Cerebral Palsy

Medical Nutrition Therapy

The Basics
Cerebral Palsy can occur
when there is a disturbance in
the development of the fetal
brain.
Causes motor dysfunction,
and the underdevelopment of
movement and posture.

Cognition

Sensation

Perception

Communication

Behavior

Common Health Problems

Associated with Cerebral Palsy

Intellectual and learning disabilities

Seizure Disorders
Vision, speech, hearing impairment
Scoliosis, joint contraction, hip dislocation, joint and muscle pain, tonal problems
Bladder Problems (urinary tract infection)
Excessive drooling
Poor nutrition
Depression
Skin Breakdown
Gastrointestinal problems
Pneumonia
Osteoporosis

Predictors of Cardiometabolic Risk

Among Adults with Cerebral Palsy
BMI

Not a reliable tool to use for prediciting cardiometabolic risk in patients with
Cerebral Palsy.
BMI was found to be inversely related to gross motor function classification
system (GMFCS).

WHR (Waist-to-Hip Ratio)

Since this population is at such
great risk for muscle atrophy, it is
important to monitor adipose
accumulation.
May be a reliable prediction for
different makers for dyslipidemia,
when considering age and GMFCS.
WHR is not influenced by GMFCS

The effect of gastrostomy tube feeding on body

protein and bone mineralization in children with
quadriplegic cerebral palsy
Study Design

21 participants (9 females, 12 males)

Subjects were malnourished children with quadriplegic cerebral palsy.

Median time taken between initial measurements and reassessment was 20.6
months

Height, weight, bone mineral density, total body protein

TF designed to give 75%-100% daily energy needs

Results
Significant increases in:
Total body protein
Measures of fat
Height
Bone mineral content

Cross-Section Study of Bowel Symptoms in

Adults with Cerebral Palsy: Prevalence and
Impact on Quality of Life
Lower GI tract problems are common
Poor function is associated with a lower
quality of life

28.6% of participants report

rarely/never have had control for
formed stool
30.8% of participants had trouble
controlling liquid stools
57.1% of participants said bowel
function has caused them some
embarrassment

Constipation medications and spacity medications were the top two type of
drugs used for bowel dysfunction

Mean BMI of 27.2

Participants were on average overweight

GI Function
Metabolism and absorption can be affected by
Drug-Nutrient Interactions
Delayed Gastric Emptying
Promotenormal GI function through diet and exercise if medically feasible
After meal bowel program
Upright positioning during and immediately after feeding
Small, frequent meals
Speech Therapy
Anti-ulcer medication
Respiratory conditions are of particular concern:
Monitor swallowing function
Monitorfor scoliosis
Monitorfor signs of pneumonia

Meet the Patient

Patient MG, is a 24-year-old, female, who has a

past medical history of Cerebral Palsy, spastic
quadriplegia, type 2 diabetes, microcephaly, is
nonverbal, and requires total around the clock
care.

Social History

Pt MG is one of two fraternal twins who are both affected by cerebral palsy.
The twins require total care, that is carried out by their maternal
grandparents.
Patient MG's mother suffered a brain aneurysm early into pregnancy. She
now suffers from hemiplegia, and requires total care from her parents.
The grandparents report that they have a makeshift physical therapy center
in their home, where they keep all three women active, even though they are
wheelchair dependent.

Past Medical/Surgical History

Cerebral Palsy, severe

Spastic Quadriplegia
Scoliosis
Type 2 Diabetes (2009)
Chronic Constipation
Incontinence
Gastronomy Tube Dependent (1994)
Irregular Menses
Endometrial Ablation (2013)
Cholecystectomy (2000)

Most Recent Admit

Admitted with complaints of abdominal pain and found to have

cecal volvulus with gangrene cecum and perforation.
S/P right colectomy with ileocolic anastomosis

TF Feeding Schedule

1 can Glucerna + 8 oz water continuous nighttime feeds @45 ml/hr

2 oz Glucerna + 4 oz water every hour from 8am 12pm
2 oz Glucerna + 4 oz water every hour from 2pm 5pm
Blood Sugar is checked in between feedings.

