Cerebral Palsy

We know that coordinated movement is a must for each human to function independently. These movements are made possible by the command of the brain moved by the muscles and bones through the command of the nerves. A person can voluntarily control his or her movement. But sometimes not all movement is not coordinated and controlled. Not all people can voluntarily control movement. The disorder is a more familiar one:  cerebral palsy.

What is cerebral palsy?

Cerebral palsy (CP) is a disorder that affects muscle tone, movement, and motor skills.[1] Signs and symptoms vary between people. Often, symptoms include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, vision, hearing, swallowing and speaking.[2]

about-cp

Image courtesy of cerebralpalsy.org.au.  A child with cerebral palsy

CP is one of the most common neurological deficits and one of the most common causes of childhood disability and is easily recognizable. Often babies with cerebral palsy do not roll over, sit, crawl, or walk as early as other children their age. Difficulty with the ability to think or reason and seizures each occurs in about one third of people with CP. While the symptoms may get more noticeable over the first few years of life, the underlying problems do not worsen over time.[2][3]

What causes cerebral palsy?

Cerebral palsy is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture.[2][3][4] This damage can occur during pregnancy, delivery, the first month of life, or less commonly in early childhood.[2][5] Brain part or nerve damage are often structural in 80% of the cases.[2] While the main reason for CP is unknown other causes have been attributed like exposure to radiation, infection, fetal growth restriction[2], hypoxia (lack of oxygen) of the brain and trauma during birth.

cerebral-palsy-infographic

Image courtesy of beyondisability.org. Cerebral palsy in a nutshell.

What are the signs and symptoms of cerebral palsy?

Cerebral palsy is characterized by abnormal muscle tone, reflexes, or motor development and coordination.[2] CP is a disorder with symptoms ranging from mild to severe in a continuum.

List of CP symptoms[2]:
– joint and bone deformities
– contractures (permanently fixed, tight muscles and joints)
– spasms
– unsteady gait
– problems with balance
– scissor walking (where the knees come in and cross)
– toe walking
– irregular posture
– speech and language disorders
– seizure
– muscle weakness
– poor eating (due to difficulty in handling cutlery)

Cerebral palsy have types too[1]:

spastic cerebral palsy — causes stiffness and movement difficulties
athetoid cerebral palsy — leads to involuntary and uncontrolled movements
ataxic cerebral palsy — causes a problem with balance and depth perception

bd82763b05af410e3dd2019f46ffef98

Image courtesy of Pinterest. Another classification of cerebral palsy according to paralysis locations.

How is cerebral palsy detected?

The US Centers for Disease Control gives the early signs of CP in a developing child[6]:

In a Baby Younger Than 6 Months of Age

His head lags when you pick him up while he’s lying on his back
He feels stiff
He feels floppy
When held cradled in your arms, he seems to overextend his back and neck, constantly acting as if he is pushing away from you
When you pick him up, his legs get stiff and they cross or scissor
mother holding daughter

In a Baby Older Than 6 Months of Age

She doesn’t roll over in either direction
She cannot bring her hands together
She has difficulty bringing her hands to her mouth
She reaches out with only one hand while keeping the other fisted

In a Baby Older Than 10 Months of Age

He crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg
He scoots around on his buttocks or hops on his knees, but does not crawl on all fours

If you suspect that your child has these symptoms prompt attention and assessment by a general practitioner or paediatrician is a must for earlier detection and management.

Other tests to rule out CP[7]:

Blood tests

Cranial ultrasound – an ultrasound scan can help doctors see an image of the child’s brain tissue

MRI (magnetic resonance image) scan – this uses nuclear magnetic resonance of protons to produce proton density images

CT (computed tomography) scan – a series of X-rays are compiled by the computer to create a 3-D image of the baby’s brain

How is cerebral palsy managed?

Cerebral palsy has no cure but there are therapies aimed at managing CP.

