Cerebral PalsyCerebral PalsyJoe Conte and Sarah LupoJoe Conte and Sarah Lupo

VideoVideo

http://www.dailymotion.com/video/x68kwh_cerebral-palsy-wwwbrainpalsycom_shortfilms

What is Cerebral Palsy?What is Cerebral Palsy?

• A group of permanent disabling A group of permanent disabling symptoms resulting from damage to the symptoms resulting from damage to the motor control areas of the brainmotor control areas of the brain

• A non-progressive condition that might A non-progressive condition that might originate before, during, or shortly after originate before, during, or shortly after birthbirth

• Cerebral = brainCerebral = brain• Palsy = disordered movement or posturePalsy = disordered movement or posture

StatisticsStatistics

• According to the United Cerebral Palsy Association According to the United Cerebral Palsy Association an estimated 500,000 have cerebral palsy.an estimated 500,000 have cerebral palsy.

• 10-20% of children with cerebral palsy acquire the 10-20% of children with cerebral palsy acquire the disorder after birth.disorder after birth.

• The average lifetime cost for a person with The average lifetime cost for a person with cerebral palsy totals nearly $1 million cerebral palsy totals nearly $1 million

• Cerebral palsy is diagnosed in approx. 8,000 Cerebral palsy is diagnosed in approx. 8,000 children each yearchildren each year

• Cerebral palsy is the most common cause of Cerebral palsy is the most common cause of childhood physical disability, occurring in 2-3 out childhood physical disability, occurring in 2-3 out of 1000 childrenof 1000 children

Causes of Cerebral PalsyCauses of Cerebral Palsy

• Illness during pregnancyIllness during pregnancy• Premature deliveryPremature delivery• Insufficient amount/Lack of oxygen Insufficient amount/Lack of oxygen

supply to the fetus/newborn infant’s supply to the fetus/newborn infant’s brainbrain

• Lead poisoningLead poisoning• Illness early in the infant’s lifeIllness early in the infant’s life• Child abuseChild abuse• Medical negligenceMedical negligence• Many times it is unknownMany times it is unknown

Symptoms of Cerebral Symptoms of Cerebral Palsy Palsy

• Developmental delay Developmental delay

• Abnormal muscle toneAbnormal muscle tone

• Unusual posture Unusual posture

• Early development of hand preferenceEarly development of hand preference

Classifications of Classifications of Cerebral PalsyCerebral Palsy

• TopographicalTopographical• NeuromotorNeuromotor• FunctionalFunctional

TopographicalTopographical

• Based on the body segments afflictedBased on the body segments afflicted• Typically used by medical Typically used by medical

professionalsprofessionals• Classes include:Classes include:

– MonoplegiaMonoplegia– Diplegia Diplegia – Hemiplegia Hemiplegia – ParaplegiaParaplegia– Triplegia Triplegia – QuadriplegiaQuadriplegia

NeuromotorNeuromotor

• SpasticitySpasticity• AthetosisAthetosis• AtaxiaAtaxia

SpasticitySpasticity

• Result from damage to motor areas Result from damage to motor areas of the cerebrum; characterized by of the cerebrum; characterized by increased muscle tone, primarily of increased muscle tone, primarily of flexors and internal rotators, which flexors and internal rotators, which might lead to permanent might lead to permanent contractures and bone deformitiescontractures and bone deformities

AthetosisAthetosis

• A condition that occurs when there is A condition that occurs when there is damage to the basal ganglia (masses of damage to the basal ganglia (masses of gray matter composed of neurons gray matter composed of neurons located deep within the cerebral located deep within the cerebral hemispheres of the brain) results in an hemispheres of the brain) results in an overflow of motor impulses to the overflow of motor impulses to the muscles.muscles.

• Some characteristics of this type of CP Some characteristics of this type of CP include slow, writhing movements that include slow, writhing movements that are uncoordinated and involuntarily.are uncoordinated and involuntarily.

AtaxiaAtaxia• Condition that occurs when there is damage to Condition that occurs when there is damage to

the cerebellum (which normally regulates balance the cerebellum (which normally regulates balance and muscle coordination).and muscle coordination).

