Cerebral Palsy

cerebral palsy

CEREBRAL PALSY

 

cerebral palsy

It is defined as a term used to describe a group of chronic conditions affecting body movements and muscle coordination. “cerebral” refers to the “ brain”  and “ palsy” to a disorder of movement or posture. If someone has cerebral palsy it means that because of an injury to their brain (cerebral) they are not able to use some of the muscles in their body in the normal way (palsy). Children with cerebral palsy may not be able to walk, talk, eat or play in the same way as most other children do it.  This is mainly caused by damage to one or more specific areas of the brain, occurring during the foetal development or infancy. It can occur before, during or shortly following birth.

Cerebral palsy is neither progressive nor communicable ( able to communicate or transmitted) i.e. you cannot catch it. However it is also not “curable” In the accepted sense, although education, therapy can help the person with cerebral palsy to lead a productive life. It is important to know that cerebral palsy is not a disease, or illness. It doesn’t get worst. It is characterized by inability to fully control motor functions i.e. human motor system refers to many parts of our bodies that work together to enable us to act and move . Fine motor skills are the skills involving the smaller muscles such as in hands and gross motor skills are the skills in larger muscles such as in arms and legs. Therefore, cerebral palsy is a condition in which there has been damage to the areas of brain that control motor functions. Depending upon which area of brain involved or has been damaged people with cerebral palsy experience—–

1) Muscle tightness

2) Involuntary movement i.e. movement that is not under the control of brain.

3)  Disturbance in gait (how an individual walks) and mobility i.e. patient will not able to walk properly .there is imbalance between the nervous system and musculoskeletal system.

4) Abnormal sensation

5) Problem in hearing and speech

6) Seizures

 

 

 

What cause cerebral palsy

The simplest answer to this question is because your child has brain damage. cerebral palsy occurs because of brain injury before,  during or shortly after birth. There are two problems that causes cerebral palsy are

a) failure of the brain to develop properly.

b)  Neurological damage which may be due to

Lack of oxygen

Bleeding in the brain

Toxic injury, poisoning, use of alcohol or drugs by the mother.

Severe jaundice (build up of bilrubin causes yellow colour in infant)

Infection of the nervous system like meningitis i.e. inflammation of the meningis.

The severity of brain damage depends upon the type and timing of the injury. For example In pre mature baby, bleeding into the brain causes extensive damage but longer an unborn child goes without oxygen.

 

Risk factors for cerebral palsy

Risk factors means that increases the chance of something occurring. The presence of risk factors in cerebral palsy doesn’t means that cerebral palsy will occur nor the absence of risk factors means cerebral  palsy will not occur. If  a risk factor is present, it means parents and health care become more observant of the infant’s development.

Risk factors associated with parents

1)      mother 40 years or older

2)      mother 20 years or younger

3)      father 20 years or younger

Risk factors associated with child

1)      first child , or child born fifth or later in family

2)      one of pair of twins, especially if one twin dies

3)      low birth weight, less than 3.5 pounds

4)      premature infant less than 37 weeks

Other risk factors

1)      Rh or ABO blood incompatibility between infant and mother i.e. when the blood type of foetus , or developing child, differs from the blood type of the mother. This occur if mother type is O and foetus is either B,A, or AB or if mother  is A and foetus is B or AB or if mother is B and foetus is A or AB. When incompatibility occurs mother creates  antibodies to defend against the blood type of infant. These antibodies cross the placenta begin destroying the foetus blood cells and results in development of Jaundice in the foetus and if untreated it develops cerebral palsy.

2) Infection of the mother to virus in early pregnancy.

3)      Attack by micro organisms on central nervous system(CNS) of infant. CNS consist of brain and spinal cord. The brain receive and process signals delivered through spinal cord and then send signals to body. In people with cerebral palsy, this signalling system doesn’t function and the attack by micro organisms on the CNS , affects the signal system and hence to be the risk factor for cerebral palsy in infant.

