Cerebral Palsy in Children
Comprehensive Nursing Management Guide
1. Introduction to Cerebral Palsy
Definition
Cerebral palsy (CP) is a group of non-progressive neurological disorders affecting movement, muscle coordination, and posture. It is caused by abnormal brain development or damage to the developing brain, most often occurring before or during birth or in early infancy.
Key Points
- Most common childhood motor disability
- Non-progressive (brain damage doesn’t worsen)
- Permanent, but not unchangeable
- Symptoms and severity vary widely
Epidemiology
- Affects approximately 1.5-4 per 1,000 live births worldwide
- More common in males than females
- Higher prevalence in premature or low birth weight infants
- Approximately 17 million people have CP globally
Importance for Nursing Students
Understanding cerebral palsy is crucial for nursing students because:
Early Identification
Nurses are often in positions to identify early signs of CP and facilitate prompt intervention.
Holistic Care
CP requires comprehensive, multidisciplinary care addressing physical, emotional, and social needs.
Family Support
Nurses play a key role in educating and supporting families of children with CP.
2. Pathophysiology
Brain Areas Affected
Cerebral palsy results from damage to or abnormal development of the motor areas in the brain, primarily affecting:
| Brain Area | Function | Result When Damaged |
|---|---|---|
| Motor Cortex | Controls voluntary movement | Weakness, poor coordination |
| Basal Ganglia | Regulates movement and posture | Involuntary movements, dyskinesia |
| Cerebellum | Coordinates movement and balance | Ataxia, tremors |
| Pyramidal Tracts | Transmit motor signals | Spasticity, hyperreflexia |
Causes and Risk Factors
Prenatal (Before Birth)
- Maternal infections (TORCH infections)
- Placental insufficiency
- Genetic abnormalities
- Multiple births
- Maternal exposure to toxins
- Maternal medical conditions (thyroid problems, seizures)
Perinatal (During Birth)
- Birth asphyxia
- Traumatic birth
- Premature birth
- Low birth weight
- Jaundice and kernicterus
Postnatal (After Birth)
- Brain infections (meningitis, encephalitis)
- Head trauma
- Cerebrovascular accidents
- Prolonged seizures
- Severe dehydration
Neurological Impact
Mnemonic: “BRAIN DAMAGE”
B
Basal ganglia dysfunction (abnormal movement patterns)
R
Reflexes altered (hyperreflexia, primitive reflexes persist)
A
Abnormal muscle tone (hypertonia or hypotonia)
I
Impaired motor control and coordination
N
Neuroplasticity altered (affecting adaptability)
D
Developmental delays (motor milestones)
A
Associated conditions (sensory, cognitive impairments)
M
Motor pathways disrupted (pyramidal and extrapyramidal)
A
Asymmetrical impacts (varies by affected brain area)
G
Growth and development impacted
E
Executive function may be affected
3. Classification and Types
Based on Motor Disorders
Spastic CP (70-80%)
Characteristics: Increased muscle tone, stiff and jerky movements, hyperreflexia
Brain Area: Motor cortex, pyramidal tracts
Signs: Scissoring gait, contractures, difficulty with precise movements
Athetoid/Dyskinetic CP (10-15%)
Characteristics: Slow, writhing movements, fluctuating muscle tone
Brain Area: Basal ganglia
Signs: Uncontrolled movements, difficulty maintaining posture, speech problems
Ataxic CP (5-10%)
Characteristics: Poor coordination, balance problems, tremors
Brain Area: Cerebellum
Signs: Unsteady gait, intention tremor, difficulty with rapid movements
Hypotonic CP (Rare)
Characteristics: Decreased muscle tone, floppiness
Brain Area: Various regions
Signs: Poor head control, joint hypermobility, delayed motor development
Mixed CP (10-15%)
Characteristics: Features of multiple types, commonly spastic and dyskinetic
Brain Area: Multiple regions