Anthropometrics
Height: 50 inches
Date

Weight

BMI

03/06/2014

29.5 kg

19.8 kg/(m^2)

07/24/2014

29.5 kg

19.8 kg/(m^2)

05/26/2015

28.1 kg

18.5 kg/(m^2)

11/30/2015

29.5 kg

19.8 kg/(m^2)

03/11/2016

29.7 kg

19.9 kg/(m^2)

Lab

03/14/16

03/15/16

03/16/15

03/17/16

03/18/16

NA

146*

140

142

144

144

3.2*

4.5

3.4*

3.6

3.9

CL

117*

111*

107

101

103

CO2

25

23

26

31*

32*

BUN

6*

3*

4*

4*

4*

CREATININE

0.44*

0.46*

0.45*

0.52*

0.45*

GLU

136*

225*

227*

243*

228*

CALCIUM

7.5*

7.5*

7.6*

8.1*

8.0*

PHOS

--

1.0*

--

--

--

MG

1.7

1.8

--

--

--

ALBU

--

--

2.1*

2.4*

2.2*

HGBA1C

6.0*

--

--

--

--

Nutrition Related Medications

Sorbitol
Chronic constipation which they used to treat with sorbitol, but insurance d/c coverage of it,
and grandmother has since switched to miralax, and other over the counter alternative.

Estimated Needs

Protein, fat, vitamins, and

minerals should meet the
Dietary Reference Intakes for
age and total energy needs
adjusted in order to facilitate
weight gain, maintenance, or
loss (Nutrition Care Manual,
2008).

Estimated Needs

Kcal/kg per wt of 29.7

kg

Kcals

742-891 kcals

Kcal/Kg

25-30 kcal/kg

Protein (g)

35 g

G/Kg

1.2 G/Kg

Fluid (mL)

742-891 mL

Fluid mL/Kg

25-30 mL/Kg

Nutrition Diagnosis and PES

Statement

Chewing/Swallowing (NC-1.1, NC-1.2) difficulty related to altered

motor function as evidenced by diagnosis of cerebral palsy with
spastic quadriplegia and long-term PEG for nutrition.

Interventions

1. Meals/Snacks: NPO
2. Enteral Nutrition: Resume home TF regimen of Glucerna. Patients family will
continue bolus feedings during the day of 2oz of Glucerna + 8 oz water every hour
from 8:00 am to noon and 2:00pm-5:00pm. At night, patient receives continuous
nocturnal feedings of 8 oz Glucerna + 8 oz water at a rate of 45 ml/hr.

Monitoring/Evaluation

Blood Glucose
Gastric Residuals
Prealbumin
Bowel Function
Weight/Weight Changes

References:
1. 2016. Available at: 1. http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm. Accessed May 11,
2016.
2. Public Home Page - Nutrition Care Manual. (2016). Nutritioncaremanual.org. Retrieved 1 April 2016, from
https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&ncm_toc_id=255328
3. 2016. Available at: 3. https://www.cerebralpalsy.org.au/what-is-cerebral-palsy/severity-of-cerebral-palsy/grossmotor-function-classification-system/. Accessed May 11, 2016.
4. Peterson M, Haapala H, Hurvitz E. Predictors of Cardiometabolic Risk Among Adults With Cerebral Palsy.
Archives of Physical Medicine and Rehabilitation. 2012;93(5):816-821. doi:10.1016/j.apmr.2011.12.024.
5. ARROWSMITH F, ALLEN J, GASKIN K, SOMERVILLE H, CLARKE S, OLOUGHLIN E. The effect of gastrostomy tube
feeding on body protein and bone mineralization in children with quadriplegic cerebral palsy.Developmental
Medicine & Child Neurology. 2010;52(11):1043-1047. doi:10.1111/j.1469-8749.2010.03702.x.
6. Marciniak C, Lee J, Jesselson M, Gaebler-Spira D. Cross-Sectional Study of Bowel Symptoms in Adults With
Cerebral Palsy: Prevalence and Impact on Quality of Life.Archives of Physical Medicine and Rehabilitation.
2015;96(12):2176-2183. doi:10.1016/j.apmr.2015.08.411.