PE27.10 | Cerebral Palsy — Summary & Reflection

KEY TAKEAWAYS

Cerebral palsy is a group of permanent, non-progressive motor disorders caused by a static brain lesion in the developing brain, occurring prenatally, perinatally, or postnatally. The most important cause in India is perinatal HIE; prematurity/PVL and kernicterus are other key causes. Motor type classification: spastic (70–80%; hemiplegia/diplegia/quadriplegia), dyskinetic (basal ganglia; choreoathetosis from kernicterus), ataxic (cerebellar), and mixed. Functional severity is classified using the GMFCS (I–V), which guides prognosis and therapy planning. MRI brain identifies the structural lesion; mandatory comorbidity screening includes epilepsy (35–40%), intellectual disability (~50%), sensory impairments, and feeding difficulties. Management is multidisciplinary — physiotherapy (cornerstone), OT, SLT, spasticity management (stepped: stretching → oral agents → BTX-A → ITB pump → surgery), orthotics, epilepsy management, and feeding support. The family is the most important rehabilitation partner, and parent training is central to every management plan.

REFLECT

Reflect on the public health dimension of cerebral palsy in India: most cases due to birth asphyxia are preventable with better intrapartum monitoring, skilled birth attendance, and immediate neonatal resuscitation. Kernicterus is entirely preventable with timely phototherapy. Think about a context in your future practice — a rural PHC, a district hospital, an urban tertiary centre — and consider: what single intervention in the perinatal period would most reduce the burden of CP in that setting? How would you train a birth attendant or ASHA worker to recognise a baby needing resuscitation? And for children who already have CP, what does a realistic conversation with a family about GMFCS prognosis look like — balancing honesty with hope and emphasising the child's strengths?