cerebral palsy
沈佳祎 顾芸 顾雯雯 姚依蕾
Topics
•
•
•
•
•
•
Definition
Causes
Types & forms
symptom
Diagnosis
Therapy
definition
Definition
• Cerebral palsy (CP) is an umbrella term
encompassing a group of non-progressive,
non-contagious motor conditions that
cause physical disability in human
development, chiefly in the various areas
of body movement.
causes
Causes
• It is caused by damage to one or more
specific areas of the brain, usually
occurring during fetal development or
infancy.
• It also can occur before, during or
shortly following birth.
Causes
Brain Injury or Brain
Periventricular Leukomalacia
(PVL)脑室周围白质软化
Malformation
脑损伤和脑畸形:
Cerebral Dysgenesis脑发育障碍
Lack of oxygen to the brain or asphyxia缺乏大脑缺
母亲生产
氧或窒息
生产前：孕怀时期母体感染、放射线
Intracranial
Hemorrhage颅内出血
受伤、发烧、感染、脑部外伤、全身疾病、
过度照射、药物中毒、子宫或胎盘功能
核黄疸：由于胆红素沉积在基地神
黄疸等。
不好、先天性异常，或母亲疾病、代谢、
经节、脑干神经核而引起的脑损害。
内分泌异常、受伤等。 核黄疸可能导致手足徐动型脑瘫，
生产时：早产、缺氧、产伤、(产钳或
对脑组织损害较大。
真空吸取)、多胞胎、胎儿窘迫、脐带绕
出生后各种脑部、脑外伤及全身疾
颈等。
病：常见的病因有脑膜炎、脑炎或
全身重症感染所致的脑病，脑外伤
所致的颅内出血，一氧化碳中毒引
起的脑缺氧等，都可能引起脑瘫。
Types & forms
Types & forms
Classification by
Severity level
Topographical distribution
Motor function
Gross motor function classification
system
Using motor function gives
parents, doctors, and
therapists a very specific, yet
broad, description of a child’s
symptoms, which helps doctors
choose treatments with the
best chance for success.
Severity level
• Mild - Mild cerebral palsy means a child can move
without assistance; his or her daily activities are not
limited.
• Moderate - Moderate cerebral palsy means a child will
need braces, medications, and adaptive technology to
accomplish daily activities.
• Severe - Severe cerebral palsy means a child will require
a wheelchair and will have significant challenges in
accomplishing daily activities.
• No CP - No CP means the child has cerebral palsy signs,
but the impairment was acquired after completion of
brain development and is therefore classified under the
incident that caused the cerebral palsy, such as
traumatic brain injury.
Topographical distribution
Paresis means weakened Plegia/Plegic means paralyzed
The prefixes and root words are combined to yield the topographical
classifications commonly used in practice today.
• Monoplegia/monoparesis means only one limb is affected. It is
believed this may be a form of hemiplegia/hemiparesis where one
limb is significantly impaired.
affected
diplegic more
• Diplegia/diparesis usually indicatesseverely
the legs
are affected
child
may be
inability to
than the arms; primarily affects the
lower
body.
pronounce/s/, /th/, /l/, or /r/
• Hemiplegia/hemiparesis indicates the arm and leg on one side of
the body is affected.
• Paraplegia/paraparesis means the lower half of the body, including
both legs, are affected.
Topographical distribution
continued
• Triplegia/triparesis indicates three limbs are affected.
• Double hemiplegia/double hemiparesis indicates all four limbs
are involved, but one side of the body is more affected than the
other.
• Tetraplegia/tetraparesis indicates that all four limbs are
involved, but three limbs are more affected than the fourth.
Quadriplegia/quadriparesis means that all four limbs are
involved.
• Pentaplegia/pentaparesis means all four limbs are involved, with
neck and head paralysis often accompanied by eating and
breathing complications.
Gross motor function
classification system
• GMFCS Level I- walks without limitations.
• GMFCS Level II- walks with limitations.
• GMFCS Level III- walks with adaptive equipment
assistance.
• GMFCS Level IV- self-mobility with use of powered
mobility assistance.
• GMFCS Level V- severe head and trunk control
limitations.
Motor function
Spastic cerebral palsy
（Pyramidal）
Non-spastic cerebral palsy
（Extrapyramidal）
Ataxic 共济失调
Mixed
Dyskinetic
不随意运动
Athetoid手足徐动型
Dystonia低张型
Motor function
• Spastic cerebral palsy is characterized
by increased muscle tone.
