An Overview of Cerebral Palsy

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Cerebral palsy is a name given to a set of nervous disorders which affects muscle coordination and body movement. Damage to particular areas of a developing brain before, during, or shortly after a child is born, usually causes cerebral palsy. Flawed development of motor areas in the brain negatively affects the brain’s ability to effectively control movement and posture.

Cerebral Palsy (CP) itself is not progressive; though, secondary conditions like muscle spasticity may occur which gets worse or better over time. With that said, cerebral palsy’s effects can be as slight as just weakness in one part of the body, ranging to a nearly complete lack of movement.

While Cerebral Palsy is not curable to date, therapy, and medical management can help improve function. In addition, several promising treatments and therapies are currently being investigated.

Prevalence of Cerebral Palsy

Nearly 8,000 babies and infants are diagnosed with cerebral palsy every year. A startling number, 1 out of every 300 kids suffer from cerebral palsy. Generally, about 500,000 individuals of all ages in America have cerebral palsy.

Types of Cerebral Palsy

There are four major types of cerebral palsy

Spastic Cerebral Palsy

Almost 80% of CP cases are spastic. This form of cerebral palsy is the most common form. The motor functions of a child with this kind of cerebral palsy have increased muscle tone (stiff and contracted muscles).

Trying to move with incessantly contracted muscles makes movement short and jerky. Spastic cerebral palsy is normally caused by damage to the part of the brain which controls movement. Although formal diagnosis may be delayed by months or years, most cerebral palsy patients are born with this disorder.

Athetoid Cerebral Palsy

Athetoid or Dyskinetic cerebral palsy affects about 10-15% of sufferers. It is described by uncontrollable and unintentional movements due to constantly changing muscle tone. Individuals with this condition often have a movement which looks sluggish and are at times circular in nature.

Facial muscles might be affected resulting to drooling distorted facial movements. When the middle part of the brain is damaged Athetoid CP is likely to occur.

Ataxic Cerebral Palsy

This is the least common type of CP, affecting about 5-10% of sufferers. It is highly characterized by improper coordination of movement as well as muscle tone. The definition of Ataxia, means “incoordination” or being “without order”.

The sense of depth and balance is affected and there is no coordination when walking or standing. One may experience tremors and shaky movements. This kind of cerebral palsy is caused by damage to the cerebellum.

Mixed Cerebral Palsy

Many cerebral palsy sufferers have a mixture of different conditions. The most prevalent is a mix of Athetoid and Spastic while the least prevalent is Ataxic and Athetoid. It’s possible, though unusual, to have a mixture of all three forms of cerebral palsy. Mixed cerebral palsy can affect all parts of the body.

History of Cerebral Palsy

William Little documented the first study on cerebral palsy, which highlighted a condition that caused inflexible, spastic muscles in the arms and legs. His study culminated in 1861 stating that “abnormal forms of labor” where the “child has been partially suffocated “, harms the nervous system causing spastic rigidity and at times paralytic contraction.

Sigmund Freud made further studies on Little’s theory, asserting that CP can be caused by atypical development of a child’s brain during birth.    

These medical theories are important in the history of CP and have since acted as a benchmark for other breakthroughs in medicine, therapy, and technology. The ever-increasing success, in awareness and treatment of cerebral palsy, is continuing to rise and compliments to its history to this date.

Causes of Cerebral Palsy

Even though cerebral palsy is usually deemed a congenital syndrome (present at birth), it can also occur after birth (acquired cerebral palsy). CP that occurs after birth is mostly as a result of  brain damage ensuing from an accident, fall or from a brain infection (e.g. encephalitis, meningitis).

It used to be assumed that insufficient oxygen during delivery was the primary cause of congenital CP, but researchers now believe this is only responsible for about 10% of the cases. Brain damage caused by medical negligence is also a possible cause of CP.

When the baby is not supplied enough oxygen during delivery, the damage is significant to cause CP. Inappropriate use of forceps and other apparatus during delivery, delaying to perform a Cesarean section, not correctly monitoring the wellbeing of the fetus, or not identifying and treating infections early can also lead to occurrence of this condition.    

A large number of other risk factors, which affect a developing brain, might also lead to CP. Basically a risk factor is never a cause but a variable that when present, raises the likelihood of this condition occurring. A risk factor serves as an alert to physicians and parents to be more observant of the infant’s development.