Signs: Combined symptoms from different types
Based on Body Parts Affected
| Type | Body Areas Affected | Characteristics |
|---|---|---|
| Monoplegia | One limb only | Rare; affects one arm or leg |
| Hemiplegia | One side of the body | Affects arm more than leg; possible scoliosis |
| Diplegia | Both legs primarily | Arms mildly affected or not at all; common in premature infants |
| Triplegia | Three limbs | Typically both legs and one arm |
| Quadriplegia | All four limbs | Most severe; affects trunk and face; often with cognitive impairment |
| Double Hemiplegia | All four limbs, one side more affected | Asymmetrical involvement; can be confused with quadriplegia |
GMFCS Classification
The Gross Motor Function Classification System (GMFCS) is a 5-level system that describes the gross motor function of children with cerebral palsy, with focus on sitting, transfers, and mobility:
GMFCS Levels
- Level I: Walks without limitations
- Level II: Walks with limitations (difficulty with long distances and balance)
- Level III: Walks using a hand-held mobility device (canes, crutches, walkers)
- Level IV: Self-mobility with limitations; may use powered mobility
- Level V: Transported in a manual wheelchair; severely limited self-mobility
4. Clinical Manifestations
Primary Manifestations
Primary CP Manifestations
Motor Dysfunction
- Delayed motor milestones
- Abnormal muscle tone
- Impaired coordination
- Balance problems
- Abnormal reflexes
Movement Disorders
- Spasticity (stiffness)
- Dyskinesia (involuntary movements)
- Ataxia (lack of coordination)
- Tremors (rhythmic shaking)
- Dystonia (twisted postures)
Posture Issues
- Abnormal standing/sitting posture
- Scissoring of legs
- Toe walking
- W-sitting
- Asymmetrical postures
Gait Abnormalities
- Delayed walking
- Asymmetrical gait
- Crouched gait
- Toe walking
- Wide-based gait
Secondary Manifestations (Associated Conditions)
| System | Associated Conditions | Clinical Implications |
|---|---|---|
| Neurological | Seizures (30-50%), intellectual disability (30-50%) | Require medication management; impact learning and development |
| Musculoskeletal | Contractures, hip displacement, scoliosis, osteoporosis | Cause pain, limit function; may require surgical intervention |
| Gastrointestinal | Dysphagia, GERD, constipation, malnutrition | Affect growth, comfort; may require special feeding approaches |
| Respiratory | Aspiration pneumonia, sleep apnea, reduced pulmonary function | Increase morbidity; require respiratory monitoring |
| Sensory | Visual impairments (40%), hearing loss (10-20%), sensory processing disorders | Affect communication, learning; require specialized interventions |
| Communication | Dysarthria, speech delay, language disorders | Limit communication; may require alternative methods |
| Urinary | Incontinence, urinary tract infections, retention | Impact independence; increase care needs |
| Behavioral/Psychological | ADHD, anxiety, depression, autism spectrum disorders | Affect socialization and quality of life; require specialized support |
Developmental Impact
Key Developmental Concerns
- Motor Development: Delayed reaching of milestones like rolling, sitting, standing, and walking
- Cognitive Development: May be affected in 30-50% of cases, ranging from mild to severe
- Communication Development: Speech and language delays due to motor control issues
- Social-Emotional Development: Challenges with peer interactions, self-esteem, and emotional regulation
- Self-Care Skills: Delayed independence in activities of daily living
The impact on development varies significantly based on the type, severity, location of brain injury, and access to early intervention services. Early, intensive, and multidisciplinary intervention can significantly improve developmental outcomes.