The goal of managing CP includes[8]:

  • Optimize mobility
  • Manage primary conditions
  • Control pain
  • Prevent and manage complications, associative conditions and co-mitigating factors
  • Maximize independence
  • Enhance social and peer interactions
  • Foster self-care
  • Optimize ability to communicate
  • Maximize learning potential
  • Provide quality-of-life

These treatments include[9]:

  • physiotherapy
  • occupational therapy
  • medication to relieve muscle stiffness and spasms

In addition, medicine, surgery, or braces can help improve muscle function. Orthopedic surgery can help repair dislocated hips and scoliosis (curvature of the spine), which are common problems associated with CP.[1]

Pain relievers can be also given for severe pain associated with muscle and bone stiffness in CP.[1]

Managing CP involves a multidisciplinary team of health and educational professionals.[10] They are:

  • Pediatrician or physiatrist. A pediatrician oversees the treatment plan and medical care.
  • Pediatric neurologist. A doctor trained in diagnosing and treating children with brain and nervous system (neurological) disorders may be involved in your child’s care.
  • Orthopedic surgeon. A doctor trained in treating muscle and bone disorders may be involved in diagnosing and treating muscle conditions.
  • Physical therapist. A physical therapist may help your child improve strength and walking skills, and stretch muscles.
  • Occupational therapist. An occupational therapist can provide therapy to your child to develop daily skills and to learn to use adaptive products that help with daily activities.
  • Speech-language pathologist. A doctor trained in diagnosing and treating speech and language disorders may work with your child if your child has difficulties with speech, swallowing or language.
  • Developmental therapist. A developmental therapist may provide therapy to help your child develop age-appropriate behaviors, social skills and interpersonal skills.
  • Mental health specialist. A mental health specialist, such as a psychologist or psychiatrist, may be involved in your child’s care. He or she may help you and your child learn to cope with your child’s disability.
  • Social worker. A social worker may be involved in assisting your family with finding services and planning for transitions in care.
  • Special education teacher. A special education teacher addresses learning disabilities, determines educational needs and identifies appropriate educational resources.

They usually work hand in hand besides parents because children affected with cerebral palsy need long-time care for support.

How to Prevent Cerebral Palsy?

Prenatal checkup and vaccinations for both the expectant mother and the newborn baby are usually the best way for prevention of CP. Rh disease and congenital rubella syndrome used to be causes of CP. Currently; Rh disease can be prevented when an Rh-negative pregnant woman receives appropriate care. Women can be tested for immunity to rubella before pregnancy and be vaccinated if they are not immune. Babies with severe jaundice are placed under phototherapy.[11] This is to make the jaundice disappear, which makes them prevent CP. Also securing babies properly in vehicles and not rocking them too hard is a must to avoid shaking of the head (shaken baby syndrome) so as not to damage the brain.

Prognosis of Cerebral Palsy

Cerebral palsy is permanent but even if this is a lifelong condition it does not worse over time.[11] Some cases with CP can be able to walk while others need lifelong assistance with movement.

Coping with Cerebral Palsy

CP is a common neurodevelopmental disorder yet one of the most disabling. Both children with CP and their families are burdened  whether financially, medically, socially and emotionally. Education, assessment and therapy and both medical and social support are needed for better coping to CP. Having cerebral palsy does not necessarily mean that it’s sad ending. With appropriate therapeutic services, patients may be able to fully integrate academically and socially.[12] With appropriate support and acceptance a child with CP can live a full life.

cp_postcard_8

Advocacy banner for cerebral palsy.

References:

  1. kidshealth.org/parents/medical/brain/cerebral_palsy.html
  2. https://en.m.wikipedia.org/wiki/Cerebral_palsy
  3. “Cerebral Palsy: Hope Through Research”.http://www.ninds.nih.gov. February 2, 2015. Retrieved 4 March 2015
  4. “http://www.nichd.nih.gov/”. Cerebral Palsy: Overview. September 5, 2014. Retrieved 4 March2015.
  5. John Yarnell (2013). Epidemiology and Disease Prevention: A Global Approach (02 ed.). Oxford University Press. p. 190. ISBN 9780199660537.
  6. http://www.cdc.gov/ncbddd/cp/facts.html
  7. http://www.medicalnewstoday.com/articles/152712.php
  8. http://cerebralpalsy.org/about-cerebral-palsy/treatment/
  9. http://www.nhs.uk/conditions/Cerebral-palsy/Pages/Introduction.aspx
  10. http://www.mayoclinic.org/diseases-conditions/cerebral-palsy/basics/treatment/con-20030502
  11. http://philippinecerebralpalsy.org/about_cerebral
  12. http://emedicine.medscape.com/article/1179555-overview#a7
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