Cerebral Palsy (CP)

Prevention

The best prescription for having a healthy baby is to have regular prenatal care and good nutrition, and to avoid smoking, alcohol consumption, and drug abuse. Other forms of prevention include:

Prevent head injuries by using child safety seats in automobiles and helmets when riding bicycles, skateboards, etc. Supervise young children closely during bathing and swimming. Prevent child abuse. Keep poisons out of reach.

Treat jaundice in newborns with phototherapy. Exposing jaundiced babies to special blue lights that break down bile pigments and prevent them from building up and causing brain damage. In rare cases, a blood transfusion may be necessary.

Identify potential Rh incompatibility in expectant mothers. Incompatible Rh factor usually is not problematic with first pregnancies, as the mother’s body typically produces the unwanted antibodies only after delivery. A special serum given after each delivery can prevent the production of antibodies.

If antibodies develop during a first pregnancy, or if antibody production is not prevented, the developing baby is monitored closely. If necessary, a transfusion may be given to the infant in the womb or an exchange transfusion may be given after birth, removing and replacing a large volume of the infant’s blood.

Be vaccinated against German measles (rubella) before becoming pregnant.

Alternative Therapies

Adults with CP may benefit from alternative therapies such as acupuncture, massage, osteopathy, and homeopathy.

Support Groups

To meet the challenges of cerebral palsy, patients, families, and caregivers need help and support. There are many government-supported and private voluntary groups that provide information about prevention, diagnosis, and treatment, as well as clinical and support services.

Prognosis

Most people with cerebral palsy experience a normal life span. Those with severe forms of CP may have a reduced life span. As people with cerebral palsy age, they may experience long-term effects of chronic physical impairment, such as the following:

• Increase in spasms
• Increase in shortening of muscles (contractures)
• Joint problems (e.g., pain, loss of flexibility)
• Tight muscles
• Increase in back pain
• Emergence of incontinence
• Increase in incontinence
• Reduced energy levels

Factors that contribute to these effects include:

• Poor wheelchair seating and posture
• Spinal deformities
• Weight gain
• Severe learning disability
• Discontinuance of physical therapy
• Walking when it is increasingly difficult
• Inappropriate orthopaedic surgery

Physical exhaustion from inadequate rest or recovery from illness or injury can lead to an overall decline in physical and mental function. Ways to maintain physical function include the following:

• Appropriate wheelchair seating and posture
• Assume various positions out of the wheelchair
• Use a wheelchair when fatigued and when walking is difficult
• Regular and appropriate exercise, including stretching exercises and exercises to maintain flexibility in joints
• Maintain ideal weight
• Have regular medical check-ups
• Avoid sustained mental stress
• Carefully consider proposed surgery
• Plan for appropriate rehabilitation after surgery

NURSING MANAGEMENT

A child with cerebral palsy may be hospitalized for orthopedic surgery to correct contractures and for treatment of other complications.

• Assign the child a room with children in the same age-group.
• Speak slowly and distinctly. Encourage the child to ask for things he wants. Listen patiently and don’t rush him.
• During meals, maintain a quiet, unhurried atmosphere with as few distractions as possible. The child may need special utensils and a chair with a solidfootrest. Teach him to place food far back in his mouth to facilitate swallowing.
• Encourage the child to chew food thoroughly, drink through a straw, and suck on a lollipop between meals to develop the muscle control needed to minimize drooling.
• Allow the child to wash and dress independently, assisting only as needed.
• Give all care in an unhurried manner; otherwise, muscle spasticity may increase.
• Encourage the child and his family to participate in the care plan so they can continue it at home.
• Minimize muscle spasms that increases postoperative pain by moving and turning the child very carefully after surgery.
• After orthopedic surgery, give good cast care. Wash and dry the skin at the edge of the cast frequently, and rub it with alcohol. Reposition the child often, check for foul odor, and ventilate under the cast with a blow dryer. Use a flashlight to check for skin breakdown beneath the cast. Help the child relax, perhaps by giving a warm bath, before reapplying a bivalved cast. Help parents deal with their child’s handicap.
• A good understanding of normal growth and development will enable you to work with parents to set realistic goals.
• Assist in planning crafts and other activities.
• Stress the child’s need to develop peer relationships; warn against being overprotective.
• Identify and deal with family stress. Parents may feel unreasonable guilt about their child’s handicap and may need psychologic counseling.
• Make a referral to supportive community organizations.

REFERENCE

Davidson, S.L. Diseases Causes & Diagnosis Current Therapy Nursing Management Patient Education (Educational Publishing House. 1990)

Kumar Et Al. Robbins & Cotran Pathologic Basis of Disease (Elsevier Saunders Inc. 7th edition. 2005)

Huether, S. Et Al. Understanding Pathophysiology (Mosby, Inc. 2nd edition. 2000)

Cerebral Palsy; http://www.drgreene.com/21_1044.html

Cerebral Palsy; http://gait.aidi.udel.edu/res695/homepage/pd_ortho

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