Nursing Diagnoses

Identifying nursing diagnoses for patients with cerebral palsy will help us determine what specific issues should be the focus of our nursing care.

Some examples of priority nursing diagnoses for CP:

• Readiness for enhanced mobility / related to willingness to work with physical and occupational therapists, and potential for development of muscle control
• Risk for injury / related to muscle spasms and lack of coordination
• Impaired verbal communication / related to facial muscle spasms, possible co-morbid cognitive impairments
• Readiness for enhanced family coping / related to family investment in care for the child
• Self-care deficit / related to impairments in feeding, mobility, and communication

And to create a more detailed care plan, we would create nursing interventions and expected outcomes-- or goals-- for each diagnosis.

Nursing Diagnosis	Intervention	Expected Outcome
Readiness for enhanced mobility r/t willingness to work with healthcare team, and potential for development of muscle control	Assess patient for current physical mobility and assess patient and/or family for current goals Engage the patient in daily exercises, focusing on range of motion, flexibility, and muscle coordination Provide positive reinforcement for small changes	Patient and/or family will identify goals for increased mobility Patient will demonstrate greater range of motion, flexibility, and muscle coordination Patient and/or family will recognize progress and identify successes

For more cerebral palsy care plans-- check out Prentice Hall and Nursing-Help.com.

Nursing care for children and adolescents with CP

First of all, I want to share an incredible story about an older man with cerebral palsy who creates truly incredible works of art using only a typewriter. Paul is unable to hold a paintbrush, pen, or pencil, but he's found ways to create shading, shape, and depth using his symbol keys.

Access to quality healthcare and therapy during childhood can greatly increase the motor control, coordination, independence, and ability to communicate for people with CP. Normally, an interdisciplinary team-- including physicians, occupational therapists, physical therapists, speech and language therapists, and nurses-- will work with an individual to meet their and their families' needs.

Nursing care goals for children with CP:

• Child will remain safe and free from injury or skin breakdown.
• Child's movement, coordination, communication, and independence will be optimized.
• Child will demonstrate their optimal level of learning ability.
• Child will participate in activities with other children.
• Parents/caregivers will demonstrate understanding of childcare needs and actively participate in care.

The nursing care plan will integrate these goals, prioritizing safety while encouraging activities that foster muscle control, coordination, communication skills, independence in activities of daily living, and bonding with other children and family members. The parents or caregivers will be included in the care process, and will be engaged in the process of creating a care plan for their child.

OHSU has provided excellent Guidelines of Care for children and adolescents with CP-- they include interview questions for the family, a template for a plan of care, and critical evaluations and procedures for each age group.

Treating CP

One common thread runs through all of the research on treating cerebral palsy-- the sooner the better. The earlier treatment starts, the more likely the child is to find ways to overcome their motor disabilities, or find other means of achieving their goals.

The goal of treatment for CP is to improve quality of life for the client by optimizing mobility, pain control, independence, self-care, communication and learning abilities, and social interaction.

Multiple therapies are usually used together-- physical, occupational, recreational, and speech and language therapists will often all work as a team with one child. These professionals provide the child with exercises, activities, and opportunities to practice motor control, balance, communication, and whatever other skill development the child needs support in. These therapists will frequently introduce assistive devices, such as walkers, braces, and voice synthesizers, depending on their client's needs.

In the video below, Noreen Scott, a physical therapist at Tender Ones Therapy Services in Georgia, talks about how she approaches the incredibly varied needs of her young clients with cerebral palsy.

In addition to these therapies, in some cases drugs are prescribed to relax chronically contracted muscles. Oral medications are most frequently used, starting with diazepam, baclofen, dantrolene sodium, and tizanidine. In more severe cases, botulinum toxin may be injected into a contracted muscle in order to relax its contractions, or baclofen might be pumped into the area surrounding the spinal cord for a more widespread muscle relaxant.

Orthopedic surgery is also sometimes used to lengthen muscles or tendons that might be restricting movement. Surgery is also sometimes done to cut nerves that are contributing to spastic movement.

More information on the treatment of cerebral palsy can be found at CerebralPalsy.org

What does cerebral palsy look like?

Cerebral palsy looks different for every person living with it. Some infants with CP are easily identified-- some may even be suspected of having CP at birth. Others may not show clear signs until they're two years old.

The signs a healthcare provider will look for are issues with muscle tone, gross and fine motor developmental delays, and difficulties with control, coordination, balance, reflexes, and posture. People with CP may also have trouble swallowing, eating, and speaking.

The video below has a great deal more information on looking for signs of CP--

In addition to individual differences, CP is also divided into categories, which will each present differently. Athetoid, or dyskinetic, cerebral palsy affects 25% of people with CP. It is characterized by difficulty controlling and coordinating limb movements. The child below is showing early typical signs of athetoid CP.

A more severe example is Emma, in the video bellow Her mother explains that in addition to living with quadriplegic athetoid CP, meaning she has difficulty controlling both arms and both legs, Emma also has intermittent spastic CP, which in her case makes it difficult for her to speak or form sounds.

Signs and symptoms of cerebral palsy vary widely-- but a common thread is a sense among parents of children with CP that something is different about their child. The intuitions of caregivers have led to many early diagnoses of CP, which make a huge difference in providing effective treatment.