5. Assessment and Diagnosis
Screening and Assessment Tools
Early Motor Assessment
- General Movements Assessment (GMA) – Assesses spontaneous movements in infants
- Hammersmith Infant Neurological Examination (HINE) – Evaluates neurological function
- Alberta Infant Motor Scale (AIMS) – Measures gross motor development
Functional Classification
- GMFCS – Gross Motor Function Classification System
- MACS – Manual Ability Classification System
- CFCS – Communication Function Classification System
- EDACS – Eating and Drinking Ability Classification System
Outcome Measures
- GMFM – Gross Motor Function Measure
- PEDI – Pediatric Evaluation of Disability Inventory
- CP-QOL – Cerebral Palsy Quality of Life Questionnaire
- COPM – Canadian Occupational Performance Measure
Diagnostic Methods
| Diagnostic Approach | Purpose | Nursing Considerations |
|---|---|---|
| Clinical Assessment | Evaluate neurological status, muscle tone, reflexes, movement patterns | Document observations thoroughly; assess for persistence of primitive reflexes |
| Medical History | Identify risk factors, pregnancy complications, birth trauma | Take detailed history including maternal, birth, and developmental history |
| Neuroimaging (MRI, CT) | Identify brain abnormalities, damage, or malformations | Prepare child/family for procedure; monitor during sedation if required |
| Genetic Testing | Identify genetic causes of CP or rule out progressive disorders | Explain purpose of testing; provide genetic counseling referrals |
| Metabolic Screening | Rule out metabolic disorders that can mimic CP | Ensure proper collection of specimens; explain procedure to family |
| Electroencephalogram (EEG) | Assess for seizure activity, often associated with CP | Prepare child for electrode placement; monitor during procedure |
Nursing Assessment
Comprehensive Nursing Assessment for CP
Neurological Assessment:
- Assess muscle tone (hypertonia, hypotonia, fluctuating)
- Evaluate reflexes (hyperreflexia, persistence of primitive reflexes)
- Check for clonus, ankle dorsiflexion
- Assess for seizure activity
Motor Assessment:
- Observe spontaneous movement patterns
- Assess gross and fine motor skills
- Evaluate posture and alignment
- Assess gait if ambulatory
- Document developmental milestones achieved
Functional Assessment:
- Evaluate feeding/swallowing abilities
- Assess communication methods and abilities
- Evaluate activities of daily living (ADLs)
- Assess play and social interaction
Associated Conditions:
- Vision and hearing assessment
- Respiratory function (breathing patterns, secretion management)
- Gastrointestinal function (GERD, constipation)
- Skin integrity (pressure areas)
- Pain assessment (using appropriate pain scales)
Growth and Nutrition:
- Measure weight, height/length
- Plot on appropriate growth charts for CP
- Assess nutritional intake and feeding methods
- Check hydration status
Psychosocial Assessment:
- Evaluate family coping and support systems
- Assess for signs of stress or caregiver burnout
- Identify educational needs of family/caregivers
- Assess child’s emotional well-being and social interactions
6. Nursing Management
Nursing Process for CP
Assessment
Diagnosis
Planning
Implementation
Evaluation
Nursing Diagnosis: Impaired Physical Mobility
Assessment
Assess type and severity of motor impairment, muscle tone abnormalities, presence of contractures, current mobility status, and functional limitations.
