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Evidence based therapy of cerebral palsy

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by

Ayşe Numanoğlu

on 10 March 2015

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Transcript of Evidence based therapy of cerebral palsy

Cerebral Palsy
2. Abnormal muscle tonus
• Hypertonus (more common)
• Hypotonus
• Muscle fluctuation
• Cause:?? pyramidalvs
Most common motor disorder of childhood
1-2-3-4/1000
Caused by abnormal development or
damage
in one or more parts of the brain that control muscle tone and motor activity
Permanent but not progressive
Symptoms can change during lifespan
Cerebral palsy (CP) is an
umbrella term
for a group of disorders affecting body movement, balance, and posture
What is the difference from brain lesions of adult?
What happens?
• Absent or abnormal postural mechanism

• Abnormal muscle tone

• Sensory impairment

• Muscle weakness
1. Developmental Delay

Motor delay
• Abnormal postural tone

• Neglect

• Reduced voluntary movement

• Poor selective muscle contraction

• CNS lesion
3. Muscle weakness
5. Sensory impairment
•Touching
•Proprioception
•Vestibular
•Hearing
•Vision
4. Absent or abnormal postural mechanism
• CNS lesion


• Poor, inadequate reciprocal innervation, fixation
6. Orthopedic problems
7. Walking Impairments

Because of
Poor selective muscle contraction
Primitive reflex patterns
Abnormal muscle tone
Imbalance between agonist-antagonist muscles
Poor balance reactions

Pure ataxia is rare
Before walking only hypotonic,
Loss of kinesthesia and balance
Incoordination
Dysmetria
Impaired trunk control and stabilization
Joint hypermobility
Miks type
According to topographical distrubition
Diparesis
Quadriparesis
Hemiparesis
Monopharesis:
Triparesis
Paraparesis

Double hemiparesis:Upper extremities
Lover extremities
• Berta Bobath (PT 1907-1971)
• Karel Bobath (Neurologist 1906-1971)
Amaçlanmı Fonksiyonel Odaklı Yaklaım•Hareketler amaca yönelik olmalıdır

Hippotherapy
Hydrotherapy
Acupuncture
Myofacial release therapy
Hyperbaric oxygen therapy
Space suit therapy
Craniosacral therapy
What is the difference from adult brain damage?
•Prenatal period
Genetic factors,
Intrauterine trauma,
Maternal infection during pregnancy,
Drinking alcohol, smoking and taking certain drugs during pregnancy
•Natal Period
Premature birth of the baby (before 37 weeks)
Cerebral anoxia
Difficult labor
Birth trauma
Perinatal stroke
Asphyxia at birth
Forceps
•Neonatal Period
Anoxia
Asphyxia
Infections (Meningitis, Encephalitis...)
Trauma
Tumors
Poisoning
A clinic picture
Classification
According to clinical symptoms

Hypertonus in extremity muscles
Hypotonus in trunk muscles
Deformity and contractures
Impaired mid line orientation

Most effected muscles from spasticity?

Shoulder:
Elbow:
Forearm:
Wrist:
Fingers:
Hip:
Knee:
Ankle/foot:
Spastic Type
Dyskinetic /Athetoid Type
Reduced postural tone,
Keeping appropriate posture
Involuntary extremity and body movements
Abnormal respiratory patterns
Korea, tremor, ballismus, rigidity, distonia can be seen
..........
Ataxic Type
Hypotonic Type
Spasticity is common
Athetoid Type: Upper limbs
Spastic Type: Lower limbs
Rehabilitation
Techniques
Neurodevelopmental Treatment
Strengthening

PNF kabat-Knott

Functional Electrical stimulation

Massage

Biofeedback

Stretching (manual, positioning, serial casting, orthosis)

Kinesiotapeing
.........
General Approaches
Adaptive equipment and
Mobility Aids
Orthosis
Treatment of spasticity
Other
Oral medication,
Btx-A,
Intratechal baclofen
Selective dorsal rhizotomy
Relatively New
Goal Directed
Virtual Reality
Body Weight Supported
Systems
CIMT
Bobath Neorodevelopmental Treatment
Vojta
Patterning (Fay)
Rood
Sensory integrative therapy
Conductive education
A living approach
Facilitation
Stimulation
Communication
Basic principles
1. Positioning
2. Facilitation of head control
3. Facilitation of body movements
4. Facilitation of balance and protective extensor reflexes
2. Tone
Hypotonus
Hypertonus
Theratogs...
Biofeedback
Physical Activity
Activity guidelines
Evidence Based Therapy of Cerebral Palsy
Occupational Therapy
Hand-Arm Bimanual Intensive Therapy
Thank you for your attention
Full transcript