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Respiratory status

Evidence of seizure activity

Speech ability

Visual and auditory acuity

Pain level and effectiveness of interventions

Swallowing function

Reflexes

Nutritional status

Skin integrity, especially under braces and splints

Motor development

Muscle strength

Overall growth and development and achievement of developmental milestones

(Lippincott Advisor, 2020)

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Auscultate lung sounds for changes.

Institute safety precautions to provide a safe physical environment.

Initiate seizure and fall precautions.

Assess for difficulty with swallowing. Consult with a speech therapist for appropriate measures.

Provide a diet with adequate calories.

Administer parental nutrition if appropriate.

Measure intake and output.

Speak slowly and distinctly, making sure to face the patient.

Provide all care in an unhurried manner.

Allow participation in care decisions. Foster the patient's sense of control over the situation.

Administer prescribed medications such as baclofen to reduce spasticity.

Provide frequent mouth and dental care.

Provide meticulous skin care, especially to areas of pressure such as under braces or splints.

Assist with the application of braces or splints or the use of assistive devices, as necessary.

Perform prescribed exercises to maintain muscle tone.

Care for associated hearing and vision disturbances, as necessary.

Prepare the patient and family for possible surgery; postoperatively, give analgesics for pain relief, as ordered.

Consult with physical and occupational therapists, as appropriate, to maximize the patient's functional capacities.

(Lippincott Advisor, 2020)

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Evaluation of function

o   This is an important role in planning treatment because it is based on limitations with regards to the client’s structure and function

o   Standardized measurements of function test include:

Gross Motor Function Classification System (GMFCS)

Modified Ashworth Scale

Manual Ability Classification System (MACS)

Communications Function Classification System (CFCS)

Management of Spasticity

o Botulinum type A is inserted by injection into affected muscles

It is given every 3-8 months to maintain effectiveness.

It is typically seen used in the calf muscles of clients who have diplegia or hemiplegia.

It is given to children who have greater muscle mass that decreases function, especial with growth that are likely to cause contractures.

o   Antispastic drugs

These are given orally and are not as effective as Botox.

They include:

Benzodiazepines (Diazepam)

Dantrolene

Baclofen

This medication can also be given via an implanted pump in the abdomen that delivers directly to the spinal cord

It can also be given intrathecally to achieve higher drug levels within cerebral spinal fluid (CSF)

Surgical Treatments

Selective dorsal rhizotomy (SDR)

This surgery is the main intervention to treat spasticity

See YouTube video below

Deep brain stimulation (DBS)

This is a newer therapy and is being researched in the treatment of dyskinetic cerebral palsy. It was previously used in treatment for adults with severe primary dystonia that did not respond well to pharmacotherapy.

Orthopedic Interventions

Gait analysis

Ankle-foot orthoses

Casting

Muscle-tendon surgery

Surgical treatment for hip disorders

Physical Therapy

Physical therapy

is a key component of treatment and management

Bi-manual training

Constraint-induced Movement Therapy (CIMT)

Context-focused therapy

Goal directed/functional training

Management of Drooling

Anticholinergic medications

Benhexol hydrochloride

Scopolamine

Glycopyrrolate

Botox injections into salivary glands

Surgical treatment

Behavior management techniques

Biofeedback techniques

Management of osteopenia

Biphosphonates

Management of urinary incontinence

Anitcholinergic medications

toileting schedule modifications

intermittent catheterization

(Nettina, Lippincott Manual of Nursing Practice 2019)

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WARNING: Graphic Medical Procedure - Selective Dorsal Rhizotomy Surgery

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Cerebral Palsy is a combination of disorders that is non-progressive involve motor  disabilities, movement, balance and posture. Resulting from brain damage during prenatal, perinatal or postnatal a lifelong condition. It is usually diagnosed after the 2nd year of birth. Cognitive impairment not always involved depends on the location of damage in the brain.
(Pearson, 2019).

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Most common

Caused by an injury to the upper neurons of the pyramidal tract

Hypertonicity

Permanent contractures

Hyperreflexia

Movement, posture, and balance are poorly controlled

Babinski reflex

Truncal hypotonia present during first year of life

May walk on outside of feet or tip toes

Dyskinetic Cerebral Palsy
-Athetoid

Caused by basal ganglia injury

May be associated with kernicterus due to high levels of bilirubin

Involuntary movements are abnormal in all extremities, head, and eyes

Normal cognitive function

Seizures may occur

Stress can increase movements

Dysarthria

Movements may be worm-like or twisting

-Dystonic

Rare

Muscle tone is decreased

Stiff movement

Reduced activity

Ataxic Cerebral Palsy

Caused by injury to cerebellum

Rare

Balance, depth perception, and voluntary movements are abnormal

Normal cognition

Coordination is poor and falls are likely to occur

Unsteady and wide-based gait

Rigid form of Cerebral Palsy

Uncommon

Poor prognosis

Little movement

Deformities

Tremors

Atonic

Mixed form of Cerebral Palsy

Occurs when there is more than one type of motor pattern present

No motor pattern significantly dominates the other

Complications:

