Cerebral Palsy

The term cerebral refers to the brain's two halves, or hemispheres, and palsy describes any disorder that impairs control of body movement. Cerebral Palsy (CP) is the name given to a group of conditions characterized by brain damage that produces a disorder of movement or posture.

Children with CP have uncoordinated or spastic movements, so they are referred to as 'Spastic Children'. These children have multiple handicaps, hearing impairments, speech defects, epilepsy, etc. These children may have difficulty with fine motor tasks, such as writing or cutting with scissors; experience trouble with maintaining balance and walking; or be affected by involuntary movements, such as uncontrollable writhing motion of the hands or drooling. The symptoms differ from one child to the next, and may even change over time in the same child. Cerebral palsy is classified into four broad categories - spastic, athetoid, ataxic, and mixed forms -- according to the type of movement disturbance.



Types of CP

  • Spastic Cerebral Palsy :In this form the muscles are stiffly and permanently contracted. This may cause the legs to turn in and cross at the knees. The child develops a characteristic walking rhythm known as the Scissors Gait.
  • Athetoid, or Dyskinetic, Cerebral Palsy : This form has uncontrolled, slow, writhing movements. These abnormal movements usually affect the hands, feet, arms, or legs and, in some cases, the muscles of the face and tongue, causing grimacing or drooling.
  • Ataxic Cerebral Palsy : This rare form affects the sense of balance and depth perception. They have poor coordination; walk unsteadily with a wide-based gait, placing their feet unusually far apart; and experience difficulty while writing or buttoning a shirt.
  • Mixed forms : This form has symptoms of more than one of the previous three forms. The most common mixed form includes spasticity and athetoid movements.

About one-third of children who have cerebral palsy are mildly intellectually impaired, one-third are moderately or severely impaired, and the remaining third are intellectually normal. As many as half of all children with cerebral palsy have seizures or epilepsy.

Causes of CP

  • Congenital CP is present at birth. It includes:
    1. Infections during pregnancy
    2. German measles, or rubella
    3. Jaundice in the infant
    4. Rh incompatibility
    5. Severe oxygen shortage in the brain or trauma to the head during labor and delivery.

  • Acquired CP results from brain damage in the first few months or years of life and can follow brain infections, such as bacterial meningitis or viral encephalitis, or results from head injury -- most often from a motor vehicle accident, a fall, or child abuse.

Detection

Early signs of cerebral palsy usually appear before 3 years of age, and parents are often the first to suspect that their infant is not developing motor skills normally. Infants with cerebral palsy are frequently slow to reach developmental milestones, such as learning to roll over, sit, crawl, smile, or walk.
They may have abnormal muscle tone. Decreased muscle tone is called hypotonia; the baby may seem flaccid and relaxed, even floppy. Increased muscle tone is called hypertonia, and the baby may seem stiff or rigid.


Diagnosis


Diagnosis can be made on the basis of

  • Slow development,
  • Abnormal muscle tone,
  • Unusual posture,
  • Infant's reflexes
  • Early development of hand preference.

The physician may carry out specialised tests like computed tomography CT scan, or Magnetic Resonance Imaging MRI technique to identify brain disorders. 


Management

A child with CP can enjoy near-normal life if his neurological problems are properly managed. Keeping in mind his unique needs and impairments individual treatment plans has to be devised. 

A plan has to include drugs to control seizures and muscle spasms, special braces to compensate for muscle imbalance, surgery, mechanical aids to help overcome impairments, counseling for emotional and psychological needs, and physical, occupational, speech, and behavioral therapy. In general, the earlier treatment begins, the better chance a child has of overcoming developmental disabilities or learning new ways to accomplish difficult tasks.

Physical therapy program will include specific sets of exercises to work toward two important goals: preventing the weakening or deterioration of muscles that can follow lack of use (called disuse atrophy) and avoiding contracture, in which muscles become fixed in a rigid, abnormal position, some physical therapy programs is to improve the child's motor development. 

A child with CP will benefit with aids such as Velcro shoes, light pointer or headband. The computer can make a dramatic difference in the lives of those with cerebral palsy.





Remember that every child with CP may not be mentally subnormal. In many cases, the child may have normal intelligence, but due to lack of awareness, people assume that every child with CP has a low level of IQ, which leads to lower expectancy resulting in poor performance

Useful links


http://www.nrcissi.org/