Related Factors
- Neuromuscular impairment
- Muscle tone abnormalities (spasticity, hypotonia)
- Musculoskeletal impairment (contractures, deformities)
- Pain
- Limited joint mobility
Defining Characteristics
- Limited range of motion
- Difficulty with fine/gross motor movements
- Uncoordinated or jerky movements
- Postural instability
- Delayed motor milestones
Goals/Expected Outcomes
- Child will maintain or improve current mobility status
- Child will demonstrate proper use of assistive devices
- Child will show improved participation in daily activities
- Child will maintain joint range of motion
- Family will demonstrate proper positioning and transfer techniques
Nursing Interventions
- Perform range-of-motion exercises as prescribed
- Position child properly using supports as needed
- Implement consistent handling techniques
- Facilitate therapy sessions (PT, OT)
- Teach proper use of assistive devices
- Promote age-appropriate play that encourages movement
- Monitor skin integrity at pressure points
- Encourage regular position changes
- Teach family proper positioning and transfer techniques
Rationale
- ROM exercises help prevent contractures and maintain joint mobility
- Proper positioning prevents deformities and promotes function
- Consistent handling techniques provide predictability
- Therapy reinforcement enhances treatment effectiveness
- Appropriate assistive devices maximize independence
- Play encourages movement while providing motivation
- Skin monitoring prevents breakdown in immobile children
- Regular position changes reduce pressure injuries and promote comfort
- Family education ensures continuity of care
Evaluation
- Monitor child’s functional mobility status
- Assess effectiveness of positioning and assistive devices
- Evaluate for development of contractures or deformities
- Observe child’s participation in activities
- Assess family’s competence with mobility techniques
Nursing Diagnosis: Risk for Aspiration
Assessment
Assess swallowing function, oral motor skills, presence of drooling, coughing or choking during feeding, respiratory status, and positioning during meals.
Risk Factors
- Impaired swallowing
- Poor oral motor control
- Feeding difficulties
- GERD (gastroesophageal reflux disease)
- Reduced cough reflex
- Impaired positioning during feeding
Goals/Expected Outcomes
- Child will maintain clear airways
- Child will demonstrate safe swallowing during feeding
- Child will maintain adequate nutritional status
- Family will demonstrate proper feeding techniques
- Child will show no signs of aspiration pneumonia
Nursing Interventions
- Position child upright (45-90 degrees) during and after feeding
- Monitor for signs of aspiration during and after feeding
- Modify food and fluid consistency as recommended
- Implement specific feeding techniques (pacing, small bites)
- Coordinate care with speech therapist for swallowing evaluation
- Teach family proper feeding techniques and emergency responses
- Monitor respiratory status
- Keep suction equipment available if needed
- Administer medications for GERD if prescribed
Rationale
- Upright positioning reduces risk of aspiration
- Early detection of aspiration allows prompt intervention
- Modified consistencies make swallowing safer
- Proper feeding techniques minimize aspiration risk
- Speech therapy input optimizes swallowing safety
- Family education ensures consistent safe feeding
- Respiratory monitoring helps identify early complications
- Suction equipment provides emergency intervention
- GERD management reduces aspiration risk
Evaluation
- Monitor for signs of aspiration during feeding
- Assess respiratory status for signs of pneumonia
- Evaluate effectiveness of feeding techniques
- Monitor nutritional status and weight trends
- Assess family’s competence with feeding techniques
Additional Nursing Diagnoses for CP
Mnemonic: “CEREBRAL”
C
Communication, Impaired Verbal
E
Elimination (Bowel/Bladder) Dysfunction
R
Risk for Injury
E
Everyday Self-Care Deficit
B
Body Image Disturbance
R
Risk for Impaired Skin Integrity
A
Altered Nutrition: Less Than Body Requirements
L
Limited Family Coping
Key Nursing Interventions
CP Nursing Interventions
Positioning & Mobility
- ROM exercises
- Proper positioning
- Transfer techniques
- Assistive device use
- Contracture prevention
Nutrition & Feeding
- Safe feeding techniques
- Aspiration prevention
- Growth monitoring
- Hydration maintenance