Factors that can lead to Cerebral Palsy

  • Premature birth
  • Lack of important growth factors during uterine life
  • Failure by the placenta to supply the fetus with nutrients and oxygen
  • Infection of mother with herpes, German measles, chickenpox or other viral infections during pregnancy
  • A-B-O or RH blood type incompatibility between infant and the mother.
  • Stroke
  • Bacterial infection of the fetus or mother
  • Severe jaundice shortly after birth

Symptoms to Look For

Signs and symptoms of cerebral palsy are often identified by the parents when the kid is usually 6 months old. Possible first signs include:

  • Excessive floppiness (decreased muscle tone) or rigidity (increased muscle tone)
  • Adopting strange positions and favoring specific side of the body when walking
  • Muscle wasting, sluggish or uneven growth
  • Not developing at a normal pace – failure to reach milestones like smiling, walking, or sitting up
  • Unresponsiveness or apparent deafness
  • Seizures
  • Difficulties in swallowing or eating
  • Delays in speech development

Cerebral Palsy Diagnosis

If your doctor suspects you may have cerebral palsy, he will evaluate your signs and symptoms, assess medical history and then carry out a physical evaluation. Here are some of the ways the doctor can diagnose this condition.

Brain scan

Brain imaging technologies are used to expose areas with abnormal development in the brain. They may include Magnetic resonance imaging (MRI) or cranial ultrasound.

If your kid has had seizures, the physician may conduct an electroencephalogram (EEG) to establish if the kid has epilepsy, which usually happens in individuals with cerebral palsy.

Laboratory tests

Laboratory tests can also be used to screen metabolic or genetic problems.

Additional tests

If your kid is diagnosed with cerebral palsy, you will probably be referred to specialists for further assessment. These tests may identify:

  • Hearing impairment
  • Vision impairment
  • Intellectual disabilities
  • Speech delays
  • Movement disorders
  • Other development delays

Treatment Options

There is no known cure for CP; however, much can be done to restrict the level of disability which may have happened if treatment had not been administered.

The main purpose of treatment is to enhance the overall quality of life for individuals with cerebral palsy. Those treatments could focus on improving motion and motor skills, preventing or minimizing physical deformities, and improving your capabilities to succeed in a range of environments.

Physiotherapy and Occupational Therapy

One of the key aims of physical therapy is to limit or prevent the limb deformities and contractures which occur with spastic cerebral palsy. Physiotherapists focus on power, mobility and range of movement. Physical therapy is also great for improving pain management and sensory impairment.

Another form of treatment, known as occupational therapy can include mobility training, splints, braces, exercises, and many others. Occupational therapy helps assist patients with physical and cognitive disorders, and improving the overall quality of life for individuals with cerebral palsy. This form of therapy can also improve children’s independence skills, such as dressing, feeding and moving independently.

Medication

Usually, medications for cerebral palsy have a limited role. For instance, botulinum toxin injections are used in some instances to relax spastic muscles. Calf muscles, hamstrings, and muscles which pull the hips together are the most commonly injected muscles.

Medication is also useful in controlling the symptoms of cerebral palsy. Anticonvulsant medication can be administered to control seizures while anticholinergic medications are used to help control tremors, drooling, and urinary incontinence.

Surgery

Depending on the degree and type of muscle contracture, a surgical procedure may help – for instance, a surgery to correct a joint deformity or to loosen tight muscles. The intention is to give more control and flexibility to the affected joints and limbs. Most surgical procedures are carried out on the muscles around knees, ankles, and hips.

Alternative therapies

Some alternative treatment, such as cranial osteopathy, massage, acupuncture, and acupressure may be handy in managing symptoms like muscle spasms. Stem cell therapy is being studied as a treatment option for cerebral palsy, although research is still undergoing to verify if the option is safe and effective.

Cerebral Palsy Prevention

Since the cause of CP is not always easily identifiable, ensure you follow all your physician’s directions during pregnancy, such as eating nutritious food, taking regular walks, abstaining from drugs and alcohol and keeping your vaccinations up to date while pregnant.

While CP may be as a result of other factors, such as birth injuries caused by negligent medical care, the most important preventive measure one can observe, is to take good care of herself while pregnant.

Life Span

Life Span of individuals with cerebral palsy depends on the severity of the condition. In general, individuals with milder forms have life spans which match up to that of the general population. Individuals with severe forms are likely to have significantly reduced life expectancy. With that said, because of earlier diagnosis, and better medical care, the lifespan of severely affected individuals is increasing.

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