What is Cerebral Palsy?
Cerebral palsy is a long term disorder causing impaired control of movement. The symptoms develop over the first few years of life, and generally do not worsen thereafter.
The disorder is caused by damage to the motor control areas of the brain which disrupts the brain & ability to control movement and posture.
The term cerebral refers to the brain, and palsy refers to impaired control of body movement. There is a spectrum of symptoms for cerebral palsy. Someone with cerebral palsy may have difficulty with fine motor tasks, such as writing; or 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 person to the next, and may even change over time.
Unfortunately people with cerebral palsy are often affected by other medical disorders, including epilepsy or mental impairment. Contrary to common belief, however, cerebral palsy does not always cause profound handicap.
Cerebral palsy is not contagious nor is it usually inherited. At this time, cerebral palsy cannot be cured, although scientific research continues to yield improved treatments. Classification and incidence of cerebral palsy.
There are three broad types of cerebral palsy
Affecting 70 – 80% of patients, the muscles are stiffly and permanently contracted. Spastic cerebral palsy is further classified by the limbs affected.
Diplegia: either the arms or legs are affected.
Hemiplegia: the arm and leg on one side of the body.
Quadriplegia: all four limbs are affected.
When both legs are affected by spasticity, the legs may turn in and cross at the knees. This causes a walking rhythm, known as the scissors gait in which the legs move awkwardly and stiffly and nearly touch at the knees.
Individuals with spastic hemiplegia may also experience hemiplegic tremors, in which uncontrollable shaking affects the limbs on one side of the body. If these tremors are severe, they can seriously impair movement.
Affecting around 10 – 20% of patients. It is characterised by 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.
The movements often increase during periods of emotional stress and disappear during sleep.
Patients may also have problems co-ordinating the muscle movements needed for speech, a condition known as dysarthria.
Affecting 5 -10% of patients, this involves the sense of balance and depth perception.
Affected individuals often have poor co-ordination; walk unsteadily with a wide-based gait, placing their feet unusually far apart; and experience difficulty when attempting quick or precise movements, such as writing or buttoning a shirt.
They may also have intention tremor – this is where a voluntary movement, such as reaching for a book, causes a trembling that affects the body part being used and that worsens as the individual gets nearer to the desired object.
Babies with cerebral palsy are frequently slow to reach developmental milestones, such as learning to roll over, sit, crawl, smile, or walk. This is sometimes called developmental delay.
Some affected babies 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. In some cases, the baby has an early period of hypotonia that progresses to hypertonia after the first two to three months of life.
Affected babies may also have unusual posture or favour one side of their body. Parents who are concerned about their baby’s development for any reason should contact their doctor, who can help distinguish normal variation in development from a developmental disorder.
Doctors diagnose cerebral palsy by testing a child’s motor skills and looking carefully at the child’s medical history. In addition to checking for slow development, abnormal muscle tone, and unusual posture – a doctor also tests the child’s reflexes and looks for early development of hand preference. Reflexes are movements that the body makes automatically in response to a specific cue. For example, if a new-born baby is held on its back and tilted so the legs are above its head, the baby will automatically extend its arms in a gesture, called the Moro reflex, that looks like an embrace. Babies normally lose this reflex after they reach 6 months, but those with cerebral palsy may retain it for abnormally long periods. This is just one of several reflexes that a doctor can check.
Doctors can also look for hand preference – a tendency to use either the right or left hand more often. When the doctor holds an object in front and to the side of the child, a child with hand preference will use the favoured hand to reach for the object, even when it is held closer to the opposite hand. During the first year, babies do not usually show hand preference. But babies with spastic hemiplegia, in particular, may develop a preference much earlier, since the hand on the unaffected side of their body is stronger and more useful.
The next step in diagnosing cerebral palsy is to rule out other disorders that can cause movement problems. Most important, doctors must determine that the child’s condition is not getting worse.
Although its symptoms may change over time, cerebral palsy is not progressive. If a child is continuously losing motor skills, the problem is more likely to be genetic diseases, muscle diseases, disorders of metabolism, or tumours in the nervous system. The child’s medical history, special diagnostic tests, and, in some cases, repeated check-ups can help confirm that other disorders are not at fault. The doctor may also order specialised scans of the brain, including CT (computerised tomography), MRI (magnetic resonance imaging), EEG (electro encephalogram), or Ultrasound, to learn more about the possible cause of cerebral palsy.
Finally, doctors may want to look for other conditions that are linked to cerebral palsy, including epilepsy, mental impairment, and vision or hearing problems.
Cerebral palsy cannot be cured, but treatment can often improve a child’s capabilities. There is no standard therapy that works for all patients. Instead, the doctor must work with a team of health care professionals, first to identify a child’s unique needs and impairments, and then to create an individual treatment plan that addresses these.
Some approaches that can be included in this plan are:
- drugs to control fits and muscle spasms
- special braces to compensate for muscle imbalance
- mechanical aids to help overcome impairments
- counselling for emotional and psychological needs
- physical, occupational, speech, and behavioural 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.
The members of the treatment team for a child with cerebral palsy should be knowledgeable professionals with a wide range of specialities. A typical treatment team might include:
Doctor (such as a paediatrician, a paediatric neurologist, or a paediatric psychiatrist) – the doctor, often the leader of the treatment team, works to synthesise the professional advice of all team members into a comprehensive treatment plan, implements treatments, and follows the patient’s progress over a number of years.
Orthopaedist – a surgeon who specialises in treating the bones, muscles, tendons, and other parts of the body’s skeletal system. An orthopaedist might be called on to predict, diagnose, or treat muscle problems associated with cerebral palsy.
Physical therapist – designs and implements special exercise programmes to improve movement and strength.
Occupational therapist – helping patients learn skills for day-to-day living, school, and work.
Speech and language therapist – specialising in diagnosing and treating communication problems.
Social worker – helping patients and their families locate community assistance and education programmes.
Psychologist – helping patients and families cope with the stresses and demands of cerebral palsy. In some cases, psychologists may also oversee therapy to modify unhelpful or destructive behaviours or habits.
Educator – an especially important role when mental impairment or learning disabilities present a challenge to education.
The children who have cerebral palsy and their family or caregivers are also key members of the treatment team, and they should be closely involved in all steps of planning, making decisions, and applying treatments.
Studies have shown that family support and personal determination are two of the most important predictors of which children with cerebral palsy will achieve long-term goals. Too often, however, doctors and parents may focus primarily on an individual symptom – especially the inability to walk. While mastering specific skills is an important focus of treatment on a day-to-day basis, the ultimate goal is to help individuals grow to adulthood and have maximum independence in society
It must be remembered that these are classifications, and largely represents a convenient labelling system for the medical profession. The symptoms of cerebral palsy are highly individual, and it is common for a patient to combine any of the above symptoms – to the extent that there is often a fourth type of cerebral palsy that is recognised – mixed. The most common mixed form is spasticity with athetoid movements, but other combinations are also possible.