Cerebral Palsy

Spastic
Oleh : Yanuar Yudha Sudrajat

Preceptor : dr, Denny Hermana, Sp.OT FICS

SMF Bedah Rumah Sakit Al-Islam Bandung
Cerebral Palsy
Cerebral palsy is a nonprogressive neuromuscular disorder,
which usually is recognized before age 2 years old.
The specific cause is not identifiable. There is a wide variation
in the consequences for cerebral palsy that may or may not be
associated with mental impairment. Cerebral palsy is classified
in physiologic and anatomic categories as spastic (the most
common), athetotic, ataxic, and mixed.
Cerebral Palsy (CP) merupakan group of disorders yang
mempengaruhi kemampuan untuk bergerak,
mempertahankan keseimbangan dan postur.
CP merupakan penyebab tersering dari motor disability pada
anak.


Epidemiologi & Etiologi
Pada negara berkembang, kasus CP 2-2.5/1000 kelahiran hidup.

CP diakibatkan karena adanya underlying structural abnormality
of the brain;
Early prenatal, perinatal, or postnatal injury due to vascular
insufficiency
Toxins or infections
Pathophysiologic risk of prematurity

Berdasarkan evidence diperkirakan CP diakibatkan dari
prenatal factor (70-80%), tetapi penyebab pasti masih belum di
ketahui, kemungkinan di karenakan multifaktor.


Maternal and prenatal risk
factor
Long menstrual cycle
Previous pregnancy loss
Previous loss of newborn
Maternal mental
retardation
Maternal thyroid disorder,
especially iodine
defficiency
Maternal seizure disorder
History of delivering a child
weighing less than 2000g
History of delivering a child
with a motor deficit,
mental retardation, or a
sensory deficit

Pregnancy factor
Polyhidramnios
Treatment of the mother
with thyroid hormone,
estrogen or progesterone
Maternal seizure disorder
Maternal severe proteinuria
or high blood pressure
Maternal methyl mercury
exposure
Congenital malformations in
the fetus
Male sex of fetus
Bleeding in third trimester
Intrauterine growth
retardation
Multiple gestation

Perinatal risk factors
Prematurity
Chrorioamnionitis
Nonvertex and face
presentation of fetus
Birth asphyxia
Postnatal risk :
Infections (meningitis,
encephalitis
Intracranial hemorrhage
Periventricular
leukomalacia
Hypoxia-ischemia
Persisten fetal
circulation or persistent
pulmonary
hypertension
kernicterus

Types of Cerebral Palsy
CP di diklasifikasikan berdasarkan dari area otak yang
terkena, yaitu :
Stiff muscles (spasticity)
Uncontrollable movements (dyskinesia)
Poor balance and coordination (ataxia)
Spastic Cerebral Palsy
Tipe CP yang paling banyak ditemukan sekitar 80% dari seluruh
kasus CP
Spastic CP mengakibatkan peningkatan muscle tone, otot menjadi
kaku sehingga gerakan menjadi aneh.

Spastic CP dibedakan berdasarkan dari bagian tubuh yang terkena, yaitu
Spastic diplegia/diapereis :
Muscle stiffness pada kaki dengan tangan normal atau sedikit terkena
Spastic hemiplegia/hemiparesis :
Hanya mengenai satu sisi dari tubuh
Spastic quadriplegia/quadriparesis :
Mengenai seluruh extremitas, trunk dan wajah. Biasanya mempunyai
developmental disabilities yang lain speerti : seizure, vision, hearing, or
speech


Sign & Symptom
A child over 2 months :
Have difficulty controlling head
when picked up
Have stiff legs that cross or
scissor when picked up
A child over 6 months :
Continue to have hard time
controlling head when picked
up
Reach with only one hand while
keeping the other in a fist
A child over 10 months :
Crawl by pushing off with one
hand and leg while dragging
the opposite hand and leg
Not sit by himself or herself
A child over 12 months :
Not crawl
Not be able to stand with support
A child over 24 months :
Not be able to walk
Not be albe to push a toy with
wheels

Treatment
Management of abnormal
movements
Btulinum toxin (Botox)
type A dapat mengurangi
spasticity 3-6 bulan, dan
harus dipertimbangkan
untuk anak dengan
cerebral palsy with
spasticity
Phenol intramuscular
neurolyisis
Antiparkinsonian,
anticonvulsant,
antidopaminergic, dan
antidepressant agent.
Surgery
Intratecal baclofen pump
insertion: to treat spasticity
and/or dystonia
Selective dorsal rhizotomy: to
treat velocity-dependent
spasticity
Streotactic basal ganglia: may
improve rigidity,
choreoathetosis and tremor
Orthopedic surgical
intervention: to treat scoliosis,
joint contractres or dislocation

Terima Kasih