- Tube feeding management
Communication
- Alternative methods
- Assistive devices
- Clear speech patterns
- Visual supports
- Patience and time
Safety
- Seizure precautions
- Fall prevention
- Skin care
- Safe environment
- Emergency planning
Family Support
- Education
- Respite care resources
- Emotional support
- Care coordination
- Resource connecting
Medication Management
- Administration
- Side effect monitoring
- Efficacy assessment
- Family teaching
- Medication schedules
7. Therapeutic Interventions
Medications for CP Management
| Medication Class | Examples | Indication | Nursing Considerations |
|---|---|---|---|
| Muscle Relaxants (Oral) | Baclofen, Diazepam, Dantrolene, Tizanidine | Spasticity management | Monitor for drowsiness, liver function with dantrolene, withdrawal symptoms if stopped abruptly |
| Botulinum Toxin | Botox injections | Focal spasticity | Temporary effect (3-6 months); monitor for weakness, pain at injection site |
| Intrathecal Baclofen | Baclofen pump | Severe spasticity | Monitor pump function, refill schedule, signs of withdrawal or overdose |
| Anticonvulsants | Levetiracetam, Carbamazepine, Valproic acid | Seizure management | Monitor therapeutic levels, drug interactions, side effects |
| Anticholinergics | Trihexyphenidyl, Benztropine | Dystonia, drooling | Monitor for dry mouth, constipation, blurred vision |
| GI Medications | Proton pump inhibitors, H2 blockers, laxatives | GERD, constipation | Monitor for effectiveness, fluid/electrolyte balance with laxatives |
| Pain Management | NSAIDs, Acetaminophen, Gabapentin | Musculoskeletal pain | Assess pain regularly, monitor for side effects |
Therapy Approaches
Physical Therapy
Goals:
- Improve motor function
- Enhance strength and flexibility
- Prevent contractures and deformities
- Promote functional mobility
Techniques:
- Neurodevelopmental Treatment (NDT)
- Constraint-Induced Movement Therapy
- Strength training
- Gait training
- Aquatic therapy
- Serial casting
Nursing Support:
- Reinforce exercises between sessions
- Ensure proper positioning
- Monitor equipment use (orthotics)
Occupational Therapy
Goals:
- Enhance independence in ADLs
- Improve fine motor skills
- Adapt environment for accessibility
- Develop compensatory strategies
Techniques:
- Fine motor activities
- Sensory integration
- Adaptive equipment training
- Visual-perceptual training
- Hand splinting
Nursing Support:
- Encourage self-care practice
- Use recommended adaptive equipment
- Facilitate environmental modifications
Speech Therapy
Goals:
- Improve communication
- Enhance oral motor function
- Develop safe swallowing
- Introduce alternative communication
Techniques:
- Oral motor exercises
- Articulation therapy
- Augmentative and Alternative Communication (AAC)
- Feeding therapy
- Language development activities
Nursing Support:
- Use consistent communication approaches
- Implement safe feeding techniques
- Support use of communication devices
Other Therapeutic Approaches
| Approach | Description | Benefits | Nursing Role |
|---|---|---|---|
| Orthopedic Surgery | Procedures to correct contractures, hip dislocations, scoliosis | Improved alignment, reduced pain, better function | Pre/post-operative care, rehabilitation support |
| Selective Dorsal Rhizotomy | Neurosurgical procedure to reduce spasticity | Permanent reduction in spasticity, improved mobility | Post-operative monitoring, intensive rehab support |
| Hippotherapy | Therapeutic horseback riding | Improved posture, trunk control, self-confidence | Encourage participation, monitor response |
| Hydrotherapy | Water-based therapy | Reduced joint loading, relaxed muscles, improved mobility | Ensure safety, monitor fatigue |
| Adaptive Sports | Modified recreational activities | Improved fitness, socialization, self-esteem | Encourage participation, ensure appropriate adaptations |
| Music Therapy | Using music to address physical, emotional needs | Improved motor control, communication, emotional expression | Incorporate rhythmic elements in care, observe responses |
| Assistive Technology | Devices to support function (mobility, communication) | Enhanced independence, participation, quality of life | Ensure proper use, maintenance, and updates |
8. Family-Centered Care
Family Education
Essential Education Topics
- Understanding CP: Pathophysiology, types, prognosis, and management in simple terms
- Handling Techniques: Proper positioning, transfers, and carrying methods