• Diagnosed when the child attempts to walk.Diagnosed when the child attempts to walk.• Muscles show abnormal degrees of hypotonicity.Muscles show abnormal degrees of hypotonicity.• ConditionsConditions

– Individual shows lack of balance and coordination Individual shows lack of balance and coordination necessary for proper arm and leg movement causing a necessary for proper arm and leg movement causing a wide-based gait to be exhibited.wide-based gait to be exhibited.

– Individuals show difficulty with performing basic motor Individuals show difficulty with performing basic motor skills and pattern that include locomotor movements skills and pattern that include locomotor movements such as running, jumping, and skipping. such as running, jumping, and skipping.

FunctionalFunctional

• Individuals are placed into one of eight ability Individuals are placed into one of eight ability classes according to the severity of the classes according to the severity of the disability. disability.

• Important system for physical education Important system for physical education teachers because it categorizes the individuals teachers because it categorizes the individuals according to their disability levels.according to their disability levels.

• Teachers and coaches can use this classification Teachers and coaches can use this classification system to help make the competition among the system to help make the competition among the individuals equal (in competitive activities individuals equal (in competitive activities individuals who have the same classification individuals who have the same classification can compete against each other. can compete against each other.

FunctionalFunctional

Common Characteristics Common Characteristics in the Psychomotor in the Psychomotor

DomainDomain• SeizuresSeizures• Spastic or rigid Spastic or rigid

musclesmuscles• Contractures may Contractures may

develop when develop when restricted range of restricted range of motion is severemotion is severe

• Hyperactive Stretch Hyperactive Stretch ReflexReflex

• Scissoring gate or Scissoring gate or hemiplegic gatehemiplegic gate

• Persistence of Persistence of unwanted primitive unwanted primitive reflexes and tremorsreflexes and tremors

• Involuntary movement Involuntary movement (e.g., constant, (e.g., constant, unpredictable, unpredictable, purposeless movement)purposeless movement)

• May exhibit both May exhibit both hypertonic and hypertonic and hypotonic muscle tonehypotonic muscle tone

• Low postural tone; may Low postural tone; may be able to walk unaided, be able to walk unaided, usually with arms held usually with arms held out to the sidesout to the sides

• Often under or over Often under or over reachesreaches

• Falls and stumbles Falls and stumbles easilyeasily

Common Characteristics in Common Characteristics in the Cognitive Domainthe Cognitive Domain

• Loss of perceptual ability Loss of perceptual ability • Difficulty with speech Difficulty with speech • Learning disability or mental Learning disability or mental

retardation retardation

Common Characteristics in Common Characteristics in the Affective Domainthe Affective Domain

• Difficulty socializing with their peersDifficulty socializing with their peers• May be withdrawnMay be withdrawn• ADHDADHD

Teaching StylesTeaching Styles

• Be very patient and use wait timeBe very patient and use wait time• Reinforce language and speechReinforce language and speech• Add weights to implements, such as Add weights to implements, such as

bats and racquets, to help with bats and racquets, to help with tremors or unwanted movementstremors or unwanted movements

• Be careful with how you have them Be careful with how you have them movemove

Exercising with Cerebral Exercising with Cerebral PalsyPalsy

• Know the characteristics of each Know the characteristics of each individual and their capabilitiesindividual and their capabilities

• Resistance training helps improve Resistance training helps improve overall motor function and even overall motor function and even flexibilityflexibility– Isokinetic trainingIsokinetic training

• Cycle ergometers help with Cycle ergometers help with cardiorespiratory endurancecardiorespiratory endurance

DiagnosisDiagnosis• Test reflexesTest reflexes

• Check for hand preference Check for hand preference

• Rule out other disorders that can cause movement problemsRule out other disorders that can cause movement problems

• Perform CT scan, MRI, and/or ultrasonography Perform CT scan, MRI, and/or ultrasonography

• Look for other conditions linked to cerebral palsyLook for other conditions linked to cerebral palsy

How to Manage Cerebral How to Manage Cerebral PalsyPalsy

• Management is directed at Management is directed at alleviating symptoms that are alleviating symptoms that are caused by damage to the brain and caused by damage to the brain and helping the child achieve maximum helping the child achieve maximum potential in growth and potential in growth and development. development.

