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Cerebral Palsy

Definition

Cerebral Palsy is considered a neurological disorder caused by a non-progressive brain injury or malformation that occurs while the child’s brain is under development. Cerebral Palsy primarily affects body movement and muscle coordination. (www.cerebralpalsy.org)

Characteristics

Early warning signs - The baby has difficulty in sucking, swallowing, has feeding difficulty and poor head control. 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.

Causes

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

    • Acquired CP results from brain damage in the first few months or years of life due to 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.



    Types can be described in two ways

    • Type of Movement
    • Type of Limb Involvement

      • Based on Type of movement CP is classified into four broad categories – Spastic, Athetoid, Ataxic and Mixed Forms.
    • Spastic Cerebral Palsy: In this form, the muscles are stiff 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 Dyskinesia 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 Cerebral Palsy: This form has symptoms of more than one of the previous three forms. The most common mixed form includes spasticity and athetoid movements.

      • Type of Limb Involvement

    • Monoplegia - One limb is affected.
    • Diplopia - Both the legs are affected.
    • Trilegiant -Any three limbs are affected.
    • Quadriplegia -The whole body is affected.
    • Hemiplegia - One side of the body is affected.
    • Double Hemiplegia - The whole body is affected and the hands are more affected.

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

      Treatment


      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 hypertonia; 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
    • Abnormal 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

      Medical Management

      A child with CP can enjoy a 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. The plan has to focus on medical aspects which includes physiotherapy, occupational therapy, sometimes speech therapy and vision, hearing, posture correction. It will also include antiepileptic drugs to control seizures, special braces to compensate for muscle imbalance, mechanical aids and sometimes surgery to overcome impairments. In general, earlier the treatment begins, better are the chances of overcoming developmental disabilities or strategies to learn difficult tasks.

      Physiotherapy 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. Recently, Aqua therapy is proving to be very beneficial for a child with CP.

      A child with CP will benefit with aids such as Velcro shoes, light pointer or headband. Appliances like gaiters and callipers give support to the affected part of the body and improve the child's functioning. The computer can make a dramatic difference in the lives of those with cerebral palsy, satisfying emotional and psychological needs.

      Educational Management

      Educational Program will depend on the level of intellectual ability, degree of physical handicap and associated learning disabilities. A child with C.P. may not necessarily be intellectually disabled. If he is intellectually normal, he has to attend a regular school but may require support in areas like accessible arrangement of his class, extra attention to problems of speech and vision if present. He may also require special remediation in some perceptual areas.

      Inclusion in sports activities of children with CP is many times a neglected aspect in regular schools. With innovations in the games, these children can also participate, which will tremendously help in providing an equal opportunity to build positive self-esteem.

      Tips to Parents

      Make use of adaptive clothing’s, Velcro tapes/closings, self-twisting shoe laces etc. Take stock of his strengths & limitations. If in regular school, encourage your child's friends to support him by sensitising them to his extra needs and be his Buddy.





      Note

      Remember that every child with CP may not be intellectually Sub-normal. 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.