Seizure

Cognitive-perceptual  impairments

Difficulties with senses

Common form is athetoid and spastic

Manifestations of Cerebral Palsy

Different presentations

Poor balance and posture

Uncontrollable movements

Irregular muscle tone

Primitive reflexes

Impaired sensations

Dysarthria

Dysphagia

Trouble concentrating

Seizures

Hemiplegia- one side of the body is affected

Paraplegia- both legs are affected

Quadriplegia- all extremities are affected

(Carman, 2016, p. 1713)

(Massey, 2020)

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About one in 400 children born alive has cerebral palsy. An expert explains causes, symptoms and treatment

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Carman, S.R. K. (2016). Lippincott CoursePoint for Ricci, Kyle & Carman: Essentials of Maternity, Newborn and Women's Health Nursing. (3rd ed.). Retrieved from https://coursepoint.vitalsource.com/#/books/9781469898162/

Cerebral Palsy Diagnosis. (n.d.). Retrieved July 19, 2020, from https://www.cerebralpalsy.org/about-cerebral-palsy/diagnosis

CP Family Network. (2020). CPFN. CPFN. https://cpfamilynetwork.org/

Lippincott Advisor for Education. (2020, July 10). Cerebral palsy. Retrieved July 18, 2020, from https://advisor-edu.lww.com/lna/document.do?bid=4

Massey, M. (2020). Mobility HCC III [PPT].

Nettina, S. M. (2019). Cerebral Palsy Management . In Lippincott manual of nursing

Pearson. (2019). Nursing : a concept-based approach to learning. Volume 2. (3rd ed.). Pearson.

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Know that there is no manual for Cerebral Palsy care, but here are some guidelines:

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Know that there is no manual for Cerebral Palsy care, but here are some guidelines:

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As the caregiver, the care you give to the patient depends on your health and well being, Take care of YOU!

Have a good support network to give you positive encouragement, helpful advice, somebody to vent to,  to let you know that your stress is normal

Look for Cerebral Palsy websites that provide updated and mutual experiences shared by other parents/caregivers such as

Cerebral Palsy Foundation: yourcpf.org

Cerebral Palsy.org: http://cerebralpalsy.org/

United Cerebral Palsy: http://www.ucp.org

Cerebral Palsy Family Network: http://cpfamilynetwork.org/

Use a Care Giver organizer as a communication guide for other family members, other care givers and for referencing at medical and therapy appointments

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Infection during pregnancy, especially varicella, rubella, cytomegalovirus, toxoplasmosis, syphilis, herpes

Exposure to toxins during pregnancy, such as mercury

Other conditions during pregnancy, such as seizures, thyroid problems

Premature birth, low birth weight, breech delivery, multiple fetus delivery

Infant illness, such as bacterial meningitis, untreated severe jaundice, viral encephalitis

(Lippincott Advisor, 2020)

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Informative additional resource available on one CP website that includes mothers sharing their personal experiences.

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Family education about the patient includes:

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Family education about the patient includes:

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Know what type of CP the patient has and customize their care accordingly

Know the patients medicine, how they work, what they are for, how they are given,  and their side effects

Know what adverse effects to look for, when and who to report them to

Monitor skin daily for redness, abrasions,  indentions, changes that appear abnormal due to the splints or braces that are worn

Know how to apply splints and braces properly

Work with professional resources such as therapy to develop a safe and therapeutic massage regimen for the patient

Know that your child's developmental milestones will be different then children without CP

Exercise and ROM will help with spasticity, muscle stretching for joint flexibility

Learn seizure precautions

Encourage independence and social skills with adaptive utensils, toys, playgroups

Keep all appointments with physical and rehab therapist for congruent care

In regards to nutrition work with a nutritionist to identify the recommended caloric intake and proper diet for growth and development

Work with a speech therapist to develop the proper food and drink consistency the patient can safely tolerate

Understand the safety measures for swallowing food properly to avoid aspiration

Learn to monitor respiratory status to avoid aspiration pneumonia

Do involve siblings in care appropriately

(Lippincott Advisor, 2020)
(Pearson, 2019)
(Cerebra Palsy Family Network, 2020)

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There is no test that confirms or rules out Cerebral Palsy. Genetic testing, blood work and urinalysis can be done to rule out other diseases.

Computed tomography scanning of the brain and magnetic resonance imaging may show structural abnormalities of the brain, such as cerebral atrophy.

Electroencephalography may show the source of seizure activity.

Test results may not be conclusive until the brain is fully developed somewhere between 3 to 5 years of age.

(cerebralpalsy.org)
(Lippincott Advisor, 2020)