Technology and Cerebral Technology and Cerebral PalsyPalsy

• Assistive technology Assistive technology – ComputersComputers– Communication boards with words or Communication boards with words or

symbol systemssymbol systems– Bikes or scootersBikes or scooters– Motorized wheelchairsMotorized wheelchairs

Treatment TeamTreatment Team

• People involved in the planning, People involved in the planning, treatment, and decision-making of treatment, and decision-making of an individual with cerebral palsyan individual with cerebral palsy– Healthcare professionals who are Healthcare professionals who are

involved with the individualinvolved with the individual– Family and other caregiversFamily and other caregivers– Teachers who know the individualTeachers who know the individual

Treatment and TherapyTreatment and Therapy• Since cerebral palsy is Since cerebral palsy is

so diverse the so diverse the treatment of it can treatment of it can vary greatly from one vary greatly from one individual to another.individual to another.

• There is no cure, but There is no cure, but there are many there are many therapies to help therapies to help people better handle people better handle their conditiontheir condition– Physical therapyPhysical therapy– Occupational therapyOccupational therapy– BotoxBotox– Stem cellsStem cells

• The focus of The focus of treatment is on treatment is on helping the individual helping the individual reach his/her highest reach his/her highest level of independence.level of independence.

• Individualized plans Individualized plans for treating C.P. for treating C.P. should be centered should be centered around the needs of around the needs of the individual.the individual.

Other interesting ways to Other interesting ways to treat cerebral palsytreat cerebral palsy

• Dolphin therapy:Dolphin therapy:– Developed by American psychologist Developed by American psychologist

David E. Nathanson around 1978David E. Nathanson around 1978– Allows children with cerebral palsy to Allows children with cerebral palsy to

step into a different environment and step into a different environment and interact with the dolphin in a way that interact with the dolphin in a way that is both playful as well as constructive is both playful as well as constructive for that child.for that child.

Dolphin Therapy Dolphin Therapy (Continued)(Continued)

– Research has shown that dolphins who are one of the Research has shown that dolphins who are one of the most intelligent animals are actually able to recognize most intelligent animals are actually able to recognize the child’s deficiency which helps the child create a the child’s deficiency which helps the child create a connection with the dolphin.connection with the dolphin.

– The connection has been known to help the child relax The connection has been known to help the child relax as well as an openness to learn and heal that can help as well as an openness to learn and heal that can help lead to developmental progress.lead to developmental progress.

– http://www.metacafe.com/watch/714493/dolphin_therapy_in_kemer_antalya_turkey/

Space Suit TherapySpace Suit Therapy

• Becoming increasingly popular for Becoming increasingly popular for individuals with cerebral palsy.individuals with cerebral palsy.

• The suit is also known as Therasuits or The suit is also known as Therasuits or Therapy suits and it resembles an outfit Therapy suits and it resembles an outfit that was originally developed by the that was originally developed by the Russians that helped their astronauts Russians that helped their astronauts maintain their muscle tone while they maintain their muscle tone while they were in space.were in space.

Space Suit Therapy Space Suit Therapy (Continued)(Continued)

• The suit has elastic cords that attach to The suit has elastic cords that attach to different areas of the body and they are different areas of the body and they are positioned to keep the body properly aligned positioned to keep the body properly aligned to forcibly encourage movement within a to forcibly encourage movement within a normal range of motion.normal range of motion.

• The design of the suit causes an individual The design of the suit causes an individual with cerebral palsy to limit body movement with cerebral palsy to limit body movement in particular ways in order to force the body in particular ways in order to force the body into proper physical alignments and help to into proper physical alignments and help to replace awkward movements with more replace awkward movements with more proper movements.proper movements.

