CASE REPORT 0The present case is presented to show the effect of physical therapy on severely affected child using GMFCS as measurement scale pre- and post-therapy. The patient was a 9-year-old boy with spastic diplegia functioning at GMFCS Level V. [ijcpjournal.org]

The clinical presentation is variable. The most severe presentation is of infantile acidosis, resulting in death by 6 months of age. [adc.bmj.com]

In the past three years he has made presentations on the application of HBOT to autism and chronic neurological conditions to the U.S. [hbot.com]

[…] been associated with genetic abnormalities; congenital brain malformations; maternal infections or fevers; and/or injury before, during or shortly after birth. [1] [3] [4] There is no cure, and treatment options vary depending on the signs and symptoms present [rarediseases.info.nih.gov]

Certain medical conditions and factors may increase the risk of a child having cerebral palsy and spastic diplegia: Maternal infection or high fever during pregnancy; Complicated labor and delivery; Breech presentation; Rh (blood type) incompatibility [birthinjurysafety.org]

• Pain

  Cerebral palsy problems in adults that people experience as they get older include: Increased pain. Pain is the most common problem for older adults with cerebral palsy. [griswoldhomecare.com]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 14, 2019 [patientslikeme.com]

  I asked my friend to give me an aspirin for my “CP pain” because it was raining. She laughed at me, gave me a pill, and said “you don’t take aspirin for CP pain, you take this!” [lovethatmax.com]

  In instances in which medication isn’t enough to reduce the pain, yoru doctor may recommend orthopedic surgery. [birthinjuryguide.org]

• Surgical Procedure

  There is a defined set of orthopaedic surgical procedures that can enhance function, and the challenge for the surgeon is to identify which combination of procedures is appropriate for each individual patient and at what point during development to implement [journals.lww.com]

  For cases of severe spasticity, selective dorsal rhizotomy (SDR) is a surgical procedure recommended when more conservative treatments – physical therapy, oral medications and drug infusion – have failed to reduce spasticity. [childrens.memorialhermann.org]

  When used prudently, this procedure may prevent surgical intervention. [abclawcenters.com]

  During a surgical procedure, a pump is implanted under the skin that continuously delivers the anti-spasmodic drug baclofen. [americanpregnancy.org]

  Aims of surgery: To improve function To decrease pain To correct deformities and stabilize joints To prevent further deformity To improve cosmesis The following are the surgical procedures commonly used: Tendon Lengthening Tenotomy (division) of contracted [physiotherapy-treatment.com]

• Fatigue

  Other symptoms of diplegic cerebral palsy include: Toe walking Flexed knees Fatigue Strabismus (One eye turning inwards) Fatigue Seizures (not all children with spastic diplegia will develop seizures) Coordination and balance issues Late developmental [cerebralpalsyguidance.com]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: May 14, 2019 [patientslikeme.com]

  He had to use a walker, wear leg braces, he was fatigued very frequently, so he would rest his eyes a lot and be out at least one day a week. For typing, he used a keyboard with very large keys and letters so he could read it easily. [forums.atozteacherstuff.com]

  On Observation: Behaviour of the child◦ Whether child is alert, irritable or fearful in thesession or during particular activities◦ Child becomes fatigued easily or not during activity◦ What motivates his action – particular situation,person or special [slideshare.net]

• Developmental Disorder

  Growth curves : crossing major percentile lines raises concerns for growth and developmental disorder CP is non-progressive but can change its clinical manifestations throughout childhood. [pathophys.org]

  TREATMENT TECHNIQUES 4.1 NEURO DEVELOPMENTAL THERAPY (BOBATH THERAPY) Bobath concept is the most familiar and widely used approach for children with neurologic disorders. It is originated in 1940 and early 1950. [ukessays.com]

• Failure to Thrive

  The initial presentation is commonly in the first year of life, with failure to thrive and hepatosplenomegaly. [adc.bmj.com]

  […] to Thrive Respiratory Problems Incontinence Intellectual Impairment This image gives a nice pictorial overview of the problems experienced by children with Cerebral Palsy. [physio-pedia.com]

