Sandbox cerebral palsy

Causes

Birth asphyxia used to be considered the principal etiology for CP. However, it is now believed that 70% to 80% of cases of CP are due to antenatal factors, while only 10% to 28% of cases are due to birth asphyxia in term and near-term infants More than 1 etiologic factor is often identified. For example, intrauterine infection may result in growth restriction, maternal fever, and prematurity, all of which have been associated with CP Prenatal causes:

Abnormal intrauterine growth may be the result of multiple factors such as placental insufficiency, intrauterine infection, and chromosomal abnormalities, among others Maternal infections and fever: evidence of maternal fever around the time of delivery and chorioamnionitis have been associated with low Apgar scores, neonatal encephalopathy, seizures, and increased risk of CP TORCH infections (toxoplasmosis, syphilis, rubella, cytomegalovirus, varicella zoster, HIV, herpes viruses) are thought to be responsible for 5% of CP cases Multiple births: twins carry a higher risk of CP when compared to single births; risk of having a child with CP is 0.2% for single births, 1.3% for twins, and 7.6% for triplets Weight discordance greater than 30% is associated with a 5-fold increased risk of CP Death of a co-twin or co-triplet is associated with a 10% and 29% risk of CP for the surviving twin or triplets, respectively Placental pathology: Thrombotic lesions and placental ischemia have been associated with spastic diplegia Chronic villitis (focal areas of inflammation) has been associated with growth restriction, preterm birth and pre-eclampsia Genetic factors Maternal metabolic disturbances (diabetes mellitus type 1 or type 2 or thyroid abnormalities) Intrauterine exposure to toxins Malformations of cortical development Perinatal causes:

Hypoxia-ischemia: 6% of children with CP have an identifiable birth complication that could result in hypoxia. Neonatal encephalopathy is usually present Periventricular leukomalacia (PVL) increases the risk of CP, independent of gestational age. Approximately 75% of infants with cystic PVL develop CP Fetal/neonatal stroke: most often resulting in hemiplegic CP Hyperbilirubinemia Hemolytic disease in the newborn, especially due to Rh incompatibility, was previously a common cause of kernicterus and CP prior to the use of Rho(D) immune globulin. It is still being reported in North America, Western Europe and the developing world Kernicterusis the preferred term to describe the chronic permanent sequelae of bilirubin toxicity. Affected children often develop severe athetoid CP Postnatal causes:

Stroke Trauma Infection

Classification

The Manual Ability Classification System (MACS) describes how children with cerebral palsy (CP) use their hands to handle objects in daily activities. MACS describes five levels. The levels are based on the children’s self-initiated ability to handle objects and their need for assistance or adaptation to perform manual activities in every day life.

Does the child handle most kind of daily activities independently ( during play and leisure, eating and dressing)

Yes

No

Does the child handle even more difficult tasks with fair speed and accuracy and does not need alternative ways to perform

Yes

No

D03

E01

E02

E03

F01

F02

A01

B01

B02

C01

C02

D01

D02

D03

D04

E01

E02

E03

E04

F01

F02

G01

G02

A01

C01

C02

C03

D01

D02

D03