Benefits of Space Suit Benefits of Space Suit TherapyTherapy

• Provides proper body alignment Provides proper body alignment which helps improves muscle tone as which helps improves muscle tone as well as body awareness, gross motor well as body awareness, gross motor skills and balance.skills and balance.

• Because the suit helps align and Because the suit helps align and balance the body it also strengthens balance the body it also strengthens the body as well.the body as well.

Incorporating Video Incorporating Video GamesGames

• Though more research and studies need to be done, Though more research and studies need to be done, a recent study showed that using a Nintendo Wii a recent study showed that using a Nintendo Wii for children with cerebral palsy help them improve for children with cerebral palsy help them improve in different areas including their visual perception, in different areas including their visual perception, bodily control as well as their functional mobility.bodily control as well as their functional mobility.

• If more research shows the same types of If more research shows the same types of consistency, this could be a huge step for helping consistency, this could be a huge step for helping individuals with cerebral palsy because compared individuals with cerebral palsy because compared to other types of rehabilitation techniques the Wii to other types of rehabilitation techniques the Wii is only a fraction of the cost and is commercially is only a fraction of the cost and is commercially produced, which means the individuals could have produced, which means the individuals could have it in their house and use it on a daily basis. it in their house and use it on a daily basis.

Could malpractice cause Could malpractice cause cerebral palsy?cerebral palsy?

• If a mistake is made during the birth of an infant that If a mistake is made during the birth of an infant that was the cause of cerebral palsy doctors as well as was the cause of cerebral palsy doctors as well as nurses can be held accountable.nurses can be held accountable.

• Many doctors and nurses do not know enough about Many doctors and nurses do not know enough about cerebral palsy and this can result in devastating cerebral palsy and this can result in devastating mistakes and lawsuits if a mistake is made.mistakes and lawsuits if a mistake is made.

• While caring for the expectant mother and fetus, While caring for the expectant mother and fetus, medical providers are responsible for assuring medical providers are responsible for assuring adequate care during the pregnancy, during labor adequate care during the pregnancy, during labor and delivery, and immediately after the delivery of and delivery, and immediately after the delivery of the infant. When injury does occur during the the infant. When injury does occur during the birthing process, the results can be devastating. birthing process, the results can be devastating.

• A cerebral palsy lawyer can help you determine if A cerebral palsy lawyer can help you determine if medical malpractice caused your child's cerebral medical malpractice caused your child's cerebral palsy. palsy.

Malpractice That Can Malpractice That Can Result in Cerebral PalsyResult in Cerebral Palsy

• Leaving the child in the birth canal Leaving the child in the birth canal too longtoo long

• Failure to detect a prolapsed Failure to detect a prolapsed umbilical cordumbilical cord

• Failure for the doctor to perform a Failure for the doctor to perform a cesarean section (c-section)cesarean section (c-section)

• Failure to respond to the mother’s Failure to respond to the mother’s changing conditionschanging conditions

• Failure to recognize and treat Failure to recognize and treat seizuresseizures

Something to Keep in Something to Keep in MindMind

• In an Australian study, most medical In an Australian study, most medical students have a very limited students have a very limited knowledge of cerebral palsyknowledge of cerebral palsy

• They also have negative attitudes They also have negative attitudes toward individuals with cerebral toward individuals with cerebral palsy as a resultpalsy as a result

Legal Information and Legal Information and CT LawsCT Laws

• Cerebral Palsy LawyersCerebral Palsy Lawyers– Haymond LawHaymond Law– http://www.haymondlaw.com/cerebral_palsy/index.asp

• A lawsuit may be filed within 2 years from the date of the A lawsuit may be filed within 2 years from the date of the injuryinjury

• An expert witness must be presentAn expert witness must be present– Must be a doctor who has been licensed and practicing for 5 yearsMust be a doctor who has been licensed and practicing for 5 years

• CompensationCompensation– There is no limit on the amount of damage awardThere is no limit on the amount of damage award

• Limit for Attorney FeesLimit for Attorney Fees– No more than 1/3 of the first $300,000No more than 1/3 of the first $300,000– 25% of the next $300,00025% of the next $300,000– 20% of the next $300,00020% of the next $300,000– 15% of the next $300,00015% of the next $300,000– 10% of an award greater than $1.2 million10% of an award greater than $1.2 million

