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Infant Toddler Development Training
Module 6, Lesson 4

Movement Disorders

Read NICHCY Cerebral Palsy before going further in this lesson. More comprehensive information can be obtained through the United Cerebral Palsy Organization. This details causes, prevalence, classifications, treatments, and supports of cerebral palsy. Information in Spanish is also available.

little girl in a boatThe most commonly identified movement disorder is cerebral palsy. Cerebral palsy is a condition that affects body movement and coordination and is not a disease. Cerebral refers to the "brain" and palsy refers to "weakness". Cerebral palsy is defined as a significant motor impairment manifesting itself as abnormalities of posture and tone. It is due to brain damage that created the abnormalities in function. The damage once done does not progress. The damage may have occurred prenatally (before birth), perinatally (during birth) or in the postnatal period. Cerebral palsy may also result from a traumatic injury. Cerebral palsy is defined by weakness, spasticity and/or hypotonia. Associated issues may include global delays, mental retardation, and oral motor dysfunction. It is often difficult to identify isolated motor involvement versus global developmental delay in younger children.

baby in strollerThere are two types of cerebral palsy. The first involves the place where the brain injury occurs and consists of two kinds: pyramidal (involving neurons within the cerebral cortex) and extrapyramidal (involving areas outside the cerebral cortex). The terms spastic or cortical refer to pyramidal lesions, and the terms athetoid, sub-cortical or ataxic, or hypotonic refer to extrapyramidal and are interchangeable. Both types can be mixed in patients. Spastic cerebral palsy means that the child has stiffness or contractures of the muscles making movement difficult and does not go away during sleep. This is the main type of cerebral palsy affecting 70 – 80 % of persons who have the condition. Athetoid cerebral palsy refers to uncontrolled or writhing movements. Ataxic cerebral palsy is when the condition affects balance and perception.

A second type refers to the distribution of involvement. So the terms monoparesis, diparesis, triparesis, and quadriparesis refer to how many limbs are involved. The term –plegia is often incorrect and the term – paresis should be substituted. Rarely is a child completely devoid of movement which is what plegia implies.

Medical treatments for cerebral palsy sometimes include BoTox injections. Surgical treatments to assist in the relief of contractures in extreme cases are occasionally recommended.

Intervention Role of the ITDS

mother and child on a horseThe ITDS may be working with neurologists and therapists as well as the primary medical provider when on the team for an infant and toddler with cerebral palsy. There are many therapeutic regimens and the ITDS is encouraged to read about various treatments. It is best practice to research specific treatments each team discusses to ensure that the efficacy of treatment is backed with scientific data.

Consider how the ITDS should provide information to families on treatment options. What should the ITDS do in this regard?

Consider what role the ITDS may have in regard to equipment use for children with movement disorders. How would he/she be involved?

Reflect on how the ITDS could be instrumental in ensuring that the child and family have opportunities to infuse interventions into everyday activities, routines and places. Can you come up with some suggestions?

 

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