Cerebral Palsy

What is Cerebral palsy?

Cerebral palsy (CP) is an umbrella term for a group of disorders affecting body movement, balance, and posture. Loosely translated, cerebral palsy means “brain paralysis.” Cerebral palsy is caused by abnormal development or damage in one or more parts of the brain that control muscle tone and motor activity (movement). The resulting impairments first appear early in life, usually in infancy or early childhood. Infants with cerebral palsy are usually slow to reach developmental milestones such as rolling over, sitting, crawling, and walking.

 cerebral palsy Diagram

Common to all individuals with cerebral palsy is difficulty controlling and coordinating muscles. This makes even very simple movements difficult. Cerebral palsy may involve muscle stiffness (spasticity), poor muscle tone, uncontrolled movements, and problems with posture, balance, coordination, walking, speech, swallowing, and many other functions. Mental retardation, seizures, breathing problems, learning disabilities, bladder and bowel control problems, skeletal deformities, eating difficulties, dental problems, digestive problems, and hearing and vision problems are often linked to cerebral palsy.

What are the types of Cerebral Palsy?

Types of cerebral palsy are as follows:

Spastic (pyramidal)

Increased muscle tone is the defining characteristic of this type. The muscles are stiff (spastic), and movements are jerky or awkward. This type is classified by which part of the body is affected: diplegia (both legs), hemiplegia (one side of the body), or quadriplegia (the entire body). This is the most common type of CP, accounting for about 70% to 80% of cases.

Dyskinetic (extrapyramidal)

This includes types that affect coordination of movements. There are two subtypes.

  1. Athetoid: The person has uncontrolled movements that are slow and writhing. The movements can affect any part of the body, including the face, mouth, and tongue. About 10% to 20% of cerebral palsy cases are of this type.
  2. Ataxic: This type affects balance and coordination. Depth perception is usually affected. If the person can walk, the gait is probably unsteady. He or she has difficulty with movements that are quick or require a great deal of control, such as writing. About 5% to 10% of cases of cerebral palsy are of this type.

Mixed

This is a mixture of different types of cerebral palsy. A common combination is spastic and athetoid.

What are the causes and risk factors of Cerebral Palsy?

Cerebral palsy results from damage to certain parts of the developing brain.

  • This damage can occur early in pregnancy when the brain is just starting to form, during the birth process as the child passes through the birth canal, or after birth in the first few years of life.
  • In many cases, the exact cause of the brain damage is never known.

Risk factors linked with cerebral palsy include the following:

  • Infection, seizure disorder, thyroid disorder, and/or other medical problems in the mother
  • Birth defects, especially those affecting the brain, spinal cord, head, face, lungs, or metabolism
  • Rh factor incompatibility, a difference in the blood between mother and fetus that can cause brain damage in the fetus (Fortunately, this is almost always detected and treated in women who receive proper prenatal medical care.)
  • Certain hereditary and genetic conditions
  • Complications during labor and delivery
  • Premature birth
  • Low birth weight (especially if less than 2 pounds at birth)
  • Severe jaundice after birth
  • Multiple births (twins, triplets)
  • Lack of oxygen (hypoxia) reaching the brain before, during, or after birth
  • Brain damage early in life, due to infection (such as meningitis), head injury, lack of oxygen, or bleeding

What are the symptoms of Cerebral Palsy? 

The signs of cerebral palsy are usually not noticeable in early infancy but become more obvious as the child’s nervous system matures. Early signs include the following:

  • Delayed milestones such as controlling head, rolling over, reaching with one hand, sitting without support, crawling, or walking
  • Persistence of “infantile” or “primitive reflexes,” which normally disappear 3 to 6 months after birth
  • Developing handedness before age 18 months: This indicates weakness or abnormal muscle tone on one side, which may be an early sign of CP.

Cerebral Palsy Hand

What are the non-surgical treatments for Cerebral Palsy?

 Medications for Cerebral Palsy

Medications that can lessen the tightness of muscles may be used to improve functional abilities, treat pain and manage complications related to spasticity. It’s important to talk about the risk of drug treatments with your doctor and discuss whether medical treatment is appropriate for your child’s needs. The selection of medications depends on whether the problem affects only certain muscles (isolated) or the whole body (generalized). Drug treatments may include the following:

  • Isolated spasticity
  • Generalized spasticity

Therapies for Cerebral Palsy

A variety of nondrug therapies can help a person with cerebral palsy to enhance functional abilities. These include the following:

  • Physical therapy: Muscle training and exercises may help your child’s strength, flexibility, balance, motor development and mobility. Braces or splints may be recommended for your child. Some of these supports are used to help with function, such as improved walking. Others may stretch stiff muscles to help prevent contractures.
  • Occupational therapy: Using alternative strategies and adaptive equipment, occupational therapists work to promote your child’s independent participation in daily activities and routines in the home, the school and the community.
  • Speech therapy: Speech therapists help improve your child’s ability to speak clearly or to communicate using sign language. They can also teach your child to use special communication devices — such as a board covered with pictures of everyday items and activities. Sentences can be constructed by pointing to the pictures. Speech therapists may also address difficulties with muscles used in eating and swallowing.

What are the surgical procedures for Cerebral Palsy?

Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity. These treatments include:

Orthopedic surgery

Children with severe contractures or deformities may need surgery on bones or joints to place their arms and legs in their correct positions. Surgical procedures can also lengthen muscles and tendons that are proportionally too short because of severe contractures. These corrections can lessen pain, improve mobility, and make it easier to use a walker, braces or crutches.

Severing nerves

In some severe cases, when other treatments haven’t helped, surgeons may cut the nerves serving the spastic muscles. This relaxes the muscle and reduces pain, but can also cause numbness.

 

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