• Non-spastic cerebral palsy will exhibit
decreased or fluctuating muscle tone.
Motor function
Spastic (Pyramidal)
• increased muscle tone.
– limbs stiff, rigid, and resistant to flexing or
relaxing.
– Reflexes can be exaggerated, while
movements tend to be jerky and awkward.
• The tongue, mouth, and pharynx can be
affected,impairing speech, eating,
breathing, and swallowing.
Motor function continued
Non-Spastic (Extrapyramidal)
• be decreased and/or fluctuating muscle
tone.
• involuntary movement（无意识运动）
• Movement can be slow or fast, often
repetitive, and sometimes rhythmic.
Motor function continued
• Non-spastic cerebral palsy is divided
into two groups
– Ataxic （共济失调）
– Dyskinetic（不随意运动）
Motor function continued
Ataxic cerebral palsy
• affects coordinated movements协调运动（
Balance and posture are involved）
• Walking gait is often very wide and
sometimes irregular.
• Control of eye movements and depth
perception can be impaired.
– fine motor skills requiring coordination of the
eyes and hands.
Motor function continued
Dyskinetic cerebral palsy
• Athetoid cerebral palsy includes cases
with involuntary movement, especially in
the arms, legs, and hands.
• Dystonia/Dystonic cerebral palsy
encompasses cases that affect the trunk
muscles more than the limbs and results in
fixed, twisted posture.
Motor function continued
•
non-spastic cerebral palsy is predominantly associated with
involuntary movements
• Athetosis（手足徐动） — slow, writhing movements that are
often repetitive, sinuous, and rhythmic
• Chorea （舞蹈病）— irregular movements that are not
repetitive or rhythmic, and tend to be more jerky and shaky
• Choreoathetoid — a combination of chorea and athetosis;
movements are irregular, but twisting and curving
• Dystonia（肌张力不全） — involuntary movements
accompanied by an abnormal, sustained posture
• Ataxia/Ataxic（共济失调） — does not produce involuntary
movements, but instead indicates impaired balance and
coordination
Motor function continued
• Mixed：
A child’s impairments can fall into both
categories, spastic and non-spastic,
referred to as mixed cerebral palsy. The
most common form of mixed cerebral palsy
involves some limbs affected by spasticity
and others by athetosis.
Motor function continued
2002年欧洲脑瘫监测组织(Surveillance of Cerebral Palsy
in Europe，SCPE)推荐脑瘫临床树状分型法
欧洲脑瘫监测组织脑瘫树桩分型法
Signs and symptoms
What’s the difference between
Sign and Symptom?
• Signs are clinically identifiable effects of
brain injury or malformation that cause
cerebral palsy.
• Symptoms, on the other hand, are effects the
child feels or expresses; symptoms are not
necessarily visible.
Symptom
Sign
VS
• taken on the whole, CP symptomatology is very
diverse. The effects of cerebral palsy fall on a
continuum of motor dysfunction which may range
from slight clumsiness at the mild end of the
spectrum to impairments so severe that they render
coordinated movement virtually impossible at the
other end the spectrum.
• Impairments resulting from cerebral palsy range in
severity, usually in correlation with the degree of
injury to the brain. Because cerebral palsy is a group
of conditions, signs and symptoms vary from one
individual to the next.
婴儿时期
频繁吐沫
非常"敏
感"或"激
动
小儿时期
视、听觉障 口、面功 言语障碍
碍
能障碍
喂养困难，吸
吮及吞咽不协
调
Signs and Symptoms
• 1. Abnormal muscle tone
• 2. Joint and bone deformities and
contractures
• 3. Developmental delay
• 4. Speech and language disorders
1. Abnormal muscle tone
• The primary effect of cerebral palsy is
impairment of muscle tone.
e.g. slouching over while sitting.
2. Joint and bone deformities and
contractures
• The classical symptoms are spasticities, spasms,
other involuntary movements (e.g. facial gestures),
unsteady gait, problems with balance, and/or soft
tissue findings consisting largely of decreased muscle
mass.
• Scissor walking (where the knees come in and cross)
Toe walking (which can contribute to a gait
reminiscent of a marionette) are common among
people with CP who are able to walk.
