Mobility Limitations Overview
Cerebral palsy, a condition that results from a brain injury during infancy, can have a wide range of consequences for the patient. Since CP relates to areas of the brain that control motor function, many patients experience difficulty with mobility.
Mobility refers to a person’s ability to control his or her motor functions, from raising the arms when desired, to crawling and walking. Some CP patients have severe mobility limitations and need round-the-clock care, while others can lead fairly normal lives even though they might struggle with certain specific mobility issues.
Mobility Limitation With Cerebral Palsy
Although nearly all CP patients have some form of mobility limitation, the severity can vary dramatically. Additionally, different types of cerebral palsy impact patients in different ways based on the area of the brain that received the injury. For instance, some patients might not prove capable of moving a limb, while another might have uncontrollable movement.
Spastic cerebral policy is the most common form of this condition. It results in increased muscle tone and stiffness, which can create jerky movements in the limbs and make the limbs look as though they aren’t in tune with the rest of the body. They might walk awkwardly and be at risk of stumbling.
Patients with athetoid or dyskinetic CP experience involuntary abnormal movements in the arms, legs, face and trunk. This contrasts with ataxic CP, which proves far rarer. It causes difficulty with fine motor functions as well as rhythm and force of movement.
Some cerebral palsy patients have a mixed form of CP. This means that they experience a brain injury that affects more than one motor center in the brain, so they might experience symptoms of all three types of CP.
Location of Movement and Difficulties With CP
Cerebral palsy patients can also suffer symptoms in different parts of their bodies. If a person experiences more difficulties with the legs than with the arms, for instance, he or she might not be able to walk unassisted, but will be able to reach for and grab objects more easily than a CP patient who has more mobility issues in the arms.
Several forms of CP that relate to different areas of the body:
- Monoplegia affects only one arm or leg
- Diplegia causes mobility issues in both legs and sometimes one arm
- Hemiplegia results in mobility problems with one arm and one leg on the same side of the body
- Quadriplegia involves all four limbs as well as the trunk, windpipe, and neck
- Double hemiplegia involves all four limbs, but with greater mobility issues in the arms
Children who have more problem areas might have more difficulty integrating in school and accomplishing personal goals. However, mobility issues don’t always remain static. Many children gain the ability to interact with their surroundings and to control their movements through therapy and mobility aids.
Severity of a Child’s CP
In each of these conditions, the symptoms can range from mild to severe, even in quadriplegic cerebral palsy. When a physician discovers that a child might suffer from cerebral palsy, he or she runs several tests to measure the child’s motor function and to make predictions about his or her future mobility.
For instance, the Manual Ability Classification System measures a CP patient’s ability to use their arms and hands. Clinicians use the system to rate the child according to five different levels:
- Level I: The child can handle objects with fluidity and dexterity and without assistance from others.
- Level II: The child can handle objects well, but with decreased speed or quality of movement.
- Level III: The child needs occasional help to modify specific activities and might experience difficulty with fine motor movement.
- Level IV: The child can only manipulate objects with continuous support or activity modification.
- Level V: The child cannot manipulate objects and needs complete assistance from caregivers.
The Gross Motor Function Classification System, or GMFCS, uses a similar five-level system, but it measures mobility in the legs instead of the arms. To learn more about the Manual Ability classification System for children with cerebral palsy click here – http://www.macs.nu/
- Level I: Children can walk without assistance and with fluid gait quality. They can also negotiate stairs and other obstacles.
- Level II: Children might need some assistance when climbing stairs, such as a railing, and when walking across uneven terrain. They might choose to use assistive devices to increase speed and accuracy while walking.
- Level III: Children can typically walk with hand-held assistive devices while indoors and in familiar territory, but may use a wheelchair while outdoors and can often use self-propelled wheelchairs.
- Level IV: Children alternate between powered mobility and assistance depending on the setting and may be able to use assistive devices to walk very short distances.
- Level V: Children need manual wheelchairs regardless of the circumstances.
Walking and Motion Analysis Testing for Cerebral Palsy
Clinicians also use other techniques to measure, record or analyze a CP patient’s mobility quality and needs. The medical professional uses computerized equipment to visualize a patient’s muscles, joints, tendons, ligaments and other body parts while performing various activities, such as walking across a flat surface, playing with a ball or assembling a stack of blocks. A videotaped record of these activities can be analyzed to great detail.
This process uses sensors that can record muscle movements and transmit data to the computer. These sensors can measure joint force, muscle contraction, joint motion, energy expenditure, and other data points that help analyze mobility.
After the testing, the clinician creates a three-dimensional model of the patient’s gait. Doctors and other medical professionals can analyze the results to identify problem areas and to create a customized treatment plan. This process uses gait analysis, which specifically addresses walking and other use of the legs, and upper limb analysis, which measures mobility issues related to the arms.
Conducting Mobility Limitation Testing
Clinicians have numerous options for treating gait, upper limb, and other mobility issues in patients with cerebral palsy. Children often develop improved motor function after physical and occupational therapy, for instance. Physical therapy helps strengthen muscles and joints while increasing range of motion, while occupational therapy helps children prepare for daily activities, such as dressing, bathing, brushing teeth, eating, and getting in and out of assistive devices.
There are several pharmaceutical options for patients with CP. Muscle relaxants, for instance, can help children with spastic CP and other forms of cerebral palsy that cause involuntary muscle movements. Some patients take these antispasmodics every day by mouth, while others receive intramuscular injections. Other medications can ease pain, reduce inflammation, reduce the risk of seizures, and provide other relief from cerebral palsy symptoms.
Mobility aids can also provide great relief. Walkers, canes, wheelchairs, and other assistive devices give CP patients more autonomy, which can make living with CP easier. They can also improve mood and outlook.
Mobility is one of the central issues surrounding cerebral policy. The earlier a child gets tested and enters treatment, the better the outcome. This is why doctors focus on early screening and diagnosis; older children might not adapt as easily to treatment.