Cerebral Palsy

Presented By
SUMAN JAISWAL
ROLL NO: 921
Group F
MBBS 3rd Year
JMCTH
Defini on:
• It is defined as an “umbrella term covering a group of
non-progressive, but o en changing, motor
impairment syndromes secondary to lesions or
anomalies of the brain arising in the early stages of its
development”
• It affects muscle tone , movement and motor skills.
 Causes:

 congenital
 Gene c
 Inflammatory The injury to the
 Infec ous developing brain may be
 Anoxic prenatal, natal or postnatal
 Trauma c
 Metabolic
Classifica on:
• Monoplegia
• Diplegia (commonest form (30% – 40%))
• Hemiplegia (20% – 30%)
• Quadriplegia (10% – 15%)
• Prevalence:

 Worldwide incidence being 1.5 to more than 4 per 1000 live

births
Nepal: Incidence is 3 to 5 per 1000 live birth
Management:
 Symptoma c
 Release Contracture
 Splint
 Gait Training
 Counseling & Physiotherapy
 Ra onale of Case Selec on
• Increasing order of disability associated with
Cerebral Palsy in the world especially in
developing country like ours.
• Unique feature of case management;
rehabilita on role of family is major than that
of medica on.
Pa ent Profile:
• Name: Aniket Mandal
• Age: 4 years
• Sex: Male
• Marital status: Under age
• Religion: Hindu
• Occupa on: Under Age
• Father’s name:. Saroj Mandal
• Occupa on: Labor
• Address: Ramdaiya, Bhawadi
• Case Category: Physical Handicap
• Diagnosis: Cerebral Palsy
Chief complain
• Inability to walk and bear weight since childhood
• Grasping problem on le hand.

History of present illness

• According to the pa ent mother, it was the case of pre term
labor that is baby was born at 7 month. When Shivam was
almost of 1 year and his mother no ce baby was unable to walk
& on la er life start walking but with abnormal gait. Similarly he
could not grasp things as perfectly as his right hand on the le
hand.

History of past illness

• Since the illness was during his birth, parents did visit to many
hospital & had opera on of Shivams’ Bi-later leg on 2014/9/05 &
la er on 2016/1/3 A.D
Family history
No any congenital anomaly in parents and siblings. No history of hypertension, diabetes
mellitus, tuberculosis in any member of family.

Personal history
The pa ent takes a vegetarian diet. He has normal bowel and bladder . The food habit was not
sa sfactory as the pa ent mostly preferred liquid food than solid foods.

Drug and allergy history

No known history of allergy to any drug and food.

Treatment history:
His family has supersta on belief on dhami jhakri therefore when the pa ent could not walk
properly they visit to them & when he didn’t walk even a er themantra tantra family visited
to hospital where mul ple tests were done and prescribed medica on.

Present Condi on:

Pa ent can't walk and laid down on ground for most of the me with drooling saliva. And
crossed legs for most of me.
Clinical examina on
• General condi on:
Body built: Poor
• Pallor------------------------------------------ absent
• Icterus----------------------------------------- absent
• Lymphadenopathy------------------------- no any palpable lymph
node
• Clubbing------------------------------------ absent
• Cyanosis-------------------------------------- absent
• Edema--------------------------------------- absent
• Dehydra on --------------------------------- absent
• Vitals:
Temperature : 98 F
Blood pressure : 120/80 mm of Hg
Pulse : 72/minute
Respiratory rate : 14/minute

• Central nervous system examina on:

Well oriented to me place and person
No movement when le on ground

• Respiratory system examina on

No any abnormality found.
No cough, sputum, breathlessness and hemoptysis found.
On inspec on: chest bilaterally symmetrical
On palpa on: No tenderness were present
On ausculta on: No wheeze, stridor or any other abnormality.
He doesn’t have any medical record of abnormality or problem on respiratory system.
Cardiovascular examina on
Normal heart sound. No murmur was present.

Gastro intes nal system

No any abnormality detected. But drooling of saliva is uncontrol.
Inves ga on
Blood Test
Hemoglobin………………………………10.9
Bleeding me……………………………1.35
Clo ng me……………………………..4.2

Provisional diagnosis
Cerebral Palsy (Quadriplegia)
1st family visit: 2020-01-25
Made a quick survey of her house and gathered following informa on.
Housing & Environmental Sanita on
S.N Features Findings
1. Type of house Muddy House
2. Light Sa sfactory
3. Ven la on Sa sfactory
4. Kitchen A ached
5. Chulo Smoky
6. Toilet Separate
7. Water source Hand pump
8. Water storage Covered
9. Bathroom Separate
10. Waste water disposal Sa sfactory
11. Toilet and source of water Less than 50
• Socio- economic condi on:
No. of earning member: 2
Total monthly income: 30,000

• Health seeking behavior

The family usually visits local health post for any
health related problem. Family is concern with
Aniket health. The family has no health insurance.
• Impact of the disease
On pa ent
Pa ent even don’t know what the condi on is as he is
too young to understand all. But yes when his parents
does physiotherapy he cries. Similarly some me he
speak to his mother why is he can’t walk as like other
child of his age. This denotes that he has nega ve
feeling.
On family
Shivam mother always dreams her son walking
normally as like other child. She frighten a er all this
physiotherapy & opera on what will she do. Is she will
be able to see bright future of her son? She even feels
that it’s the sin of her previous life. Obviously there is
nega ve impact on the family.
Knowledge, a tude and prac ce
• Though the family believes in medical treatment,
they believe in tradi onal healers. For minor illness
like headache, diarrhea, vomi ng, they prefer
tradi onal healers as it is cheap. They also believe in
Dhami, Jahakari. They a ribute the cause of the
illness to supernatural power.
Advice
• We advise the family to had posi ve outlook for the
condi on & con nue physiotherapy, we even
appreciated their a tude & encouraged them to
have that strength in every walk of life.
2nd visit: 2020-02-09
• Environment this me was fair as both we and
the pa ent family could have smooth
conversa on about the condi on. The family was
happy seeing us.

Third family visit: 2020-02-24

• In our third family visit, Aniket was happy to see
us and also wanted to play with us. His mother
became more frank and casual. She was very
posi ve and had a posi ve a tude.
Conclusion
• CP is a chronic condi on with considerable impact on
affected individuals. Overall preven on of CP has not
been successful. Early diagnosis and a comprehensive
management with a mul disciplinary approach
involving developmental pediatrician or neurologist,
orthopedic surgeon, speech and language therapist,
physio and occupa onal therapist are required for the
further sa sfactory management of a child with CP.
Family Health exercise Program of CP case has been
very frui ul for we the medical student. We have felt
the real pain of the family bearing person with disability
& also understand about the prognosis of condi on.
Any Query???

Thank You!