- Medication Management: Purpose, administration, side effects, and schedules
- Feeding Strategies: Safe techniques, positioning, equipment, signs of aspiration
- Home Exercise Program: ROM exercises, stretching, strengthening activities
- ADL Assistance: Bathing, dressing, toileting adaptations
- Warning Signs: When to seek medical attention
- Therapeutic Play: Incorporating therapy goals into play activities
- Sleep Management: Positioning, routines, common issues
- Communication Strategies: Supporting communication development
Family Support
Family Support
Emotional Support
- Active listening
- Grief counseling
- Support groups
- Mental health referrals
- Siblings support
Practical Support
- Respite care options
- Home modifications
- Equipment resources
- Transportation assistance
- Childcare resources
Financial Support
- Insurance navigation
- Disability benefits
- Charity programs
- Equipment funding
- Tax deductions
Healthcare Coordination
- Care coordination
- Appointment scheduling
- Interprofessional communication
- Medication management
- Health records organization
Home Care Considerations
Home Environment Assessment
Accessibility:
- Entrance accessibility (ramps, wide doorways)
- Bathroom modifications (grab bars, shower chair)
- Bedroom adaptations (specialized bed, transfer equipment)
- Kitchen access (reachable items, adaptive equipment)
Safety:
- Fall prevention measures
- Padding for sharp corners
- Secured furniture and equipment
- Emergency evacuation plan
- Emergency contact information visible
Equipment Needs:
- Mobility devices (wheelchair, walker, gait trainer)
- Positioning equipment (standing frame, adapted seating)
- Bathing and toileting equipment
- Feeding equipment
- Communication devices
Caregiver Resources:
- Available caregivers and support system
- Caregiver training needs
- Respite care arrangements
- Home health aide requirements
- Physical capability of caregivers
Daily Routine:
- Medication schedule
- Therapy exercises
- Feeding schedule and positioning
- School or daycare arrangements
- Rest periods
9. Growth and Nutrition
Feeding Difficulties
| Feeding Challenge | Cause | Nursing Interventions |
|---|---|---|
| Oral Motor Dysfunction | Poor coordination of lips, tongue, jaw; abnormal oral reflexes |
|
| Dysphagia | Difficulty swallowing; delayed or uncoordinated swallow reflex |
|
| Aspiration Risk | Food/liquid entering airway due to poor coordination |
|
| GERD | Weak esophageal sphincter, delayed gastric emptying |
|
| Prolonged Feeding Time | Inefficient oral movements, fatigue during eating |
|
| Food Refusal | Sensory issues, negative associations with eating |
|
Nutritional Challenges
Increased Energy Expenditure
Issue: Higher caloric needs due to spasticity and involuntary movements
Solutions:
- Calorie-dense foods and supplements
- Increased meal frequency
- Individualized caloric intake calculation
- Regular monitoring of weight trends
Micronutrient Deficiencies
Issue: Common deficiencies in vitamin D, calcium, iron, zinc
Solutions:
- Supplementation as prescribed
- Nutrient-rich food choices
- Regular laboratory monitoring
- Sun exposure (for vitamin D)
Hydration Concerns
Issue: Difficulty communicating thirst, swallowing liquids
Solutions:
- Regular fluid offering schedule
- Appropriate thickeners if needed
- Fluid-rich foods
- Monitoring hydration status
Enteral Nutrition
Issue: May be necessary when oral feeding is unsafe or inadequate
Solutions:
- G-tube or J-tube management
- Formula selection and rate calculation
- Site care and complication monitoring
- Combination with oral feeding when appropriate
Growth Monitoring
Growth Monitoring Considerations
- Use CP-specific growth charts when available, as children with CP often have different growth patterns
- Record weight regularly (monthly for infants, every 3-6 months for older children)
- Measure height/length accurately using adaptations for contractures (segmental measurements if needed)
- Monitor head circumference until 36 months of age, longer if concerns
- Track growth velocity rather than just absolute measurements
- Assess for signs of malnutrition: poor skin turgor, thin hair, decreased muscle mass
- Document nutritional intake using food diaries or calorie counts when concerns arise
- Refer to dietitian for comprehensive nutritional assessment
- Consider body composition measures (triceps skinfold, mid-arm circumference) which may be more useful than BMI
