Transcript Cerebral Palsy

Cerebral Palsy
Joe Conte and Sarah Lupo
Video
http://www.dailymotion.com/video/x68kwh_cer
ebral-palsy-wwwbrainpalsycom_shortfilms
What is Cerebral Palsy?
• A group of permanent disabling symptoms
resulting from damage to the motor control
areas of the brain
• A non-progressive condition that might
originate before, during, or shortly after birth
• Cerebral = brain
• Palsy = disordered movement or posture
Statistics
• According to the United Cerebral Palsy Association an
estimated 500,000 have cerebral palsy.
• 10-20% of children with cerebral palsy acquire the
disorder after birth.
• The average lifetime cost for a person with cerebral
palsy totals nearly $1 million
• Cerebral palsy is diagnosed in approx. 8,000 children
each year
• Cerebral palsy is the most common cause of childhood
physical disability, occurring in 2-3 out of 1000 children
Causes of Cerebral Palsy
• Illness during pregnancy
• Premature delivery
• Insufficient amount/Lack of oxygen supply to
the fetus/newborn infant’s brain
• Lead poisoning
• Illness early in the infant’s life
• Child abuse
• Medical negligence
• Many times it is unknown
Symptoms of Cerebral Palsy
• Developmental delay
• Abnormal muscle tone
• Unusual posture
• Early development of hand preference
Classifications of Cerebral Palsy
• Topographical
• Neuromotor
• Functional
Topographical
• Based on the body segments afflicted
• Typically used by medical professionals
• Classes include:
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Monoplegia
Diplegia
Hemiplegia
Paraplegia
Triplegia
Quadriplegia
Neuromotor
• Spasticity
• Athetosis
• Ataxia
Spasticity
• Result from damage to motor areas of the
cerebrum; characterized by increased muscle
tone, primarily of flexors and internal rotators,
which might lead to permanent contractures and
bone deformities
Athetosis
• A condition that occurs when there is damage to
the basal ganglia (masses of gray matter
composed of neurons located deep within the
cerebral hemispheres of the brain) results in an
overflow of motor impulses to the muscles.
• Some characteristics of this type of CP include
slow, writhing movements that are
uncoordinated and involuntarily.
Ataxia
• Condition that occurs when there is damage to the
cerebellum (which normally regulates balance and
muscle coordination).
• Diagnosed when the child attempts to walk.
• Muscles show abnormal degrees of hypotonicity.
• Conditions
– Individual shows lack of balance and coordination necessary
for proper arm and leg movement causing a wide-based gait
to be exhibited.
– Individuals show difficulty with performing basic motor skills
and pattern that include locomotor movements such as
running, jumping, and skipping.
Functional
• Individuals are placed into one of eight ability
classes according to the severity of the disability.
• Important system for physical education
teachers because it categorizes the individuals
according to their disability levels.
• Teachers and coaches can use this classification
system to help make the competition among the
individuals equal (in competitive activities
individuals who have the same classification can
compete against each other.
Functional
Common Characteristics in the
Psychomotor Domain
• Seizures
• Spastic or rigid muscles
• Contractures may develop
when restricted range of
motion is severe
• Hyperactive Stretch Reflex
• Scissoring gate or hemiplegic
gate
• Persistence of unwanted
primitive reflexes and
tremors
• Involuntary movement (e.g.,
constant, unpredictable,
purposeless movement)
• May exhibit both hypertonic
and hypotonic muscle tone
• Low postural tone; may be
able to walk unaided, usually
with arms held out to the
sides
• Often under or over reaches
• Falls and stumbles easily
Common Characteristics in the
Cognitive Domain
• Loss of perceptual ability
• Difficulty with speech
• Learning disability or mental retardation
Common Characteristics in the
Affective Domain
• Difficulty socializing with their peers
• May be withdrawn
• ADHD
Teaching Styles
• Be very patient and use wait time
• Reinforce language and speech
• Add weights to implements, such as bats and
racquets, to help with tremors or unwanted
movements
• Be careful with how you have them move
Exercising with Cerebral Palsy
• Know the characteristics of each individual and
their capabilities
• Resistance training helps improve overall motor
function and even flexibility
– Isokinetic training
• Cycle ergometers help with cardiorespiratory
endurance
Diagnosis
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Test reflexes
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Check for hand preference
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Rule out other disorders that can cause movement problems
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Perform CT scan, MRI, and/or ultrasonography
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Look for other conditions linked to cerebral palsy
How to Manage Cerebral Palsy
• Management is directed at alleviating symptoms
that are caused by damage to the brain and
helping the child achieve maximum potential in
growth and development.
