Cerebral Palsy

Front 1

facts about cerebral palsy

Back 1

>heterogenous
>more boys than girls
>more blacks than whites
>1.5 to greater than 4 per 1000 live births
>1 in 300 children

Front 2

is cerbral palsy associated with other disorders?

Back 2

multiple disabilities
especially motoric.

Front 3

what is heterogenous?

Back 3

diverse in character?

Front 4

literal definition

Back 4

cerbral having to do with the brain
palsy- muscle incoordination or weakness

Front 5

how did Little and Freud define cerebral palsy?

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A developmental neuromotor disorder
-affects posture and movement

Front 6

what does the world health organization emphasize?

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causes activity limitation

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some other defintions

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Nonprogressive damage to the developing fetal or infant brain
-Often accompanied by co-occurring problems with sensation, perception, cognition, communication, and/or behavior and/or a seizure disorder

Front 8

what causes cerebral palsy?

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>abnormal development of the brain
>damage to the developing brain

Front 9

when can cerebral palsy occur?

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prenatally, natally, or postnatally

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two types

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>congenital = prenatally, natally

>acquired= postnatally

Front 11

what percent of cerbral palsy is congenital

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85-90% of the cases
-often the cause is unknown

Front 12

causes of congenital cerbral palsy?

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1. Toxins, drugs, intrauterine infections ex: menigitis
2. Low Birth Weight normally 7.5 low is 5.5 or less
3. Prematurity 36 week or less

Front 13

cont...

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4. Multiple Births (anymore than twins)
5. Fetal injury ex: chord wrapped around the neck, mother fall
6. Jaundice and Kernicterus(when jaundice in brain)
7. Infertility treatments- can lead to multiple births or prematurity

Front 14

Acquired accounts for what percent

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10-15%

Front 15

Acquired

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1. head injury most common
2. infections
3. disruption of blood flow to brain (ex: stroke due to blood clots)

Front 16

early diagnostic signs

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>at risk babies ex: jaundice
>behavioral symptons
>reflexes; persistent or abnormal
ex: asymmetric tonic neck usually gone by 1
>delay in achieving developmental milestones
ex: rolling over, sitting

Front 17

when does diagnosis happen?

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typically occur within first two years
-if symptons mild can happen later

*there is no cure

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4 types

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1. spastic
2. ataxia
3. dyskinesia
4. mixed

-type may change over time

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Spastic

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-disorder of tone
-stiff muscles
*most common affects 70-80%

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Dyskinesia (Athetoid)

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-disorder of movement
-uncontrolled movement

Front 21

Ataxia

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-disorder of coordination
-poor balance and coordination
*least common, affects 5-10%

Front 22

Spastic Cerebral Palsy

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 Muscle tone is increased leading to stiff muscles
 Clasp-knife movement
 Based on location or number of limbs, spastic cerebral palsy is further classified into:
Diplegia, quadriplegia, hemiplegia
 Especially in diplegia, scissoring and toe walking are common
 Communication involvement will vary accordingly

Front 23

Dyskinetic

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 Involuntary, uncontrollable movements
 fluctuations in muscle tone and maintaining posture
 Communicative involvement is more likely
 May show grimacing or drooling
 All limbs are involved

Front 24

Ataxic Cerebral Palsy

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 Least common type of cerebral palsy
 Posture and gait are affected, e.g., may have a wide-based gait
 Precise movements may be affected, e.g., speech, writing
 Intention tremor may be noted, i.e., hand tremor increases as they get closer to the object they are trying to reach

Front 25

Speech involvement of cerebral palsy

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• Developmental Dysarthria is the distinguishing communication deficit, other communication deficits are said to be associated
• All children with cerebral palsy do not show speech involvement

Front 26

Developmental Dysarthria in cerbral palsy affects what processes?

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1. Respiration
2. Phonation
3. Resonance
4. Prosody
5. Articulation

Front 27

Respiration

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 Forced inhalation and effortful exhalation
 Shallow, rapid
 Wasted exhalation
 Reverse breathing – Uncoordinated thoracic and diaphragmatic activity

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respiration continued

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 Short phrases, soft
 Speech rate is affected
 Strained vocal quality

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Phonation

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 Breathy
o May be due to excessive airflow esp if they cannot coordinate exhalation with phonation
 Strained-strangled voice
 Low pitch, pitch breaks

Front 30

Resonance

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 Hypernasal or some form of abnormal resonance
 Can contribute to excessive airflow

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Prosody

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 Monotone, improper stress
 Excess loudness variations
 Reduced rate

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Articulation

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 Restricted mobility
 Slow movements – combining sounds may be difficult
 Undifferentiated movements – imprecise consonants
 Reduced speech intelligibility is most noticeable

Front 33

which type has the best prognosis (the likely course of the disease)?

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Athetosis(Dyskinetic) has a better prognosis for SPEECH than spastic

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Associated Issues

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 Visual deficits
o Blindness, strabismus(cross eye), and nystagmus (suddent movement)
 Language deficits
 Hearing Deficits ex:jaundice
 IDD(intellectual and developmental disability) in nearly 2/3 of individuals with Cerebral Palsy
 Seizures -common can get worse
 Spinal deformities

Front 35

associated isssues continued

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 Feeding and swallowing problems
o Common
o Growth is slow
o Factors for dysphagia: e.g., slow oral intake, poor trunk control (slump), anticonvulsant medicines, etc.
o Drooling
 Psychosocial problems
e.g., acceptance for parents

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role of the SLP

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part of a team
-OT
-PT
-Counselor

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SLP role

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-counseling
-determine if oral communication is an option? and effective?
-will use speech, AAC, or both?
-feeding and swallowing
-educational involvment

Front 38

what is the goal of intervention?

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improved intelligability

Front 39

intervention involves working on?

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>posture (positioning)
>use short phrases, take frequent breaths, short inhalation, prolonged exhalation
>slow rate
>palatal lifts
>Soft vocalizations to counteract laryngeal tension (LSVT also used for soft voice)
>Increase vocalization length and articulatory accuracy gradually

Front 40

Pennington and Goldbart (2005) EBP

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 Review of SLP treatment studies for cerebral palsy
 Only 7 studies met the criteria for inclusion in the review
 Conclusion: Direct speech-language treatment focusing on communication and expressive language was effective for children with cerebral palsy

Front 41

 Pennington et al. (2013)

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o Brief but intensive dysarthria Ix in CP was effective in improving intelligibility for some children (ages 5-11)