What is Cerebral Palsy?
- Cerebral Palsy is a group of disabilities caused by injury or insult to the brain either before or during birth, or in early infancy.
- Cerebral Palsy is the most common permanent disability of childhood.
- Cerebral refers to the cerebrum, which is the affected area of the brain (although the disorder most likely involves connections between the cortex and other parts of the brain such as the cerebellum, and palsy refers to disorder of movement.
- CP is caused by damage to the motor control centers of the developing brain and can occur during pregnancy (about 75 percent), during childbirth (about 5 percent) or after birth (about 15 percent) up to about age three.It is a non-progressive disorder, meaning the brain damage does not worsen, but secondary orthopedic difficulties are common. For example, onset of arthritis and osteoporosis can occur much sooner in adults with cerebral palsy.
- There is no known cure for CP. Medical intervention is limited to the treatment and prevention of complications arising from CP’s effects.
Classification of Cerebral Palsy:
1. Spastic Cerebral Palsy – is the most common type and may involve one or both sides of the body.
- Clinical hallmarks include hypertonicity with poor control of posture, balance, and coordinated movement, and impairment of fine and gross motor skills. Active attempts at motion increase the abnormal postures and lead to overflow of movement to other parts of the body.
- Common types of spastic cerebral palsy include:
- Hemiparesis is when one side of the body is affected
- Quadriparesis (tetraparesis) is when all four extremities are affected.
- Diplegia is when similar body parts are affected, such as both arms.
2. Dyskinetic/Athethoid Cerebral Palsy – involves abnormal involuntary movements that disappear during sleep and increase with stress.
- Major manifestations are athetosis (wormlike movement), dyskinetic movement of mouth, drooling and dysarthria.
- Movements may become choreoid (irregular, jerky) and dystonic (disordered muscle tone), especially when stressed and during the adolescent years.
3. Ataxic Cerebral Palsy – is manifested by a wide-based gait, rapid repetitive movements performed poorly, and disintegration of movements of the upper extremities when the child reaches for objects.
4. The Mixed/dystonic Cerebral Palsy – is manifested by a combination of the characteristics of spastic and athetoid CP.
- Cerebral Palsy common results from existing prenatal brain abnormalities.
- Prematurity is the single most important determinant of Cerebral Palsy.
- Other prenatal or perinatal risk factors include: asphyxia, ischemia, perinatal trauma, congenital and perinatal infections, and perinatal metabolic problems such as hyperbilirubinemia and hypoglycemia.
- Infection, trauma and tumors can cause Cerebral Palsy in early infancy.
- Some cases (about 24%) of CP remain unexplained.
- Disabilities usually result from injury to the cerebellum, the basal ganglia or the motor cortex.
- It is difficult to establish the precise location of neurologic lesions because there is no typical pathologic picture. In some cases, the brain has gross malformations; in others, vascular occlusion, atrophy, loss of neurons and degeneration may be evident.
- Cerebral Palsy is nonprogressive but may become more apparent as the child grows older.
Additional manifestations include:
1. Abnormal motor performance (e.g. early dominant hand preference, abnormal and asymmetrical crawl, poor sucking, feeding problems or persistent tongue thrust)
2. Alterations of muscle tone (e.g. increased or decrease resistance to passive movements, child feels stiff when handling or dressing, difficulty in diapering or opisthotonos)
3. Abnormal postures (e.g. scissoring legs or persistent infantile posturing)
4. Reflex abnormalities (e.g. persistent primitive reflexes, such as tonic neck of hyperreflexia)
Disabilities associated with Cerebral Palsy include mental retardation, seizures, attention deficit disorder and sensory impairment.
Severe cases may be observed at birth, mild and moderate cases usually are not detected until the child is 1 to 2 years old. Failure to achieve milestones may be the first sign.
Diagnosis of Cerebral Palsy is based on the following:
- Prenatal, birth and postnatal history
- Neurologic examination
- Assessment of muscle tone, behavior and abilities
- Other disorders, such as metabolic disorders, degenerative disorders and early slow-growing brain tumors are ruled out.
- Prevent physical injury by providing the child with a safe environment, appropriate toys, and protective gear (helmet, kneepads) if needed.
- Prevent physical deformity by ensuring correct use of prescribed braces and other devices and by performing ROM exercises.
- Promote mobility by encouraging the child to perform age-and condition-appropriate motor activities.
- Promote adequate fluid and nutritional intake.
- Foster relaxation and general health by providing rest periods.
- Administer prescribed medications which may include sedatives, muscle relaxants and anticonvulsants.
- Encourage self-care by urging the child to participate in activities of daily living (ADLs) (e.g. using utensils and implements that are appropriate for the child’s age and condition).
- Facilitated communication
- Talk to the child deliberately ad slowly, using pictures to reinforce speech when needed.
- Encourage early speech therapy to prevent poor or maladaptive communication habits.
- Provide means of articulate speech such as sign language or a picture board.
- Technology such as computer use may help children with severe articulation problems.
- As necessary, seek referrals for corrective lenses and hearing devices to decrease sensory deprivation related to vision and hearing losses.
- Help promote a positive self-image in the child:
- Praise his accomplishments
- Set realistic and attainable goals
- Encourage and appealing physical appearance
- Encourage his involvement with age and condition- appropriate peer group activities.
- Promote optimal family functioning
- Encourage family members to express anxieties, frustrations and concerns and to explore support networks.
- Provide emotional support and help with problem solving as necessary.
- Refer the family to support organizations such as the United Cerebral Palsy Association.
- Prepare the child and family for procedures, treatments, appliances and surgeries if needed.
- Assist in multidisciplinary therapeutic measures designed to establish locomotion, communication and self-help, gain optimal appearance and integration of motor functions; correct associated defects as effectively as possible and provide educational opportunities based on the individual’s needs and capabilities. Therapeutic measures include:
- Braces to help prevent or reduce deformities, increase energy of gait, and control alignment.
- Motorized devices to permit self-propulsion.
- Orthopedic surgery to correct deformities and decrease spasticity (medications are not helpful for spasticity).
- Medications to control possible seizure activity or attention deficit disorder.
- Speech therapy and physical therapy.
- Inform parents but their child will need considerable help and patience in accomplishing each new task.
- Encourage them not to focus solely on the child’s inability to accomplish certain tasks.
- Urge them to relax and demonstrate patience.
- Explain the importance of providing positive feedback.
- Encourage the family to seek appropriate functional, adaptive and vocational training for the child.
- Encourage family members to achieve balance in their lives between caring for their disabled child and other family and personal matters.
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