10. Complications and Prevention
Common Complications
| Complication | Prevention Strategies | Nursing Management |
|---|---|---|
| Contractures and Deformities |
|
|
| Pressure Injuries |
|
|
| Respiratory Complications |
|
|
| Hip Displacement/Dislocation |
|
|
| Scoliosis |
|
|
| Seizures |
|
|
| Osteoporosis |
|
|
Prevention Strategies
Mnemonic: “PREVENT CP PROBLEMS”
P
Positioning properly throughout the day
R
Range of motion exercises daily
E
Equipment use and maintenance
V
Vigilant skin monitoring
E
Early intervention for emerging issues
N
Nutrition and hydration optimization
T
Therapy program adherence
C
Consistent medication administration
P
Prevent falls and injuries
P
Promote regular medical follow-up
R
Respiratory care and infection prevention
O
Orthotic devices used as prescribed
B
Bowel and bladder management
L
Lifting and transferring safely
E
Exercise program implementation
M
Monitor for pain and discomfort
S
Safe feeding techniques practice
Early Intervention Benefits
Neuroplasticity Advantage
The young brain has greater capacity to form new neural connections and adaptive pathways. Early intervention takes advantage of this critical period to maximize development potential.
Contracture Prevention
Early positioning, stretching, and movement programs help prevent the development of contractures and deformities that can limit function and require surgical correction.
Developmental Progression
Early support for motor, communication, and cognitive skills helps children achieve developmental milestones closer to typical timeframes and builds foundations for future skills.
Family Adaptation
Early education and support for families promotes positive adaptation to the diagnosis, effective caregiving strategies, and proactive management approaches.
Secondary Prevention
Early identification and management of associated conditions (seizures, feeding issues, sensory impairments) prevents secondary complications and improves outcomes.
Reduced Healthcare Costs
Prevention of complications through early intervention reduces the need for hospitalizations, surgeries, and intensive interventions later in life.
11. Education and Community Resources
School Considerations
| Area | Considerations | Nursing Role |
|---|---|---|
| Educational Planning |
|
|
| Physical Accessibility |
|
|
| Health Management |
|
|
| Related Services |
|
|
| Social Inclusion |
|
|
Community Support Services
Community Resources
Medical Services
- Specialty clinics
- Rehabilitation centers
- Equipment providers
- Home health agencies
- Care coordination programs
Financial Resources
- Medicaid/Medicare
- SSI/SSDI benefits
- Grant programs
- Charitable foundations
- Tax deduction guidance
Family Support
- Parent support groups
- Sibling programs
- Respite care services
- Family counseling
- Parent training programs
Recreational Programs
- Adaptive sports
- Inclusive camps
- Art/music therapy
- Accessible playgrounds
- Special Olympics
Transportation Services
- Paratransit programs
- Accessible vehicle resources
- Travel training
- Reduced fare programs
- Medical transportation
Transition Services
- Vocational programs
- Independent living centers
- Post-secondary education
- Housing resources
- Adult services planning
Assistive Technologies
Mobility Technologies
- Manual and power wheelchairs
- Walkers and gait trainers
- Orthotic devices (AFOs, KAFOs)
- Adaptive seating systems
- Standing frames
Communication Technologies
- Speech-generating devices
- Adapted keyboards
- Eye-gaze technology
- Picture communication systems
- Communication apps
Activities of Daily Living
- Adapted feeding equipment
- Dressing aids
- Bathroom adaptations
- Specialized beds and sleep systems
- Transfer and lifting equipment
Educational Technologies
- Writing aids
- Audio books and recordings
- Alternative computer access
- Adapted educational materials
- Educational software
Environmental Control
- Switch-activated devices
- Voice-activated systems
- Remote control adaptations
- Automated door openers
- Smart home technology
Nursing Considerations
- Assessment for appropriate technology
- Training child and family
- Monitoring equipment function
- Regular reevaluation of needs
- Coordinating with therapists and vendors
Key Takeaways
Summary of Nursing Management for Cerebral Palsy
- Comprehensive Assessment: Perform thorough neurological, motor, functional, and developmental assessments to guide interventions.