Technology and Cerebral Palsy
• Assistive technology
– Computers
– Communication boards with words or symbol
systems
– Bikes or scooters
– Motorized wheelchairs
Treatment Team
• People involved in the planning, treatment, and
decision-making of an individual with cerebral
palsy
– Healthcare professionals who are involved with the
individual
– Family and other caregivers
– Teachers who know the individual
Treatment and Therapy
• Since cerebral palsy is so
diverse the treatment of it
can vary greatly from one
individual to another.
• There is no cure, but there
are many therapies to help
people better handle their
condition
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Physical therapy
Occupational therapy
Botox
Stem cells
• The focus of treatment is on
helping the individual reach
his/her highest level of
independence.
• Individualized plans for
treating C.P. should be
centered around the needs of
the individual.
Other interesting ways to treat
cerebral palsy
• Dolphin therapy:
– Developed by American psychologist David E.
Nathanson around 1978
– Allows children with cerebral palsy to step into a
different environment and interact with the dolphin
in a way that is both playful as well as constructive
for that child.
Dolphin Therapy (Continued)
– Research has shown that dolphins who are one of the most
intelligent animals are actually able to recognize the child’s
deficiency which helps the child create a connection with the
dolphin.
– The connection has been known to help the child relax as
well as an openness to learn and heal that can help lead to
developmental progress.
– http://www.metacafe.com/watch/714493/dolphin_
therapy_in_kemer_antalya_turkey/
Space Suit Therapy
• Becoming increasingly popular for individuals with
cerebral palsy.
• The suit is also known as Therasuits or Therapy suits
and it resembles an outfit that was originally developed
by the Russians that helped their astronauts maintain
their muscle tone while they were in space.
Space Suit Therapy (Continued)
• The suit has elastic cords that attach to different
areas of the body and they are positioned to
keep the body properly aligned to forcibly
encourage movement within a normal range of
motion.
• The design of the suit causes an individual with
cerebral palsy to limit body movement in
particular ways in order to force the body into
proper physical alignments and help to replace
awkward movements with more proper
Benefits of Space Suit Therapy
• Provides proper body alignment which helps
improves muscle tone as well as body awareness,
gross motor skills and balance.
• Because the suit helps align and balance the
body it also strengthens the body as well.
Incorporating Video Games
• Though more research and studies need to be done, a recent
study showed that using a Nintendo Wii for children with
cerebral palsy help them improve in different areas including
their visual perception, bodily control as well as their functional
mobility.
• If more research shows the same types of consistency, this could
be a huge step for helping individuals with cerebral palsy because
compared to other types of rehabilitation techniques the Wii is
only a fraction of the cost and is commercially produced, which
means the individuals could have it in their house and use it on a
daily basis.
Could malpractice cause cerebral
palsy?
• If a mistake is made during the birth of an infant that was the
cause of cerebral palsy doctors as well as nurses can be held
accountable.
• Many doctors and nurses do not know enough about cerebral
palsy and this can result in devastating mistakes and lawsuits if
a mistake is made.
• While caring for the expectant mother and fetus, medical
providers are responsible for assuring adequate care during the
pregnancy, during labor and delivery, and immediately after the
delivery of the infant. When injury does occur during the
birthing process, the results can be devastating.
• A cerebral palsy lawyer can help you determine if medical
malpractice caused your child's cerebral palsy.
