy  4) Csp.org.uk. Cerebral palsy | The Chartered Society of Physiotherapy. [Article], [Viewed 4 Dec 2013]. Available from: http://www.csp.org.uk/your-health/conditions/cerebral-palsy  5) Drugs.com. Baclofen Side Effects in Detail - Drugs.com. [Website], [Viewed 6 Dec 2013]. Available from: http://www.drugs.com/sfx/baclofen-side-effects.html  6) Minciu I. CEREBRAL PALSY MANAGEMENT. [Online Journal] Therapeutics, Pharmacology & Clinical Toxicology.; 2011 , [Viewed 3 Dec 2013] 7) Nhs.uk. Cerebral palsy - Treatment - NHS Choices. [Online]. [Viewed 4 Dec 2013]. Available from: http://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Treatment.aspx

8) Ninds.nih.gov. Cerebral Palsy Information Page: National Institute of Neurological Disorders and Stroke (NINDS). [Online], [Viewed 4 Dec 2013]. Available from: http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm  

TemplatesReference List

9) Nyp.org. Cerebral Palsy - New York Presbyterian Hospital. [Article], [Viewed 3 Dec 2013]. Available from: http://nyp.org/health/pedneuro-cpalsy.html#top ,  10) Placzek R, Siebold D, F. Funk J. Development of Treatment Concepts for the Use of Botulinum Toxin A in Children with Cerebral Palsy. [Online Journal], Toxins.; 2010, [Viewed 4 Dec 2013]. 11) Reddihough D, Collins K, Others. The epidemiology and causes of cerebral palsy. Australian Journal of physiotherapy. 2003; 49 (1): 7--14. 12) Tang KL. Interviewed by: Koshy DI. 5 Dec 2013  13) The Centre For Children with Special Need. Cerebral Palsy CRITICAL ELEMENTS OF CARE. [Article] [Accessed 4 Dec 2013]. Available from:http://cshcn.org/sites/default/files/webfm/file/CriticalElementsofCare-CerebralPalsy.pdf 14) Uspharmacist.com. USPharmacist.com > Cerebral Palsy: Pharmacologic Treatment of Spasticity. [Online], [Viewed 6 Dec 2013]. Available from: http://uspharmacist.com/content/d/featured%20articles/c/10170/  15) Zimbio.com. Untitled. [Online], [Accessed 8 Dec 2013]. Available from: http://www.zimbio.com/Cerebral+palsy/articles/H6K4PmzsnyM/Role+physiotherapy+Cerebral+palsy

Q & A

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