79 Cerebral palsy
Overview/pathophysiology
Cerebral palsy (CP) is a term used to describe a group of chronic conditions affecting body movement and muscle coordination. It is caused by damage to one or more specific areas of the brain, which typically occurs before birth during fetal development but can occur during or shortly after birth—usually before age 3 yr. CP is the most common physical disability of childhood with 2-3 children in 1000 being affected each year. About 800,000 children and adults in the United States have CP (March of Dimes, Dec. 2007). It is nonprogressive, although secondary conditions (e.g., muscle spasticity) can develop and may remain the same, improve, or deteriorate. A child with CP may have intellectual, perceptual, and language deficits. A large number of factors may contribute to CP, either singly or multifactorially. Events occurring before birth that can disrupt normal development of the brain cause CP in most cases, whereas lack of oxygen during labor and delivery contributes to only a small minority of cases. A small number of infants/young children develop CP in the first few months or years of life due to severe infections (e.g., meningitis) or head trauma (March of Dimes, Dec. 2007). No identifiable cause is found in many cases but some risk factors that increase the chance of developing CP include prematurity, low birth weight, or multiple births. Some conditions during or after birth that increase the risk of developing CP include breech presentation, small for gestational age, severe jaundice, and seizures (NIH Pub, No. 06-159, 2006).There are three main types of CP, and there may be a mixture of types.
Assessment
Involves physical assessment along with a detailed health history. Ongoing developmental surveillance is important. CP is not usually diagnosed until 6-12 mo of age and in mild forms sometimes not until 4 or 5 yr of age.
Signs and symptoms:
Clinical manifestations vary tremendously from child to child. Some children may have a mild problem with ataxia, whereas some may be severely affected. The universal clinical manifestation is delayed gross motor development. Other common problems are abnormal motor performance, alterations of muscle tone (hypertonicity or hypotonicity), abnormal postures, reflex abnormalities, and numerous associated disabilities and problems, including intellectual impairment, attention deficit hyperactivity disorder (ADHD), seizures, drooling, feeding and speech problems, orthopedic complications, increased incidence of dental problems, and visual and hearing problems.
Diagnostic tests
Primary method of diagnosis is neurologic examination with developmental screening and history. Other diagnostic testing might include the following:
Neuroimaging tests (cranial ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI):
To determine site of brain injury and provide clues to potential causes, as well as rule out slow growing brain tumors.
Cytologic studies:
Genetic evaluation is done to determine if a progressive degenerative disease is present or symptoms are part of a syndrome.
Metabolic studies:
To rule out metabolic defects (e.g., Guthrie blood test for phenylketonuria or serum galactose levels for galactosemia). Use topical anesthetic with blood draws to decrease anxiety and pain (atraumatic care).
Nursing diagnosis:
Imbalanced nutrition: less than body requirements
related to chewing and/or swallowing difficulty and motor problems/activity
Desired Outcome: Within 1 wk of intervention/treatment, child exhibits improved intake and maintains or gains weight.
Nursing diagnosis:
Risk for trauma
related to physical disability, perceptual or cognitive impairment, seizures, and/or lack of knowledge regarding injury/accident prevention
Desired Outcomes: Child remains free from signs and symptoms of trauma. Parents verbalize accurate knowledge about how to provide a safe environment for the child.
ASSESSMENT/INTERVENTIONS | RATIONALES |
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Educate family about ways of childproofing the home based on child’s developmental age. | This information reduces child’s risk for trauma in the home. Examples include:
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