• Hypertension

  Causes of Cerebral Palsy PRENATAL ‘TORCH’INFECTIONS [Toxoplasmosis,rubella,cytomegalovirus,herpis simplex virus] SMOKING/ALCOHOLISM DIABETIS/HYPERTENSION FALL CONSANGINIOUS MARRAIGES RH INCOMPATIBILITY DRUG ADDICTED MOTHER PERINATAL FORCEPS DELIVERY BREECH [physiotherapy-treatment.com]

• Muscle Spasticity

  Physical therapy helps to make their muscles flexible and increase the range of movement or motions. Botulinum toxin medication helps to reduce the spasticity from muscle. [trishlafoundation.com]

  The motor disorder may range from difficulties with fine motor control to severe spasticity (see MUSCLE SPASTICITY) in all limbs. [fpnotebook.com]

  When assessing spasticity, a clinician will assess Which muscles are affected by spasticity Severity of the spasticity in each of the affected muscles How a person is able to control their muscles (can they activate individual muscles, can they voluntarily [cerebralpalsy.org.au]

  […] find out the effectiveness of Myofascial Release on calf muscle, hamstring muscle and adductor muscles of hip spasticity in spastic diplegic subjects. [omicsonline.org]

  The child may have muscle weakness, poor motor control, or have shaking, also called spasticity, of the arms or legs. Muscle stiffness in the form of stiff legs or clenched fists may also be seen. [stanfordchildrens.org]

• Scissoring Gait

  Other signs and symptoms may include delayed motor or movement milestones (i.e. rolling over, sitting, standing); walking on toes; and a "scissored" gait (style of walking). [1] [2] As with other types of cerebral palsy, spastic diplegia is usually caused [rarediseases.info.nih.gov]

  There are a host of ways that specialists use to correct the “scissor gait” of patients diagnosed with Spastic Diplegia. [medicalook.com]

  People with spastic diplegia often walk with a “scissor gait” caused by tight muscles in the hips and legs. The muscles become so tight the legs want to turn inward and sometimes cross over each other at the knees. [cerebral-palsy-information.com]

  This causes a scissors gait, in which the hips are flexed, the knees nearly touch, the feet are flexed, and the ankles turn out from the leg, causing toe-walking. Learning disabilities and seizures are less common than in spastic hemiplegia. [healthcommunities.com]

  Most people with spastic diplegia are fully ambulatory and have a scissors gait. This means their legs cross over while they attempt to walk. They may also have other problems like hip problems, dislocations, crossed eyes or strabismus. [news-medical.net]

• Muscle Spasm

  – the muscles switch between stiffness and floppiness, causing random, uncontrolled body movements or spasms ataxic cerebral palsy – when a person has balance and co-ordination problems, resulting in shaky or clumsy movements and sometimes tremors mixed [nhs.uk]

  It helps in relieving stress and reducing the stiffness in the child’s muscles. Of course, medication can also be very helpful for decreasing muscle spasms as well as the various forms of stiffness people with cerebral palsy suffer from. [cerebralpalsysymptoms.com]

  Diplegic cerebral palsy (CP), also known as spastic diplegia, is a form of cerebral palsy marked by tense muscles and spasms. [birthinjuryguide.org]

  "Spastic" means related to or affected with muscle spasms. "Diplegia" means paralysis on both sides of the body of corresponding body parts, typically affecting the legs more than the arms. [birthinjurysafety.org]

  Other symptoms of hypotonic cerebral palsy include: Muscle spasms Muscle resistance when trying to make movements “Scissor” movements with legs Random muscle contractions Respiratory issues Possible signs of autism Abnormal truncal tone Non-Spastic (Extrapyramidal [tovmed-clinic.com]

• Back Pain

  Wilson E, Donegam – Shoafl, et al., [2003]-Conducted a study on effects of MET in patients with acute low back pain. The results showed that MET was effective in decreasing disability and improving function in patients with acute low back pain. [ukessays.com]

• Low Back Pain

  Wilson E, Donegam – Shoafl, et al., [2003]-Conducted a study on effects of MET in patients with acute low back pain. The results showed that MET was effective in decreasing disability and improving function in patients with acute low back pain. [ukessays.com]