3. Developmental delay
• Babies born with severe CP often have an irregular
posture; their bodies may be either very floppy or
very stiff. Symptoms may appear or change as a child
gets older. Some babies born with CP do not show
obvious signs right away. Classically, CP becomes
evident when the baby reaches the developmental
stage at six and a half to nine months and is starting
to mobilise, where preferential use of limbs,
asymmetry(不对称) or gross motor developmental
delay is seen.
3. Developmental delay
• In moderate to mild cases of cerebral palsy,
parents are often first to notice if the child
doesn’t appear to be developing on schedule.
• Delay in reaching key growth milestones. such
as:
•
•
•
•
Rolling over
Sitting
Crawling
Walking
•
signs such as unusual posture, persistent infant reflexes, and early
development of hand preference should also be concerned.
4. Speech and language disorders
• Speech and language disorders are common in people
with cerebral palsy. The incidence of dysarthria is
estimated to range from 31% to 88%
• Speech problems are associated with poor respiratory
control, laryngeal and velopharyngeal(腭咽) dysfunction
as well as oral articulation disorders that are due to
restricted movement in the oral-facial muscles. There
are three major types of dysarthria in cerebral palsy:
spastic(痉挛麻痹), dyskinetic (运动困难) and ataxic(运
动失调).
spastic
spasticity, weakness, limited range of motion
and slowness of movement.
dyskinetic
disorder in the regulation of breathing patterns,
laryngeal dysfunction (monopitch, low, weak and
breathy voice quality). It is also associated with
articulatory dysfunction (large range of jaw (颌)
movements), inappropriate positioning of the
tongue, instability of velar elevation.
Ataxic
Ataxic dysarthria is uncommon in cerebral palsy.
Overall, language delay is associated with
problems of mental retardation (迟钝), hearing
impairment and learned helplessness. Children
with cerebral palsy are at risk of learned
helplessness and becoming passive communicators
Early intervention often targets situations in
which children communicate with others, so that
they learn that they can control people and
objects in their environment through this
communication, including making choices,
decisions and mistakes.
• People with CP tend to be shorter in
height than the average person because
their bones are not allowed to grow to
their full potential. Sometimes bones
grow to different lengths, so the person
may have one leg longer than the other.
• 近视或斜视，其中以内斜视为多见，听力减退
以徐动型脑瘫较为多见
• 听力，对声音的节奏辨别存在困难
• 脸部肌肉和舌部肌肉均出现明显痉挛或不协调
收缩，咀嚼和吞咽困难，口腔闭合困难以及流
口水。
• 对外界的反应较平淡由于肌张力低下，抗重力
能力和维持某种姿势的能力变弱，患儿头部、
躯干的上拾，四肢的支撑均变得困难，所以这
类患儿多喜欢采用仰卧位。
• Many signs and symptoms are not readily
visible at birth, except in some severe cases,
and may appear within the first three to five
years of life as the brain and child develop.
Most
experts agree;
themade
earlier
a cerebral
• If
a diagnosis
can be
early
on, early
palsy diagnosisprograms
can be made,
better.
intervention
andthe
treatment
protocols have shown benefit in management
of cerebral palsy.
• Early diagnosis also helps families qualify for
government benefit programs and early
intervention.
Diagnosis
Diagnosis诊断
 How is the diagnosis made?
 first few months,a variety of symptoms can suspect
•Lethargy, or lack of alertness 嗜睡，或缺乏警觉性
•Irritability or fussiness 易怒或烦躁
•Abnormal, high-pitched cry 异常、高音调的喊叫
•Trembling of the arms and legs 手足颤栗
•Poor feeding abilities secondary to problems sucking and
swallowing 进食能力差继发吸吮和吞咽问题
•Low muscle tone 肌张力低下
•Abnormal posture, such as the child favoring one side of
the body
异常姿势，如孩子倾向身体一侧
•Seizures, staring spells, eye fluttering, body twitching
癫痫，直瞪，眼神飘忽，身体抽搐
•Abnormal reflexes.异常反射
Page  40
 During the first 6 months of life, other signs also
appear in an infants muscle tone and posture（肌张力和
姿势）. These signs include:
•Muscle tone change from low tone to high tone; go from
floppy to very stiff.（肌张力低下到肌张力高：由懒散变得僵硬）
•hold his or her hand in tight fists.（紧紧攥住拳头）
•asymmetries of movement（不对称运动）
•feed poorly, with tongue pushing food out of mouth
forcefully.（进食困难，舌头将有力地把食物从口中推挤出来）
Page  41
 reaches 6 months of age, picking up movement skills
become slower than normal.（拾取运动能力）
 slow to reach certain developmental milestones, such as
rolling over, sitting up, crawling, walking and talking.（翻身，
坐起来，爬行，走路和说话。）
 Parents are more likely to notice these signs of cerebral
palsy, especially if this is not their first child.