Malpractice That Can Result in
Cerebral Palsy
• Leaving the child in the birth canal too long
• Failure to detect a prolapsed umbilical cord
• Failure for the doctor to perform a cesarean
section (c-section)
• Failure to respond to the mother’s changing
conditions
• Failure to recognize and treat seizures
Something to Keep in Mind
• In an Australian study, most medical students
have a very limited knowledge of cerebral palsy
• They also have negative attitudes toward
individuals with cerebral palsy as a result
Legal Information and CT Laws
• Cerebral Palsy Lawyers
– Haymond Law
– http://www.haymondlaw.com/cerebral_palsy/index.asp
• A lawsuit may be filed within 2 years from the date of the injury
• An expert witness must be present
– Must be a doctor who has been licensed and practicing for 5 years
• Compensation
– There is no limit on the amount of damage award
• Limit for Attorney Fees
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No more than 1/3 of the first $300,000
25% of the next $300,000
20% of the next $300,000
15% of the next $300,000
10% of an award greater than $1.2 million
Examples of Lawsuits
• Cody - Aurora, Illinois – 2001-2002
– Mother filed suit against the doctors and hospital because her
son was born with brain damage and cerebral palsy
– The doctor failed to successfully use the vacuum extractor
device, which was needed to prevent brain injuries during the
delivery
– The doctors performed an emergency C-section when they
realized that the baby’s heart rate was in distress
– She received $15.35 million for her son’s past and future
medical expenses
http://www.cerebralpalsysource.com
Examples of Lawsuits
• Hannah - Tennessee
– The doctors used the wrong instruments when delivering
Hannah
– The nurse and surgical technician failed to follow instructions
of the doctor
– Two doctors at the hospital were in a relationship, which
affected morale
– As a result, Hannah has cerebral palsy
• Severe brain damage, seizures, developmental delays
– At age 8, Hannah cannot speak and feels pain when people
walk past her
http://www.cerebralpalsysource.com
Devastating Costs of Cerebral Palsy
• According to
http://www.cerebralpalsysource.com, an
“…estimated lifetime expense of living with
cerebral palsy is approximately $921,000 a
person.”
Common Medical Expenses
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Doctor visits
Hospitals
Visits to the E.R.
Various types of medications
Surgeries
Rehabilitation
Psychological counseling
Assistive devices
Common Non-Medical Expenses
• In order for individuals with cerebral palsy to
live their lives they need special arrangements
that include:
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Home modifications
Vehicle modifications
Special education programs
Other modified living arrangements to allow
mobility
Indirect Costs
• According to http://www.cerebralpalsysource.com,
“…indirect costs are considered the limitations a
person suffering from cerebral palsy has and the effect
on their overall life.”
• Some of these costs include:
– Loss of wage
– The loss of earning potential
– The inability to provide for or contribute to their life
financially, due to severely debilitating conditions
– Pain and suffering
References
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Cerebral Palsy & Technology. (n.d.). Retrieved March 10, 2009, from http://computers-technologycerebralpalsy.com
Cerebral Palsy @ Brainpalsy.com. (n.d.). Retrieved March 14, 2009, from
www.dailymotion.com/video/x68kwh_cerebral-palsy-wwwbrainpalsycom_shortfilms
Dolphin Therapy In Kemer Antalya - Turkey - Video. (n.d.). Retrieved March 30, 2009, from
http://www.metacafe.com/watch/714493/dolphin_therapy_in_kemer_antalya_turkey/
ExpertHub Inc.. (n.d.). Medical Malpractice Law in Connecticut. Retrieved March 18, 2009, from
http://www.lawfirms.com/resources/personal-injury/medical-malpractice/medical-malpractice-lawconnecticut.htm
French, R. (n.d.). Cerebral Palsy: APE Fact Sheet. Retrieved March 10, 2009, from
http://www.twu.edu/inspire/Fact%20Sheets/Cerebral_Palsy.pdf
MacLennan, A., Nelson, K., Hankins, G., & Speer, M. (2005). Who Will Deliver Our Grandchildren?:
Implications of Cerebral Palsy Litigation. Journal of the American Medical Association, 294(13), 1688-1690.
Retrieved March 30, 2009, from the Academic Search Premier database.
Martin, H., Rowell, M., Reid, S., Marks, M., & Reddihough, D. (2005). Cerebral Palsy: What Do Medical
Students Know and Believe?. Journal of Paediatrics & Child Health, 41(1/2), 43-47. Retrieved March 17, 2009,
from the Academic Search Premier database.
Infocus Studios, LLC.. (n.d.). Cerebral Palsy & Medical Malpractice Claims. Retrieved March 17, 2009, from
http://www.haymondlaw.com/cerebral_palsy/index.asp
Rimmer, Ph.D., J. H. (n.d.). Introduction to Cerebral Palsy and Exercise. Retrieved March 18, 2009, from
http://www.ncpad.org/disability/fact_sheet.php?sheet=119&view=all&print=yes
Winnick, J. P. (2005). Adapted Physical Education and Sport 4th ed.. Champaign, IL: Human Kinetics.