CEREBRAL PALSY
By: Missy Kaplan
OUTLINE

Introduction to Cerebral Palsy

Epidemiology

Etiology

Treatment and Prevention

Dental Management
WHAT IS CEREBRAL PALSY


Affects body’s ability to control muscle movement
Results from an injury to the brain during
development.

This can occur prenatally, natally, or postnatally
(United Cerebral Palsy, 2011) (Wilkins, 2009)
TYPES
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Spastic
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Athetosis

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constant, uncontrolled
movements.
Ataxic

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involuntary contractions
of muscles causing
stiffness
loss of equilibrium and
have difficulty with
balance and coordination
Mixed
(United Cerebral Palsy, 2011)
(Wilkins, 2009)
EPIDEMIOLOGY


“an average of 1 in 303 children in the United
States have cerebral palsy”
“an estimated 800,000 children and adults in te
US are living with cerebral palsy”

Black and White children > Hispanic children

Boys > Girls

Spastic form is the most common accounting for
80% of all cases
(Centers for Disease Control and Prevention [CDC], 2011)
ETIOLOGY

Injury to the brain
Can occur up to age two

Causes






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Hypoxia
Bleeding of the brain
Infections of the brain
Head injuries
Severe jaundice
Infections of mother during pregnancy
unknown
(PubMed Health, 2011)
RISKS

Low birth weight

Premature infants

Blood type incompatibility

Breech delivery
SYMPTOMS…..BESIDES MOTOR FUNCTION

Seizure disorders

Spinal deformities

Incontinence

Delayed growth and development

Mental retardation

Drooling

Impaired hearing, vision and speech
(National Institute for Neurological Disorders and Stroke [NINDS], 2011)
TYPES OF BRAIN DAMAGE

Periventricular leukomalacia


Cerebral dysgenesis


Abnormal formation of the brain
Intrapartum asphxia


Damage to the white matter
Lack of oxygen to the brain
Intracranial hemorrhage

Blocked or broken blood vessel
DIAGNOSIS


Doctor will monitor…if symptoms get worse…not
cerebral palsy
Magnetic resonance imaging (MRI)


Most common
Cranial ultrasound
No fine detail
 High risk pregnancies


Computed tomography scan (CT)
TREATMENT

No cure

Aimed at managing symptoms

Team approach
(NINDS, 2011)
TREATMENT CONT.
 Therapy!!!!

Physical

Occupational

Recreational

Speech
http://www.uthscsa.edu/mission/spring98/
horsestr.html
(NINDS, 2011)
TREATMENT CONT.

Medications
 Glycopyrolate
Diazepam (Valium)
 Baclofen
 Dantrolene sodium
 Tizanidine
reduces saliva

Treat stiff, rigid or
spastic muscles
(NINDS, 2011) (Rxlist, 2011)
SURGERY

Used when more conservative treatments fail
Orthopedic
 Selective dorsal rhizotomy (SDR)



Locate overactive nerve and sever
Spinal cord stimulation

an electrode is implanted at the base of the spinal
cord and stimulates the nerve
(NINDS, 2011)
http://www.liddlekidz.com/cerebral-palsy-massage-course.html
ORAL HEALTH

Malocclusion

Facial muscle disturbances

Attrition

Fractured teeth

Dental caries

Periodontal disease
(Wilkins, 2009)
DENTAL MANAGEMENT
Do not force limbs
 Place patients head in middle of chair
 Watch and anticipate movements
 Place patients chin down
 No sudden movements
 Tone down lights
 Early appointments
 Possible sedation


Nitrous
(Waldman, B.H., Borg, P.A., & Perlman, S.P., 2011)
(Kaufman, E., Meyer S., Wolnerman, J.S., Gilai, A.N., 1991)
(Oklahoma Association of Community Action Agencies, 2008).
CONCLUSION

The dental office can be a very stressful place and
in order to make it less stressful, we need to
understand cerebral palsy and know how to
manage their dental care.
REFERENCES
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Centers for Disease Control and Prevention. (2011). Cerebral palsy. Retrieved on
November 5, 2011 from http://www.cdc.gov/ncbddd/cp/data.html
Kaufman, E., Meyer S., Wolnerman, J.S., Gilai, A.N. (1991). Transient suppression of
involuntary movements in cerebral palsy patients during dental treatment.
American Dental Society of Anesthesiology. 38: 200-205
National Institute for Neurological Disorders and Stroke. (2011). Cerebral palsy:
hope through research. Retrieved on November 11, 2011 from
http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#179283
104
Oklahoma Association of Community Action Agencies. (2008). Oral health care for
children with special health care needs. Retrieved on November 11, 2011 from
http://www.okacaa.org/8.5%20x%2011%20Oral%20Health%20Care%20for%20Childr
en%20with%20Special%20Health%20Care%20Needs.pdf
PubMed Health. (2011). Cerebral palsy. Retrieved on November 11, 2011 from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001734/
RxList (2011) RxList Inc. Retrieved on November 11, 2011 from
http://www.rxlist.com/script/main/hp.asp
United Cerebral Palsy. (2011). Retrieved on November 5, 2011 from
http://www.ucp.org/uploads/media_items/cerebral-palsy-fact-sheet.original.pdf
Waldman, B.H., Borg, P.A., & Perlman, S.P. (2011). Periodontal care for patients
with special needs. Dimensions of Dental Hygiene. 9(9): 78-80, 83.
Wilkins, E.M. (2009). Clinical practice of the dental hygienist. (10 ed., pp 925-928).
Baltimore: Lipincott Williams and Wilkins