Examples of LawsuitsExamples of Lawsuits

• Cody - Aurora, Illinois – 2001-2002Cody - Aurora, Illinois – 2001-2002– Mother filed suit against the doctors and Mother filed suit against the doctors and

hospital because her son was born with brain hospital because her son was born with brain damage and cerebral palsydamage and cerebral palsy

– The doctor failed to successfully use the vacuum The doctor failed to successfully use the vacuum extractor device, which was needed to prevent extractor device, which was needed to prevent brain injuries during the deliverybrain injuries during the delivery

– The doctors performed an emergency C-section The doctors performed an emergency C-section when they realized that the baby’s heart rate when they realized that the baby’s heart rate was in distresswas in distress

– She received $15.35 million for her son’s past She received $15.35 million for her son’s past and future medical expensesand future medical expenses

http://www.cerebralpalsysource.com

Examples of LawsuitsExamples of Lawsuits

• Hannah - TennesseeHannah - Tennessee– The doctors used the wrong instruments when The doctors used the wrong instruments when

delivering Hannahdelivering Hannah– The nurse and surgical technician failed to The nurse and surgical technician failed to

follow instructions of the doctorfollow instructions of the doctor– Two doctors at the hospital were in a Two doctors at the hospital were in a

relationship, which affected moralerelationship, which affected morale– As a result, Hannah has cerebral palsyAs a result, Hannah has cerebral palsy

• Severe brain damage, seizures, developmental Severe brain damage, seizures, developmental delaysdelays

– At age 8, Hannah cannot speak and feels pain At age 8, Hannah cannot speak and feels pain when people walk past herwhen people walk past her

http://www.cerebralpalsysource.com

Devastating Costs of Devastating Costs of Cerebral PalsyCerebral Palsy

• According to According to http://www.cerebralpalsysource.com, an , an “…estimated lifetime expense of “…estimated lifetime expense of living with cerebral palsy is living with cerebral palsy is approximately $921,000 a person.”approximately $921,000 a person.”

Common Medical Common Medical ExpensesExpenses

• Doctor visitsDoctor visits• HospitalsHospitals• Visits to the E.R.Visits to the E.R.• Various types of medicationsVarious types of medications• SurgeriesSurgeries• RehabilitationRehabilitation• Psychological counselingPsychological counseling• Assistive devices Assistive devices

Common Non-Medical Common Non-Medical ExpensesExpenses

• In order for individuals with cerebral In order for individuals with cerebral palsy to live their lives they need palsy to live their lives they need special arrangements that include:special arrangements that include:– Home modificationsHome modifications– Vehicle modificationsVehicle modifications– Special education programsSpecial education programs– Other modified living arrangements to Other modified living arrangements to

allow mobilityallow mobility

Indirect CostsIndirect Costs

• According to According to http://www.cerebralpalsysource.com, “…http://www.cerebralpalsysource.com, “…indirect costs are considered the limitations a indirect costs are considered the limitations a person suffering from cerebral palsy has and person suffering from cerebral palsy has and the effect on their overall life.”the effect on their overall life.”

• Some of these costs include:Some of these costs include:– Loss of wage Loss of wage – The loss of earning potentialThe loss of earning potential– The inability to provide for or contribute to their life The inability to provide for or contribute to their life

financially, due to severely debilitating conditionsfinancially, due to severely debilitating conditions– Pain and sufferingPain and suffering

