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Nursing Guide to Cerebral Palsy: Nursing Diagnosis, Interventions, & Care Plans

Updated On 9 Minute Read

Cerebral Palsy Etiology and Epidemiology 

Cerebral palsy (CP) is a complicated group of conditions and is characterized by: 

  • Involuntary movements 
  • Nonprogressive spasticity 
  • Ataxia 

Damage or abnormalities in one or more regions of the developing brain cause CP, impairing the brain's capacity to control movement, regulate posture, and balance. CP is the most prevalent motor disability in children and CP affects around 1 in every 345 children (Centers for Disease Control and Prevention, 2021). 

 CP affect various parts of the brain, specifically the parts that regulate movement and posture. Each type of CP causes specific movement disorders (Victorio, 2019): 

  • Spastic Cerebral Palsy 
    • Occurs in over 70% of cases 
    • Affects one side or the entire body, causing: 
      • Muscle stiffness 
      • Muscle weakness 
      • Paralysis 
      • Exaggerated reflexes 
    • Characterized by difficulty walking due to crossing the knees or scissor-like leg movements 
  • Dyskinetic Cerebral Palsy 
    • Occurs in about 20% of cases 
    • Causes abnormal arm, hand, and leg movements which are either choreic (i.e., rapid and jerky) or athetoid (i.e., slow and writhing) 
      • Makes it difficult to sit or walk 
    • Face and tongue can also be affected 
      • Makes it difficult to swallow or talk 
    • Abnormal movements may increase with excitement and disappear during sleep 
  • Hypotonic Cerebral Palsy 
    • Characterized by diminished muscle tone 
      • Children have noticeably "floppy" muscles in their legs and arms and no head control 
      • Joints are lax and reflexes are poor 
    • Difficulty walking, speaking, and swallowing 
    • May have trouble breathing 
    • Intelligence is often unaffected
  • Ataxic Cerebral Palsy 
    • Rare form of CP that occurs in <5% of cases 
    • Causes weakness, instability, and a wide-based gait 
    • Affects balance and coordination, and performance of fine motor functions (i.e., grasping objects and writing) 
  • Mixed 
    • Caused by damage to several brain areas 
    • Includes various combinations of cerebral palsy types 
      • Most often spastic and dyskinetic CP 
    • Symptoms include issues with movement, balance, and coordination 

The exact cause of cerebral palsy is unknown but is due to brain injury that occurs before or during an infant's birth or within the first 3 to 5 years of age. The etiology is often complex and involves risk factors that increase a child's chances of having CP including (Dynamed, 2018): 

  • Low birth weight 
  • Prematurity 
  • Issues during pregnancy such as the placenta or amniotic fluid 
  • Prolonged and difficult labor, resulting in asphyxiation 
  • Brain infection 
  • Disruption to the brain's oxygen supply 
  • Maternal infection 
  • Nutrition deficiencies during pregnancy 
  • Jaundice after birth 
  • Teratogens such as medications and radiation 

Some of the conditions that are associated with CP include (Dynamed, 2018): 

  • Intellectual delays/learning disabilities 
    • Reported in 50% of individuals, mostly those with a seizure disorder 
  • Speech and language difficulties 
    • Reported in 50% of individuals 
  • Attention problems 
  • Visual impairments 
    • Mild-to-moderate visual impairment occurs in 30 to 75% of individuals 
    • Severe impairment or functional blindness occurs in 5 to 10% of individuals 
  • Hearing impairment 
    • Reported in 10% of individuals 
    • Severity is increased with increased severity of motor impairment 
  • Seizures 
    • Reported in 35 to 50% of individuals 
    • Associated with an increased need for acute care 
  • Behavioral disorders 

Cerebral Palsy Diagnosis 

CP is most often diagnosed within the first 2 years of life. However, if only mild symptoms are present, making an accurate diagnosis before 4 or 5 years old can be difficult. 

There are numerous steps to diagnosing CP (National Institute of Neurological Disorders and Stroke [NINDS], 2020): 

  • Developmental Monitoring 
    • This process involves observing and recording a child's growth and development over time at each well-child office visit. 
  • Developmental Screening 
    • If concerns regarding a child's development arise, a developmental screening test is given. Even if a provider or clinician has not identified any concerns, a child should be screened at least at the ages of 9, 18, 24, and 30 months using validated instruments. 
  • Medical and Developmental Evaluations 
    • If developmental screening indicates a concern, experts such as developmental or neurodevelopmental providers, neurologists, physiatrists, rehabilitation doctors, or other providers will conduct a more thorough evaluation. 
    • Developmental evaluations assess motor skills, muscle tone, reflexes, and posture. 
    • A thorough medical history is obtained to rule out any other illnesses that may cause comparable symptoms. 

In addition to the developmental evaluation, the provider may perform additional tests to look for a cause of CP. These include (NINDS, 2020): 

  • Brain imaging tests (i.e., CT scan or MRI) 
  • Electroencephalogram (EEG) 
  • Genetic testing 
  • Metabolic testing 

Cerebral Palsy Management 

CP is a long-term medical condition with no known cure. However, intervention can improve CP outcomes. If possible, individuals with CP should have an integrated, coordinated multidisciplinary care team that includes (NINDS, 2020): 

  • Orthopedic specialists 
  • Physical and occupational therapists 
  • Speech and language therapists 
  • Nutritionists and feeding specialists 
  • Psychologists 
  • Counselors 
  • Educational specialists 

The overall goals of care and treatment are to: 

  • Improve movement and participation in activities 
  • Reduce secondary complications such as joint contracture or other orthopedic disorders 
  • Change the natural course of increased spasticity and decreased function 
  • Reduce pain 
  • Facilitate daily life tasks and increase overall care 
  • Increase communication 
  • Encourage involvement in social activities 

Some individuals require medications or surgery. Medications used to treat the symptoms of CP may include (Dynamed, 2018): 

  • Muscle Relaxants (i.e., Baclofen [Lioresal®], Tizanidine [Zanaflex®], Diazepam [Valium®]) 
    • Intrathecal baclofen (Lioresal®) is a surgically implanted pump beneath the skin on the abdomen. 
    • Botulinum toxin type A (Botox®) is injected into targeted muscles. 
  • Anticholinergics (i.e., carbidopa-levodopa [Sinemet® CR] and glycopyrrolate [Robinul™]) 
  • Antiepileptics (i.e., Phenobarbital [Luminal™], Lorazepam [Ativan®], Phenytoin [Dilantin®], Levetiracetam [Keppra®]). 