 Sometimes after expressing to physicians, their child is
immediately diagnosed as having cerebral palsy.
Page  42
 However, medical professionals often hesitate to use
the term "cerebral palsy"at first. Instead, they may
use broader terms such as:
•Developmental delay（发育迟缓）
•Neuromotor dysfunction（运动神经功能障碍）, or delay in the
maturation of the nervous system（神经系统发育延迟）
•Motor disability（运动障碍）
•Central nervous system dysfunction（中枢神经系统功能障碍）
•Static encephalopathy（静态性脑病）, meaning abnormal brain
function that is not getting worse.
Page  43
 Why do doctors frequently delay making a final
diagnosis and prognosis（最终诊断和预后诊断）?
1.
2.
plasticity
a child's
central
nervous
system,（孩子的中枢
a child's of
nervous
system
organizes
over
time.（神经系统的
神经系统具有可塑性）
组建需要时间）
Damage to the brain may affect your child's motor
recover completely
partially
abilities
differently.orFor
example, tone can go from low to
high or vice versa, or involuntary movements （不自主运动）
a much
greater
capacity
to repair themselves
can
become
more
obvious.
the
undamaged
can take
over by
some
of 3the
functions
a
child's
motorareas
symptoms
stabilize
2 to
years
of age.
（功能代偿）
of the
areas.not going to change
After
this age,
tonedamaged
is probably
dramatically.
Page  44
 not made over night.（不能马上给出诊断）
 the extent of the problems is not clear , symptoms need to be
monitored by an interdisciplinary team. （需要由跨学科团队监控）
 gather information and make comparisons.
 keep you up to date on your child's current needs and problems,
as well as the medical reasons for these problems, if known.
 When diagnosing CP, the interdisciplinary team must first conduct
an assessment, or evaluation of the child's strengths and needs in
all areas.
 grows older, additional assessments
Page  45
 CP is diagnosed by a complete examination of current health
status. Doctors will test motor skills and look carefully at medical
history. They will also look for slow development, abnormal muscle
tone, and unusual posture.
 When diagnosing CP, doctors must rule out other disorders（排除
其他障碍）tests:
that can cause abnormal movements.
•specialized
• CT
(computed
(计算机断层扫描)
CP does
not gettomography).
worse. It is not
progressive.（非渐进性）
 Based on this fact, doctors must make the determination that
• MRI (magnetic resonance imaging).（核磁共振成像）
condition is not progressively getting worse.
•Intelligence testing（智力测试）
•A review of the mother's pregnancy,（回顾母亲孕期） labor and
delivery and care received is also conducted.
Page  46
 Electric diagnosis 电诊断项目
EEG, evoked potential examination, EEG topography,
MEG examination, electromyography and brain
impedance inspection.(脑电图检查、诱发电位检查、脑
电地形图检查、脑磁图检查、肌电图检查以及脑阻抗血流
图检查等)
了解患者头部血管功能和供血情况
脑瘫合并癫痫的患者
疑似视力和听力功能异常的脑瘫患者
脑瘫合并肌萎缩的患者
有效排查合并症是否存在
明确其脑部损伤程度
便于早期发现异常症状并及时干预
了解患者肌肉和神经的功能状
态
 diagnostic imaging program影像诊断项目
head CT examination颅脑CT检查脑部有无器质性病变
Page  47
病变部位
病因（脑萎缩、脑室周围白质
软化灶）
Page  48
Cerebral Palsy Therapy and Treatment
*
*
*
*
*
*
*
Physical Therapy 物理治疗
Occupational Therapy 作业治疗
Medical Treatment: Surgery 手术治疗
Medical Treatment: Drug Therapy 药物治疗
Speech and Language Therapy 言语语言治疗
Sensory Integration Therapy 感觉统合治疗
Adaptive Equipment 适应性的设备
Muscles
Benefits
Physical Therapy
Improve the large muscles
*Learn better ways to move
of the body, such as those in and keep balance, such as
the legs, arms and abdomen
walk, use a wheelchair, stand
by themselves, or go up and
down stairs safely
*Prevent musculoskeletal
complications (肌肉骨骼并发
症), such as contractures (痉
挛)
Occupational Therapy
Improve the small muscles
Learn daily living skills such
of the body, such as the
as dressing and eating to
hands, feet, face, fingers
make everyday jobs a little
and toes is not always necessary
easier
*Surgery
Surgery Therapy
Drug Therapy
Improve muscle development, Improve the child's ability
*Before selecting any surgical
to walk, improve balance,
correct contractures
procedure,
make sure (痉挛),
the doctor
and prevent further
and reduce discusses
spasticitythe
(痉挛)
thoroughly
risks
in the legs
involved,
long-term
effectstypes
anddeformity(畸形)
Because
there
are different
Prevent or control
follow-up.
