Cerebral Palsy Research Paper 6q6g4f

Cerebral Palsy

Amanda Davis Dental Hygiene III Kirkwood Community College 28 June 2016

Cerebral Palsy Cerebral palsy () is a muscle disorder that usually has loss or impairment of movement. There are four types of cerebral palsy—spastic, athetoid, ataxic, and mixed—and the type you could develop just depends on what parts of the central nervous system was damaged. has been well documented throughout history with Hippocrates first describing it in the fifth century. More thorough research began in the eighteenth century when Dr. William John Little who focused on spastic diplegia. William Osler first called it “cerebral palsy”. is caused by not having enough blood supply to the brain or damage to the brain. Most of cases of happen during pregnancy, but they can happen during childbirth or even in the first months of life. Cerebral palsy and other disorders similar to it occur more frequently in males than in females. The African American population is more affected than Caucasian and individuals who are lower to middle class are more affected than upper class. When you have a patient that has cerebral palsy, they could have very tight, spastic muscles, poor coordination, uncontrollable muscle movements, and may have a hard time seeing or hearing. Cerebral palsy affects the body physically because the brain was impaired during development causing patients to have trouble with muscle movement like walking, writing, or tying their shoes. Medications that are commonly used to treat cerebral palsy are found in these categories: anticholinergics, anticonvulsants, antidepressants, anti-spastic, anti-inflammatory, and stool softeners. The side effects that go along with anticholinergic medications can include dry mouth and constipation. Taking the antidepressants could worsen the and even the caregiver, who is taking care of the individual, is prone to getting depression because of the stress and challenges they face with caring for an individual with medical condition. Anticonvulsant medication side effects may include convulsions, drowsiness, and incontinence, may change

mood or appetite. Muscle relaxers also known as anti-spastic medications are used to diminish overactive or stiff muscles. While there may be benefits to taking anti-spastic medications like increasing range of motion and relaxing tight muscles, there are also limitations like confusion, insomnia, general weakness, and incontinence. Individuals with are usually prescribed an anti-inflammatory drug to address pain which could include: gastrointestinal pain, surgical pain, and orthopedic pain. individuals are generally encouraged to take a stool softener since a lot of the medications they are taking could cause constipation as a side effect. Cerebral palsy is a lifelong condition which means there is no remission period and it is non-progressive—which means it does not get worse over the course of lifetime. Cerebral palsy is a condition in where the muscles can be very tight and spastic and that does not mean it is just generalized to the muscles below the neck. It can range from the muscles of the arms and upper body to the legs and lower extremities. Gingival overgrowth is present in individuals with due to all of the medications they are taking. Periodontal disease is also prevalent in individuals with due to poor or lack of oral hygiene habits due physical abilities and malocclusion. Another oral condition that is present in individuals with cerebral palsy is dental caries. It is very high among these individuals due to lack of oral hygiene, mouth breathing, medications, and enamel hypoplasia. Malocclusion in individuals with is more than just having some crooked teeth—it has to do with the way their muscles and skeleton formed together during birth. An open bite with the anterior teeth protruding out is common due to tongue thrusting. Correcting the misaligned teeth is not possible with individuals with because of their high risk for cavities and enamel hypoplasia, but do not consider that an automatic no. If homecare and compliance were to keep up, then correcting their teeth could be a possibility. Individuals with usually have difficulty with swallowing which increases the