Cerebral Palsy Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for cerebral palsy are listed below. 

Cerebral Palsy Assessment 

The following are used for assessment (Belleza, 2021): 

  • Interview 
    • Discuss concerns about mobility or delayed motor development. 
  • History 
    • Prenatal, perinatal, and postnatal history 
    • Signs of neurobehavioral dysfunction 
    • Emotional lability 
    • Inadequate feeding/frequent vomiting 
    • Motor milestones and their timing 
    • Abnormal spontaneous generalized movements 
    • Movement asymmetry, such as early hand preference 

Keep in mind that motor skill regression does not occur in individuals with CP. 

 The assessment should focus on examining the child for more than one type of neurologic impairment. These include: 

  • Spasticity 
    • Includes increased tone and reflexes and involuntary muscle contractions (clonus). 
  • Dystonia 
    • Includes twisting, abrupt movements of the face, arms, legs, or trunk. 
  • Hypotonia 
    • Decreased muscle tone or "floppiness." 
  • Ataxia 
    • A lack of muscle control or coordination affects the extremities, eyes, and mouth. The child may have abnormal balance. 

Areas to focus on during your exam: 

  • Muscle tone that is increased or decreased. 
  • Trunk and head control that is poor or increased 
  • Motor control that is reduced in strength 
  • Primitive reflexes that persist past infancy 
  • Reflexes or movement that is asymmetrical 
  • Range of motion in the joints that is decreased and/or accompanied by contractures 
  • Deep tendon reflexes that are above average or "brisk" 
  • Delayed motor milestones 
  • Gait abnormalities: scissoring, toe-walking 

Nursing Diagnosis/Risk For 

  • Injury 
  • Impaired physical mobility 
  • Delayed growth and development 
  • Impaired verbal communication 
  • Imbalanced nutrition: less than body requirements 
  • Self-care deficit 
  • Ineffective therapeutic regimen management

Interventions 

Nursing interventions for the individual with CP include: 

  • Establish therapeutic communication. 
  • Enhance self-esteem. 
  • Offer emotional assistance. 
  • Increase family support. 
  • Prevent and protect against injury or harm. 
  • Prevent deformities. 
  • Encourage mobility. 
  • Increase oral fluid intake. 
  • Manage sleep and rest periods. 
  • Enhance self-care. 
  • Facilitate communication. 
  • Enforce therapeutic measures. 

Expected Outcomes 

The individual will: 

  • Experience no pain or a reduction in discomfort to an acceptable level when given analgesics. 
  • Have maximum mobility and no contractures. 
  • Receive the appropriate calories or nutrients needed for their age, gender, and amount of activity. 
  • Communicate their basic requirements to health care providers and family members. 
  • Be free from falls or injuries. 
  • Be exposed to environmental stimulation and show interest in people and activities around them in a setting that is free of limitations. 
  • Be able to undertake self-care tasks safely to the best of their ability

Individual/Caregiver Education 

  • Discuss the specific causes of CP, manifestations, diagnosis, and treatments. Provide written resources as available. 
  • Discuss the practical aspects of caring for an individual with CP, including emotional and psychosocial factors. 
  • Refer parents to local resources (e.g., social workers, health psychologists, parent support groups) and websites to learn more about healthcare and other therapeutic services. 
  • Emphasize the need to monitor signs and symptoms related to the child's illness, how to handle them, and when and to whom to report them. 
  • Address potentially hazardous situations within the individual with CP's environment. 
  • Instruct caregivers on how to obtain emergency medical assistance, if necessary. 
  • Recommend community resources for caregivers and families of individuals with CP. 
  • Provide plenty of opportunities to practice relevant psychomotor skills. 
  • Use a variety of teaching and learning strategies and continuously evaluate learning across the continuum of care. 

Read More About Our Clinical Guides

View Our Clinical Guides

Caring for Children/Adolescents With Cerebral Palsy

This course provides nursing and respiratory therapy professionals an overview of the pathophysiology, signs, symptoms, and interventions for CP in children.

View Course

Additional Information

Content Release Date

4/1/2022

Content Expiration

12/31/2027

Course Contributor 

The content for this course was created by Stephanie L. Whitfield, B.S.N., R.N. Stephanie has over 15 years of clinical and teaching experience. Her areas of expertise are in neonatal intensive care, general pediatrics, home health, and children with medical complexities. She earned her Bachelor of Science in nursing from Chamberlain University in 2013. Her professional practice is guided by Jean Watson’s philosophy that, “Caring is the essence of nursing.” 

References 

FAQs

Stephanie L. Whitfield, B.S.N., R.N

Stephanie has over 15 years of clinical and teaching experience. Her areas of expertise are in neonatal intensive care, general pediatrics, home health, and children with medical complexities. She earned her Bachelor of Science in nursing from Chamberlain University in 2013. Her professional practice is guided by Jean Watson’s philosophy that, “Caring is the essence of nursing.”