ReferencesReferences• Cerebral Palsy & TechnologyCerebral Palsy & Technology. (n.d.). Retrieved March 10, 2009, from . (n.d.). Retrieved March 10, 2009, from http://computers-technology-http://computers-technology-

cerebralpalsy.comcerebralpalsy.com• Cerebral Palsy @ Brainpalsy.comCerebral Palsy @ Brainpalsy.com. (n.d.). Retrieved March 14, 2009, from . (n.d.). Retrieved March 14, 2009, from

www.dailymotion.com/video/x68kwh_cerebral-palsy-wwwbrainpalsycom_shortfilmswww.dailymotion.com/video/x68kwh_cerebral-palsy-wwwbrainpalsycom_shortfilms• Dolphin Therapy In Kemer Antalya - Turkey - VideoDolphin Therapy In Kemer Antalya - Turkey - Video. (n.d.). Retrieved March 30, 2009, from . (n.d.). Retrieved March 30, 2009, from

http://www.metacafe.com/watch/714493/dolphin_therapy_in_kemer_antalya_turkey/ http://www.metacafe.com/watch/714493/dolphin_therapy_in_kemer_antalya_turkey/ • ExpertHub Inc.. (n.d.). ExpertHub Inc.. (n.d.). Medical Malpractice Law in ConnecticutMedical Malpractice Law in Connecticut. Retrieved March 18, 2009, from . Retrieved March 18, 2009, from

http://www.lawfirms.com/resources/personal-injury/medical-malpractice/medical-malpractice-law-http://www.lawfirms.com/resources/personal-injury/medical-malpractice/medical-malpractice-law-connecticut.htmconnecticut.htm

• French, R. (n.d.). French, R. (n.d.). Cerebral Palsy: APE Fact SheetCerebral Palsy: APE Fact Sheet. Retrieved March 10, 2009, from . Retrieved March 10, 2009, from http://www.twu.edu/inspire/Fact%20Sheets/Cerebral_Palsy.pdfhttp://www.twu.edu/inspire/Fact%20Sheets/Cerebral_Palsy.pdf

• MacLennan, A., Nelson, K., Hankins, G., & Speer, M. (2005). Who Will Deliver Our Grandchildren?: MacLennan, A., Nelson, K., Hankins, G., & Speer, M. (2005). Who Will Deliver Our Grandchildren?: Implications of Cerebral Palsy Litigation. Implications of Cerebral Palsy Litigation. Journal of the American Medical AssociationJournal of the American Medical Association, , 294294((1313), 1688-), 1688-1690. Retrieved March 30, 2009, from the Academic Search Premier database.1690. Retrieved March 30, 2009, from the Academic Search Premier database.

• Martin, H., Rowell, M., Reid, S., Marks, M., & Reddihough, D. (2005). Cerebral Palsy: What Do Medical Martin, H., Rowell, M., Reid, S., Marks, M., & Reddihough, D. (2005). Cerebral Palsy: What Do Medical Students Know and Believe?. Students Know and Believe?. Journal of Paediatrics & Child HealthJournal of Paediatrics & Child Health, , 4141((1/21/2), 43-47. Retrieved March 17, ), 43-47. Retrieved March 17, 2009, from the Academic Search Premier database.2009, from the Academic Search Premier database.

• Infocus Studios, LLC.. (n.d.). Infocus Studios, LLC.. (n.d.). Cerebral Palsy & Medical Malpractice ClaimsCerebral Palsy & Medical Malpractice Claims. Retrieved March 17, 2009, . Retrieved March 17, 2009, from from http://www.haymondlaw.com/cerebral_palsy/index.asphttp://www.haymondlaw.com/cerebral_palsy/index.asp

• Rimmer, Ph.D., J. H. (n.d.). Rimmer, Ph.D., J. H. (n.d.). Introduction to Cerebral Palsy and ExerciseIntroduction to Cerebral Palsy and Exercise. Retrieved March 18, 2009, from . Retrieved March 18, 2009, from http://www.ncpad.org/disability/fact_sheet.php?sheet=119&view=all&print=yeshttp://www.ncpad.org/disability/fact_sheet.php?sheet=119&view=all&print=yes

• Winnick, J. P. (2005). Winnick, J. P. (2005). Adapted Physical Education and Sport 4th ed.Adapted Physical Education and Sport 4th ed.. Champaign, IL: Human Kinetics.. Champaign, IL: Human Kinetics.• eJustice.com. (n.d.). eJustice.com. (n.d.). Cerebral Palsy SourceCerebral Palsy Source. Retrieved March 8, 2009, from . Retrieved March 8, 2009, from

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