• Clonus

  Ankle clonus. Bilateral Babinski sign. Scissoring posture of legs when held in the air supported by the axillae due to spasticity in the hip adductor muscles. Tiptoe walking. Atrophy and impaired growth of legs in severe cases. [pathophys.org]

  However, children aged 2 years and over with evolving CP will also have clonus and exaggerated deep tendon reflexes (DTRs) in the lower limbs. [adc.bmj.com]

  Further evidence of brain movement involvement on the hemiplegic side includes hyperreflexia of the deep tendon reflexes, ankle clonus, and extensor toe signs. [childneurologyfoundation.org]

  Clonus and muscle spasms are not uncommon. Clonus is a series of involuntary rhythmic muscular contractions and relaxations. These are caused by the pain and/or stress of muscle tightness, indicating especially hard-working and/or exhausted muscles. [abclawcenters.com]

  During testing we observed clonus only in gastrocnemius and soleus muscles. [omicsonline.org]

• Hyperreflexia

  Classification Physiologic Classification Spastic (most common) Velocity-dependent increased muscle tone and hyperreflexia with slow, restricted movement due to simultaneous contraction of agonist and antagonist muscles. [orthobullets.com]

  It is part of the upper motor neuron syndrome characterized by hyperreflexia, clonus, extensor plantar responses and primitive reflexes. Spastic Cerebral Palsy is the most common form of Cerebral Palsy. [physio-pedia.com]

  Hyperreflexia – Abnormal increase in deep tendon reflexes. Deep tendon reflexes are elicited by the striking of the muscle tendon with a reflex hammer. Hypertonia – Increased muscle tone from expected (See muscle tone). [childneurologyfoundation.org]

• Behavior Problem

  Children with CP may also have additional problems, including: seizures vision loss or impairment hearing loss or impairment speech impairment learning disabilities behavioral problems developmental delays swallowing difficulties challenges with nutrition [childrenshospital.org]

  behavior problems Intellectual disability Respiratory problems Bowel and bladder problems Bone abnormalities, including scoliosis (a lateral, or sideways, curvature and rotation of the back bones, giving the appearance that the person is leaning to one [stanfordchildrens.org]

  In other words there seems to be problem in motor planning in those children who are apraxic. Cerebral palsied children may also have various behavioral problems such as distractibility and hyperkinesis, which are based on the organic brain damage. [physiotherapy-treatment.com]

• Abnormal Gait

  Common patterns can be seen in people with Cerebral Palsy and movement-limiting symptoms can include: Contractures, or joints will not extend fully Movements can be exaggerated Abnormal reflexes Abnormal gait Crossed knees Walking on tiptoes Quick links [cerebralpalsy.org.uk]

  The abnormal gait is often quite bizarre and may initially be interpreted as psychogenic in origin or “hysterical”. The gait disturbance usually shows a dramatic and sustained response to small doses of levodopa. [adc.bmj.com]

• Motor Disturbances

  The CP syndromes may be classified by the predominant type of motor disturbance, including, for example, diplegia, tetraplegia, hemiplegia, dyskinesia, and ataxia, although frequently the overall clinical picture is not always pure. [adc.bmj.com]

Options for Cerebral Palsy Treatment Spastic diplegia cerebral palsy does not have any complete cure but the management in the condition of spastic CP is possible after some common treatments in patients. [trishlafoundation.com]

Experienced treatment teams for individuals with spastic diplegia CP can help determine the treatments which are best suited for them. [cerebralpalsylawdoctor.com]

Two approaches used for the treatment of children with physical disabilities are advanced physiotherapy treatment called Neuro developmental therapy (NDT) and muscle energy technique (MET). [ukessays.com]

[…] et al, NDT was compared to the Adeli Suit Treatment (AST) in twenty-four children with CP for four weeks, five days per week for two-hour sessions. [pediastaff.com]

Group A: Myofascial release and conventional PT treatment. Group B: conventional PT treatment. Both the groups received training for 4 weeks. [omicsonline.org]