of postoperative
seizures,
different
drugs may be
特别是年龄较小的患儿，脑
prescribed
because no one drug seizures(痉挛)
组织正处于生长发育期，适
prevents
or controls all types of
当给予促进脑组织生长发育
seizures.
的药物是很有必要的。
Sensory Integration Therapy:
To achieve their optimal level
of functioning
This therapy helps to overcome
problems experienced by many young
children in absorbing and processing
sensory information.
Encouraging these abilities ultimately
improves balance and steady
movement.
方法：刺激不同身体部位的触摸感觉和压力
工具：聚苯乙烯泡沫塑料芯片，水，或有纹理的玩具
Cerebral Palsy Speech and
Language Therapy
• What is Speech and Language Therapy?
• When is Speech and Language Therapy
advised?
• What are the benefits of Speech and
Language Therapy?
• How is Speech and Language Therapy
performed?
What is Speech and Language Therapy?
• Speech and Language Therapy is a process by
which a licensed therapist treats the
communication, speech and language disorders.
• Speech pathologists increase a child’s oral
motor skills and communication acumen by
using exercises that train the brain to
pronounce as well as understand and interpret
individual words, sounds, numbers and
gestures.
• Additionally, speech and language pathologists
improve functioning of the mouth, jaw and
throat muscles (oral motor functioning) that
can interfere with not only speech, but also
breathing and swallowing.
Some aspects of speech a therapist will
address include:
•
•
•
•
•
Word formation 构音
Pronunciation 发音
Fluency
流畅性
Listening 听觉
Language and vocabulary development
语言词汇的发展
• Word comprehension and meaning 字意的理解
• Engaging in direct conversation
鼓励直接对话
• Mouth and throat muscle coordination and strength
嘴&喉部肌肉的协调性和张力
When is Speech and Language Therapy
Advised?
*Studies show that speech and language therapy pose
s the greatest chance of success the
earlier it is introduced into a child early.
*This means that that sooner therapy commences, the
brain can begin to make crucial connections that can’t
be made later in life.
So the therapy often begins in infancy - when
speech and language are developmental appropriate.
What are the benefits of Speech and
Language Therapy?
The benefit of speech therapy is that the
child will learn adaptive and compensatory
strategies to communicate.
•
•
•
•
•
•
•
•
•
•
Eliminate pronunciation issues
消除发音问题
Implement proper word usage
实施适当词的用法
Understand grammar
理解语法
Develop controlled speech cadence
发展控制言语节奏的能力
Speak using complex sentences
说话使用复杂的句子
Expand vocabulary 扩大词汇量
Develop conversational capabilities
发展对话的能力
Comprehend words and statements 理解词语和语句
Improve memory and recall
改善记忆
Draw parallels between the spoken and written word
建立语言和文字的桥梁
How is Speech and Language Therapy
performed?
Examine
Conduct a thorough
assessment of a
child’s physical and
cognitive functioning
This assessment will
determine the nature
of a child’s speech and
communication abilities,
identify causative
factors, and determine
the best approach to
therapy.
irregularities of the
oral cavity or throat
Case history
Examination of the
oral cavity
*Examine all medical
records
* Ask parents or
caregivers several
questions about a child’s
overall physical and
cognitive functioning
Audiology tests
“friend” →“frien”
Cognitive
assessments
Articulation
assessments
Language and fluency
assessments
thank u