Cerebral Palsy

The nurse supervises a graduate nurse caring for a child with cerebral palsy. Which action by the graduate nurse requires intervention? The graduate nurse

• A. initiates gentle range-of-motion exercises for the client.

• B. lowers the bed to its lowest position.

• C. wheels the client to the playroom via a wheelchair.

• D. feeds the client with the head of the bed elevated at 30 degrees.

Answer explanation

Choice D is correct. Strategies to prevent aspiration are important to care and overall clinical outcome. For clients at risk of aspiration, elevating the head of the bed to > 30 degrees may help decrease the risk of aspiration. Here, when caring for a school-aged client with cerebral palsy, the nurse should position the client with the head of the bed elevated at 60 – 90 degrees to prevent aspiration. Feeding the client with the head of the bed at 30 degrees places the pediatric cerebral palsy client at an increased risk of aspiration, therefore warranting intervention by the charge nurse.

Choice A is incorrect. Range of motion (ROM) exercises are performed to prevent contractures in this pediatric cerebral palsy client.

Choice B is incorrect. Lowering the bed to its lowest position is done to decrease the risk of injury in the event of a fall. Therefore, the nurse would be appropriate in lowering the bed to this position.

Choice C is incorrect. Transporting the client to the playroom allows the client to play. This action by the nurse represents an independent nursing action in which the nurse demonstrates client advocacy.

A nurse is caring for a 5-year-old child diagnosed with cerebral palsy (CP). Which intervention is most appropriate for promoting mobility and preventing contractures in this child?

• A. Encouraging the child to remain in a stationary position to avoid fatigue.

• B. Encouraging the child to engage in strenuous physical activities to strengthen the affected muscles.

• C. Implementing a regular stretching and range of motion exercises routine.

• D. Administering muscle relaxants to reduce muscle spasms and stiffness.

Answer explanation

Choice C is correct. Regular stretching and range of motion exercises are essential components of managing cerebral palsy. These exercises help prevent contractures, maintain joint flexibility, and improve overall mobility in children with cerebral palsy. They should be performed regularly under the guidance of healthcare professionals to maximize their effectiveness and minimize the risk of injury.

Choice A is incorrect. Encouraging the child to remain stationary can actually worsen muscle stiffness and contractures in cerebral palsy. Prolonged immobility can lead to muscle atrophy and exacerbate the child's condition. 

Choice B is incorrect. Strenuous activities can potentially exacerbate muscle stiffness, increase the risk of injury, and worsen the symptoms of cerebral palsy. Children with cerebral palsy often have limitations in muscle control and coordination, making strenuous activities not only ineffective but also potentially harmful. 

Choice D is incorrect. While muscle relaxants may be prescribed in some cases to manage muscle spasms and stiffness associated with cerebral palsy, they are not the primary intervention for promoting mobility and preventing contractures. 

The nurse is talking with the parent of an infant with cerebral palsy. The parent asks the nurse, "Will my child always have cerebral palsy?" Which of the following responses would be appropriate for the nurse to make?

• a. 1. "Dietary and lifestyle modifications can slow the progression of cerebral (5%)

  palsy."

• b. "Symptoms of cerebral palsy will diminish over time, but early treatment (6%) can accelerate your child's recovery."

• c. "Cerebral palsy is permanent, but a multidisciplinary team will help your child to maximize independence."

• 4. d. "Periods of remission from cerebral palsy are possible when treated with (6%) surgery and long-term medication use."

Answer explanation

Cerebral palsy (CP) is a nonprogressive neuromuscular disorder caused by a perinatal or postnatal (up to age 2) brain injury.  Clinical manifestations include abnormal posture and muscle tone (eg, spasticity, gait disturbances); impairments in speech, swallowing, and cognition; and seizures.

CP is permanent, and early interventions by a multidisciplinary team (eg, physical therapy, occupational therapy, speech-language therapy) is vital to maximize independence, reduce secondary musculoskeletal deficits (eg, contractures), and manage comorbid conditions (eg, visual, intellectual impairment) (Option 3).  Assistive devices such as communication boards and positioning devices are often used for clients with CP.

(Option 1)  CP is caused by a static brain injury and is not a progressive condition.

(Option 2)  CP is a permanent condition, and treatment is focused on optimizing functional independence.

(Option 4)  Surgery may be indicated to release contractures if range-of-motion exercises, muscle relaxants (eg, baclofen pump), and assistive positioning devices are not effective.  However, remission does not occur with CP.

The nurse is caring for an 18-month-old client who was born prematurely and has decreased muscle tone and delayed gross motor skills. The nurse should expect the client will receive an order for

• a. a muscle biopsy

• b. an MRI of the brain

• c. a serum lead level

• d. a whole-body PET scan

Answer explanation

Cerebral palsy (CP) is a neuromuscular disorder characterized by impaired posture and movement that results from brain injury before or after birth (up to age 2).  Clients with CP commonly experience alterations in communication, behavior, and musculoskeletal integrity (eg, decreased muscle tone, delayed motor skills).

Clients with risk factors for CP (eg, premature birth, brain injury) should be closely monitored to facilitate early implementation of supportive therapies (eg, physical therapy).  CP is diagnosed based on client history, neurological examination findings, and neuroimaging (ie, MRI of the brain) (Option 2).

(Option 1)  A muscle biopsy can be used to diagnose muscular dystrophy (MD).  However, clients with MD typically reach initial motor developmental milestones and lose function gradually as the disease progresses.

(Option 3)  A serum lead level is used to diagnose lead poisoning, which can cause neurological deficits, including behavioral problems (eg, hyperactivity, impulsivity) and mild developmental delays.  However, the client's musculoskeletal symptoms are more consistent with CP.

(Option 4)  Although the client's symptoms could be indicative of brain cancer, a whole-body PET scan is typically performed after an MRI of the brain to evaluate for tumor metastasis.  In addition, the client's history (eg, premature birth) is more concerning for CP.

The nurse is talking with the parent of an infant with cerebral palsy. The parent asks the nurse, "Will my child always have cerebral paisy?" Which of the following responses would be appropriate for the nurse to make?

• a. "Dietary and lifestyle modifications can slow the progression of cerebral (5%)

• b. "Symptoms of cerebral palsy will diminish over time, but early treatment can accelerate your child's recovery."

• c. *Cerebral palsy is permanent, but a multidisciplinary team will help your child to maximize independence."

• d. "Periods of remission from cerebral palsy are possible when treated with surgery and long-term medication use."

Answer explanation

Cerebral palsy (CP) is a nonprogressive neuromuscular disorder caused by a perinatal or postnatal (up to age 2) brain injury.  Clinical manifestations include abnormal posture and muscle tone (eg, spasticity, gait disturbances); impairments in speech, swallowing, and cognition; and seizures.

CP is permanent, and early interventions by a multidisciplinary team (eg, physical therapy, occupational therapy, speech-language therapy) is vital to maximize independence, reduce secondary musculoskeletal deficits (eg, contractures), and manage comorbid conditions (eg, visual, intellectual impairment) (Option 3).  Assistive devices such as communication boards and positioning devices are often used for clients with CP.

(Option 1)  CP is caused by a static brain injury and is not a progressive condition.

(Option 2)  CP is a permanent condition, and treatment is focused on optimizing functional independence.

(Option 4)  Surgery may be indicated to release contractures if range-of-motion exercises, muscle relaxants (eg, baclofen pump), and assistive positioning devices are not effective.  However, remission does not occur with CP.