Cerebral Palsy
Transcription
Cerebral Palsy
Cerebral Palsy Soeroyo Machfudz & MTS Darmawan PENDAHULUAN • Penyebab gangguan otak besar adalah adanya injuri pada brain sebelum atau selama persalinan atau pada awal kehidupan • Ini sering menyebabkan gangguan yang menetap pada anak PENDAHULUAN • Penyebabnya adalah adanya kerusakan pusat kontrol motorik pada pengembangan otak dan ini dapat terjadi : - during pregnancy (about 75 %) - during childbirth (about 5 %) or - after birth (about 15 %) up to about age 3 years PENDAHULUAN • Non-progressive disorder, artinya kerusakan otak tidak berdampak buruk, tetapi gangguan secondary orthopedic sering terjadi……. – Contoh onset of arthritis and osteoporosis dapat terjadi lebih awal pada orang dewasa dengan CP. PENDAHULUAN • Tidak diketahui pengobatan penderita CP yang memuaskan. • Medical intervention terbatas dalam treatment and prevention pada kejadian komplikasi dari efek CP. Definition • Group dari kondisi khronis yang akan berdampak pada body movement and muscle coordination. • Ini disebabkan karena kerusakan satu atau lebih dari specific areas didalam otak, usually occurring during fetal development; before, during, or shortly after birth; or during infancy Definisi • Jadi kelainan ini masalahnya bukan kelainan pada otot dan sarafnya • Pada dasarnya kecacatan dan kerusakan perkembangan motor areas akan menganggu fungsi otak sehingga kemampuan otak tidak adequat dalam mengontrol gerakan dan postur tubuh. • Prevention : dengan ANC yang baik bisa menduga dan mengurangi kondisi oksiginasi janin kurang adekuat. • Pencegahan terjadinya CP pada beberapa bayi dengan cara resusitasi yang baik. • Kejadian CP di Amerika Serikat menurun tajam sd 50%. Hal ini disebabkan karena dokter mengikuti training khusus tentang resusitasi neonatal Insidensi • 1-2 dari 1000 bayi • 10 x lebih sering ditemukan prematur • Bagian otak yang mengendalikan pergerakan otot pada bayi tersebut sangat rentan terhadap cedera. Klasifikasi dari CP 1.Spastic CP 2.Dyskinetic/Athethoid CP 3.Ataxic 4.The Mixed/dystonic Classification of CP 1. Spastic CP ~ Muscle Stiffness • Most common • May involve 1 or both sides of the body. • Clinical hallmarks include hypertonicity with poor control of posture, balance, and coordinated movement, and impairment of fine and gross motor skills. Classification of CP 1. Spastic CP ~ Muscle Stiffness • Active attempts at motion ↑ the abnormal postures & lead to overflow of movement to other parts of the body. • Common types of spastic CP include: – Hemiparesis – Quadriparesis (tetraparesis) – Diplegia is when similar body parts are affected, such as both arms. Table 1. Topographical Distribution of Cerebral Palsy Topographical Descriptor Area affected Monoplegia One limb involved Hemiplegia Involvement of one side of the body Diplegia Lower extremities more involved than the upper extremities Triplegia Three extremities involved Quadriplegia or tetraplegia All four extremities involved Classification of CP 2. Dyskinetic / Athethoid CP ~ Uncontrolled Movements involves abnormal involuntary movements that disappear during sleep & ↑ with stress. • Major manifestations • Movements may become Classification of CP 2. Dyskinetic / Athethoid CP ~ Uncontrolled Movements • Major manifestations : – Athetosis (wormlike movement), – Dyskinetic movement of mouth – Drooling – Dysarthria. Classification of CP 2. Dyskinetic/Athethoid CP ~ Uncontrolled Movements • Movements may become – choreoid (irregular, jerky) and – dystonic (disordered muscle tone), especially when stressed and during the choreoid adolescent years. choreoid dystonic Classification of CP 3. Ataxic CP ~ poor balanced Manifested by – Wide-based gait, – rapid repetitive movements performed poorly – disintegration of movements of the upper extremities when the child reaches for objects. Classification of CP 4. The Mixed / dystonic CP • Combination of spastic & athetoid CP. Etiology • Common results from existing prenatal brain abnormalities. • Prematurity : the single most important determinant of CP. • Other