- Individualized Care Planning: Develop care plans addressing mobility, nutrition, communication, self-care, and family support.
- Interdisciplinary Collaboration: Work with physical therapists, occupational therapists, speech therapists, physicians, and other specialists.
- Positioning and Mobility: Implement proper positioning, range-of-motion exercises, and equipment use to prevent complications.
- Nutrition Management: Address feeding difficulties, monitor growth, and implement safe feeding techniques.
- Communication Support: Facilitate communication through various methods appropriate to the child’s abilities.
- Family Education: Teach families about CP, home care techniques, and community resources.
- Complication Prevention: Proactively address potential issues like contractures, pressure injuries, and respiratory problems.
- Medication Management: Administer and monitor medications for spasticity, seizures, and associated conditions.
- Advocacy: Support families in navigating healthcare, educational, and community systems.
Critical Thinking Exercise
Case Scenario: 5-year-old with Spastic Quadriplegic CP
You are caring for a 5-year-old child with spastic quadriplegic CP who is admitted to the hospital with aspiration pneumonia. The child has a gastrostomy tube for nutrition, uses a wheelchair for mobility, and communicates using a picture board. The child is experiencing increased tone and discomfort.
Questions to Consider:
- What are your priority nursing assessments for this child?
- What nursing interventions would you implement to manage the increased tone and discomfort?
- How would you adapt your communication approach with this child?
- What precautions would you take during feeding and medication administration?
- What education and support would you provide to the family during this hospitalization?
This scenario encourages you to integrate knowledge about CP management in an acute care setting.
References and Resources
References
- Mayo Clinic. (2023). Cerebral palsy – Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/diagnosis-treatment/drc-20354005
- Centers for Disease Control and Prevention. (2023). About Cerebral Palsy. https://www.cdc.gov/cerebral-palsy/about/index.html
- Cerebral Palsy Guide. (2023). Medications for Cerebral Palsy. https://www.cerebralpalsyguide.com/treatment/medications/
- Nurseslabs. (2023). Cerebral Palsy Nursing Care Planning and Management. https://nurseslabs.com/cerebral-palsy/
- National Institute of Neurological Disorders and Stroke. (2023). Cerebral Palsy Information Page. https://www.ninds.nih.gov/health-information/disorders/cerebral-palsy
- Physiopedia. (2023). Activities of Daily Living in Cerebral Palsy. https://www.physio-pedia.com/Activities_of_Daily_Living_in_Cerebral_Palsy
- Cleveland Clinic. (2023). Cerebral Palsy: What It Is, Causes, Symptoms & Treatment. https://my.clevelandclinic.org/health/diseases/8717-cerebral-palsy
- American Academy for Cerebral Palsy and Developmental Medicine. (2023). Care Pathways. https://www.aacpdm.org/publications/care-pathways
Professional Organizations
National Organizations
- American Academy for Cerebral Palsy and Developmental Medicine (AACPDM)
- Cerebral Palsy Foundation
- United Cerebral Palsy (UCP)
- Child Neurology Foundation
Nursing Resources
- Society of Pediatric Nurses
- Association of Pediatric Hematology/Oncology Nurses
- National Association of Pediatric Nurse Practitioners
- American Association of Neuroscience Nurses
Additional Learning Resources
Nursing Education
- Pediatric Nursing Certification Board
- Nursing care planning guides
- Continuing education courses
- Clinical practice guidelines
Parent Resources