With early intervention and proper treatment, the prognosis for children with spastic diplegia is favorable. [cerebralpalsyguidance.com]

Diplegic Cerebral Palsy Prognosis Per the U.S. National Library of Medicine (NCBI), prognosis is favorable for children with diplegic CP. As previously mentioned, diplegic CP is the least invasive type of CP, affecting mainly the legs. [birthinjuryguide.org]

Homeopathy Prognosis These children should be diagnosed early and treated as babies on neurological lines. The result of early treatment can be surprising. [icddelhi.org]

Prognosis CP is not a progressive but the symptomscan become more severe over time Prognosis depends on intensity oftherapy during early childhood Tend to develop arthritis at a youngerage than normal because of pressureplaced on joints by excessively [slideshare.net]

Prognosis Clin Obstet Gynecol. 2008 Dec;51(4):816-28. JAMA. 2002 Sep 18;288(11):1357-63. Pediatrics. 2011 Aug;128(2):e299-307. Dev Med Child Neurol. 2008 Jul;50(7):487-93. [pathophys.org]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Etiology Clin Obstet Gynecol. 2008 Dec;51(4):775-86. Pediatr Neurol. 2009 Mar;40(3):168-74. [pathophys.org]

Traditionally prenatal etiology, prematurity, total growth retardation, perinatal asphyxia and other perinatal causes like trauma have all been implicated as risk factors for cerebral palsy. (National collaborative perinatal project NCPP data). [ukessays.com]

Several other classification systems exist based on the pathophysiology, etiology, and distribution of motor deficits [ 5 ]. [omicsonline.org]

Cerebral palsy epidemiology: where are we now and where are we going?. Dev Med Child Neurol. 1992 Jun. 34(6):547-51. [Medline]. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. [emedicine.staging.medscape.com]

Cerebral palsy: classification and epidemiology. Physical Medicine and Rehabilitation Clinics of North America, 20(3), 425-452. doi: 10.1016/j.pmr.2009.06.001 See abstract Paneth, N. (2008). Establishing the diagnosis of cerebral palsy. [cerebralpalsy.org.au]

The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil. 28(4): 183-91. Review. Pandyan AD, Gregoric M, et al. 2005. Spasticity: clinical perceptions, neurological realities and meaningful measurement. [theratogs.com]

Epidemiology Unfortunately, it is difficult to access and clarify the prevalence and incidence rate of disabilities in poor-resource settings (Gladstone, 2010). [physio-pedia.com]

Epidemiology The incidence of CP is about 2 per 1000 livebirths The incidence is higher in males than infemales Other associated problems include◦ Mental disadvantage (IQ < 50): 31%◦ Active seizures: 21%◦ Mental disadvantage (IQ < 50) and not walking [slideshare.net]

Pathophysiology Arch Dis Child Fetal Neonatal Ed. 2008 Mar;93(2):F153-61. [pathophys.org]

Neonatal Encephalopathy and Cerebral Palsy: Defining the Pathogenesis and Pathophysiology. Washington, DC: American College of Obstetricians and Gynecologists; 2003. [Full Text]. Capute AJ, Accardo PJ, eds. [emedicine.staging.medscape.com]

Several other classification systems exist based on the pathophysiology, etiology, and distribution of motor deficits [ 5 ]. [omicsonline.org]

The CP prevention research was unveiled at the prestigious American Academy of Cerebral Palsy and Developmental Medicine Conference held in Orlando, Florida. [cpaustralia.com.au]

Minimizing the numbers of surgeries a child experiences is essential because it might prevent them from seeing themselves as being, 'sick.' [disabled-world.com]

Can cerebral palsy be prevented? In many cases, the cause of cerebral palsy is not known, so there is nothing that can be done to prevent it. [americanpregnancy.org]

The increased extensor spasm prevents the child from rolling over and the absence of body-righting reflexes prevents him from developing a reciprocal flexion and extension of the hips and knees to rollover smoothly. [icddelhi.org]

and joint receptors. [11] Severe consequences in a cerebral palsy child can be prevented with early diagnosis and comprehensive physiotherapy intervention. [ijcpjournal.org]