الفهرس 
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Abstract
Cerebral Palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity
limitation, that are attributed to non-progressive disturbances that
occurred in the developing fetal or infant brain. The motor disorders
of cerebral palsy are often accompanied by disturbances of sensation,
perception, cognition, communication, and behavior, by epilepsy, and
by secondary musculoskeletal problems. Children with cerebral palsy have complex healthcare needs and
often require complex multidisciplinary care. It is important for
clinicians to understand which approaches to healthcare service
delivery for this population. Therefore, it is beneficial for children with CP to receive
services in order to improve their health, and solve associated
difficulties. One way a child with CP can receive services is through
an early intervention program, which is treatment provided to children
who have or at risk of having a developmental delay. Training parents will provide knowledge of typically developing
children, as well as information regarding developmental delays and
intervention programs for young children with Cerebral Palsy.
The aim of this study was to support families with cerebral
palsy child and training them how to deal with different difficulties
that face their child. The current study was conducted on 75 patients 37males and 38
females already diagnosed with cerebral palsy with variable types and
degrees diagnosed according to the criteria of diagnosis and the
investigations, with age ranged from 2-15years,, attending the
pediatric genetic and endocrinology clinic and impatient at Menoufia
University Hospitals.
Patients are classified as follows:
1. age group(< 3 years) ;20patient (8male and12 female)
2. age group( 3- < 6 years );23patients(13male and10 female)
3. age group( 6– < 12 years) ;24patiens(12male and12female)
4. age group(≥12years) ;8patients(5maleand3 female)
All children were subjected to the following:
1. Detailed history taking (antenatal ,natal ,postnatal ,family
,developmental and past histories)
2. Family pedigree.
3. Anthropometric measurements (weight in Kg, length/height in
cm, head circumference in cm and BMI) all measurements were
plotted on CP growth charts.
4. Full clinical examination (general and systemic examination)
5. I.Q. assessment (Lewis Meleka, 1998).
6. Routine investigation (Urine analysis, Complete Blood Picture)
and other investigations if needed.
7. Genetic counseling : good communication with parents and
explain how we will apply appropriate early intervention system
8. Supportive aids :
training stage:
We trained mothers or caregivers to solve their child difficulties in
weekly visit that sustained for four months
- In first visit parents were learned about their child disease
and determine existing difficulties and plane for
supportive aids.
- Then in the second visit we train parents for solving their
child problems by applying our training program.
- Followed by weekly visits where the same schedule was
repeated.
- We start to assess training, until be sure that mothers
understood and knew how to apply our training program
and retraining if needed.
There was close and continuous contact with mothers and
recall if anything needed
Evaluation stage:
First evaluation at the end of 4th month, assessment of the
progress of the children every two months for one year, At the
same time children and their caregivers keep in visiting the clinic
every week for sharing of knowledge, helping and supporting
other families with cerebral palsy child.
Our training program assessed interventions for:
Feeding difficulty :
Good hygienic practices, balanced nutritious diet, food
consistency, Positions for feeding, Utensils, independent
feeding.
locomotors disability: training mother simple maneuvers of
physical therapy
Bowel control :
First step: conservative management (Behavioral
modification including timing voiding, scheduled method
and treatment of constipation)
Second step: Biofeedback and pelvic muscle exercise for
selected patients
Management of convulsions.
Some patients were referred for speech therapy and others for
orthopedic surgery.
10. Statistical Analysis:
The Results were statically analyzed by statistical package
SPSS version 20.statistics were done in term of frequencies,
mean, range, standard deviation ,percentage when for
comparing categorical data ,chi square test, , a probability
value (p value) less than 0.05 was considered statistically
significant
Most common associated problems with cerebral palsy patients were
- Feeding difficulty: Suffering cases from this problem were
47patients, 80%of them in age group (<3years)
- Bowel incontinence: Suffering cases from this problem were
63patients 87% of them were in age group (3<6years).
- Speech difficulty: Suffering cases from this problem were
66cases, 42 of them no speech and 24of them with difficulty.
- Convulsion: 20 patients were suffering from convulsion.
- Recurrent chest infection: 31 cases were suffering from this
problem.
- Constipation: Suffering cases from these problem were53
patients
After training the parents on the solutions of these difficulties, the
results showed that:
response of children with cerebral palsy to training program for
feeding difficulty outcome of training for feeding difficulty:
30 out of 75 patients (40%) showed adequate position during
feeding and jaw stabilization in first evaluation (at the fourth
month) then at the second evaluation (at the sex month) the number
increased to be 39 patients (52%), and at third evaluation number
of them were 45 patients (60%)
Among co operative mothers of patients there were 24 (32%) who
start to give nutritious food to their children in first evaluation
leading to improvement in general health of children, decrease
frequency of infection, and that encourage more mother to follow
our training program so number of patients increased to 41patients
(54.7%) at the third evaluation
Improved mother-child contact increase child cooperation and
decrease child distress during feeding leading to shorter meal time
.number of children showed cooperation and shorter meal time was
11 patients (14.7%) in first evaluation, increased to be 20 patients
(26.7%) in second evaluation and to be 35 patients (46.7%) in third
evaluation.
Outcome of physiotherapy training:
- Most of mothers learned how to apply physiotherapy at home,
continuous physiotherapy lead to improvements in the form of
movement of both hands actively, sitting, Standing with
Support and walking without support .in percentage of 40%,
45.3%, 38.7%, 26.7% respectively.
from our study we found that continuous scheduled training programs
have a positive impact on CP children and their families
Also the prognosis of patients in different problems depends on early
intervention, degree of severity of cerebral palsy, education and cooperation
of parents.