chance of getting cavities. This is routinely due to the caregivers giving the individuals soft foods. Having an open bite increases the chances of an individual with cerebral palsy to drool and this also affects oral hygiene. Low muscle tone and hypotonia also contributes to the drooling. Bruxism, or grinding of the teeth, is ordinarily seen in individuals with severe forms of cerebral palsy. Mouthguards are always a good option for patients with bruxism, but before recommending it to your patient just consider that they may have problems with swallowing or gagging. Individuals with may have an oversensitive gag reflex so schedule them for morning appointments before they have eaten or drank anything. Individuals with cerebral palsy are usually on six different categories of medications and they include: anticholinergic, anti-spastic, antidepressants, anti-inflammatory, anticonvulsants, and stool softeners. Some commonly prescribed medications for anticholinergic are: Robinul, Kemadrin and Sinemet. These drugs work by obstructing signals that cause muscle stimulation. Anticholinergic medications effects on the oral cavity include xerostomia and Kemadrin may help contribute to periodontal disease. Anti-spastic drugs help relax the muscles and some of the commonly prescribed ones are: Valium, Dantrolene, Flexeril and Tizanidine. The oral effects for these drugs include: xerostomia and when patients take Valium, someone should accompany them to and from the dental office. Depression, anxiety, and even seizures can be treated by taking antidepressants. Celexa, Prozac, Zoloff, and Lexapro are commonly prescribed antidepressant drugs. Xerostomia, slower blood clotting time, bruxism, no vasoconstrictors in local anesthesia, toothache, and abnormal taste are how antidepressant medications affect the mouth. Individuals with experience some sort of discomfort and anti-inflammatory drugs can help reduce that pain. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, or corticosteroids are the four main categories for pain medication. Oral effects include: bleeding

concerns, increase in blood pressure, and muscle weakness. Anticonvulsants can stabilize mood, but they are also used to reduce and prevent seizures. Commonly recommended anticonvulsants include: Neurontin, Trileptal, Topamax, Zonegran, and Lamictal. These drugs can cause xerostomia, dry throat, slow blood clotting time, abnormal taste, and Topamax can cause gingivitis, difficulty swallowing, gum hyperplasia, and large tongue. Stool softeners come in many different types and they help by conserving water to help prevent the stool from becoming hard and difficult to . Constipation is common in children who have and it can be caused by diet, lack of fluids, not getting enough activity, and medications. Most individuals, not all, with cerebral palsy are in a wheelchair due lack of muscle movement. Working around their wheelchair is how you would get through the appointment. Morning appointments usually work best for patients with due to the possibility of them having a strong gag reflex or active bite. Their caretaker may need to hold their head during the appointment to minimize you injuring them. The need for modified toothbrushes depends on the mobility of their hands. Some toothbrush modifications for individuals could comprise of: a tennis ball with a slit cut in the top to hold the toothbrush—this would help them hold it on their own, a universal cuff (u-cuff)—to help stabilize the toothbrush for them, or a toothbrush with a wider handle would also help them out. Floss or water flosser would be helpful to sustain a neutral pH in their mouth since they are at high risk for cavity development. Showing and telling the caretaker of how to brush and floss their teeth would be necessary and nutritional counseling would be helpful to tell them how the sugary (soft) foods are harming their children’s teeth. The way you treat or modify the appointment for patients with any of the four types of cerebral palsy are a little different so always make sure to check the health history before each appointment to see what modifications are required.

References Vieira Pinto, V., Anderson César Alves, L., Mendes, F. M., & Ciamponi, A. L. (2016). The nutritional state of children and adolescents with cerebral palsy is associated with oral motor dysfunction and social conditions: a cross sectional study. BMC Neurology, 161-7. Wynn, R.L., Meiller, T.F., & Crossley, H.L. (2014). Drug information handbook for dentistry: Including oral medicine for medically compromised patients and specific oral conditions (20th edition). Hudson, OH: Lexicomp. Reed, K.L. (2014). Quick reference to occupational therapy (3rd edition). Austin, TX: PRO-ED, Inc. Chin, M., Fenton, S.J., Lyons, R., Miller, C., Perlman, S.P., & Tesini, D. (2014, August). Practical oral care for people with cerebral palsy. Retrieved from http://www.nidcr.nih.gov/oralhealth/Topics/DevelopmentalDisabilities/PracticalOralCare PeopleCerebralPalsy.htm#12