prenatal or perinatal risk factors : – Asphyxia, ischemia, perinatal trauma, – Congenital & perinatal infections, and perinatal metabolic problems such as • hyperbilirubinemia and • hypoglycemia. PENYEBAB CP • Infeksi, trauma dan tumor dapat menyebabkan CP pada bayi usia dini. • Beberapa kasus (sekitar 24%) dari CP tidak bisa diterangkan lebih lanjut. Pathophysiology • Disabilities usually result from injury to the cerebellum, the basal ganglia or the motor cortex. • It is difficult to establish the precise location of neurologic lesions because there is no typical pathologic picture. Pathophysiology • In some cases, the brain has – gross malformations; in others, – vascular occlusion, atrophy, loss of neurons – degeneration may be evident. Pathophysiology • CP is nonprogressive but may become more apparent as the child grows older. Clinical Manifestations Most common : • Delayed gross motor development – delay in all motor accomplishments; – delay becomes more profound as the child grows) Clinical Manifestations • Additional manifestations include: 1. Abnormal motor performance – e.g. early dominant hand preference, abnormal and asymmetrical crawl, – poor sucking, feeding problems or – persistent tongue thrust (melet) 2. Alterations of muscle tone (e.g. increased or decrease resistance to passive movements, child feels stiff when handling or dressing, difficulty in diapering or opisthotonos) Clinical Manifestations • Additional manifestations include: 3. Abnormal postures (e.g. scissoring legs or persistent infantile posturing) Clinical Manifestations • Additional manifestations include: 4. Reflex abnormalities (e.g. persistent primitive reflexes, such as tonic neck of hyperreflexia) Clinical Manifestations • Disabilities associated with CP include – mental retardation, seizures, – attention deficit disorder and – sensory impairment. Clinical Manifestations • Severe cases : at birth • Mild and moderate : 1-2 years old. • Failure to achieve milestones may be the first sign. Diagnosis • Prenatal, birth and postnatal history • Neurologic examination • Assessment of muscle tone, behavior and abilities • Other disorders, such as metabolic disorders, degenerative disorders and early slow-growing brain tumors are ruled out. What can be done? • The damaged parts of the brain cannot be repaired, but often the child can learn to use the undamaged parts to do what she wants to do. • It is important for parents to know more or less what to expect: What can be done? • The child with cerebral palsy will become an adult with CP. • Searching for cures will only bring disappointment. • Instead, help the child become an adult who can live with her disability and be as independent as possible. Treatment Should address the following: • • • • • spasticity, dystonia, muscle stiffness, contracture, joint deformity, muscle weakness, and other aspects of abnormal motor control. Therapy • STRETCHING • STRENGTHENING • POSITIONING STRETCHING • CP tend to have ↑ muscle tone leading to generally tight muscles. • → keep the child limber so they can perform everyday tasks. • The arms and legs must be moved in ways that produce a slow, steady pull on the muscles to keep them loose. STRENGTHENING: • Therapists will work specific muscle groups to enable them to support the body better and ↑ function. • A new technique : aquatic work. • Water can help resist or assist in the performance of an exercise and also works on lengthening and stretching muscles by the mere force of gravity and suspension. POSITIONING • Braces, abduction pillows, knee immobilizers wheelchair inserts, sitting recommendations, and handling techniques are all ways of positioning a patient. • Such techniques require the body to be placed in a specific position to attain long stretches and can help eliminate unwanted tone due to hyperactive muscles. • This is potentially the most important aspect of therapy because it enables the body to do tasks it is being asked to perform. The ultimate goal of therapy is to make the patient more independent. MATUR NUWUN