When more than 1 risk factor can be present at the same time, such as low birth weight and being a twin, such combination further increase the risk of cerebral palsy.         `

 

 

 

 

Types of cerebral palsy

In order to study different types of cerebral palsy, one must know about muscle tone. Muscle tone refers to the amount of tension to the movement in a muscle. Changes in the muscle tone enables us to move. For example when we bend our arm in order to do brush, we must shorten( increase the muscle tone) our biceps and at the same time lengthening of triceps (decrease the muscle tone). Abnormal muscle tone is the prominent symptom of cerebral palsy. There are mainly different types of cerebral palsy..

a)      Spastic cerebral palsy

b)      Athetoid cerebral palsy

c)      Ataxic cerebral palsy

d)     mixed cerebral palsy

 

Spastic cerebral palsy(i.e.stiff and difficult movement)

In this children having one or more tight muscles group which limit movements .patients having stiff and jerky movements. These having hard time to move from one position to another and also find difficulty in holding and letting go of objects.

 

Athetoid cerebral palsy

This type of cerebral palsy  causes damage to cerebellum and basal ganglia(areas of the brain). These are responsible for smooth. voluntary, coordinated and purposeful movement. Damage to these areas causes involuntary, purposeless movements i.e. not under control of brain, especially in face, arms. These involuntary movements often interfere with speaking, feeding , grasping and other skills. These patients have low muscle tone and having problem in maintaining the postures for sitting, and walking.

 

Ataxic cerebral palsy

 

This type of cerebral palsy is commonly rare. Children with this palsy affects the sense of balance and having poor coordination and walk with a wide base, placing their feet usually apart. Because of shaky movements (just like tremor which is seen in very old people especially when try to hold a small object). These children take longer time to complete certain tasks such as writing a sentence.

 

Mixed cerebral palsy

This type of cerebral palsy is mixture of both spastic and athetoid cerebral palsy. These patients show both features of  spastic and athetoid cerebral palsy.

 

 

 

 

How to diagnose  child with cerebral palsy

When an infant or child with brain damage, a variety of symptoms can lead doctors and parents to suspect something is wrong. Following symptoms can indicate cerebral palsy.

a) Lethargy or lack of alertness i.e. infant is listless and doesn’t move around normally.

b) Irritability

c) Abnormal high pitched cry

d) Trembling of arms and legs

e)  Poor feeding abilities like sucking and swallowing.

f) Abnormal posture, child favour one side of body

g) Abnormal reflexes

h) Seizure

i) Muscle tone changes from low tone to high tone

j) Child may hold his/her hand in tight fist

k)      Presence of asymmetric movement i.e. one side of body move more easily and freely than other side.

l)        Infant feed poorly i.e. tongue push the food out of their mouth forcefully.

m) Child usually appear slower in performing movements like rolling. Sitting up, crawling, walking and talking ( developmental delay)

 

 

Doctors use different specialized tests in diagnose cerebral palsy.

Computed tomography

Imaging that determine under developed areas of brain tissue.

Magnetic resonance imaging

Generates picture of brain to determine brain area that may be damaged.

Intelligence testing

Determine child from mental standard point…

 

Treatment of cerebral palsy

Since cerebral palsy is a group of chronic conditions therefore its treatment plan is classified as…

1)      cerebral palsy treatment with physical therapy.

2)      Cerebral palsy treatment with occupational therapy

3)      Cerebral palsy treatment with speech and language therapy

 

Cerebral palsy treatment with physical therapy

Stretching, range of motion and strengthening exercises are essential in all children. Neuromuscular facilitation stimulate the CNS to establish normal pattern of movements . These minimize the neurological impairments  and help in healing CNS to recognize . The parents must repeat the exercises with children every day and observe children for improvement.

Conventional exercises consist of active (performed by patient himself) , passive (performed by therapist) range of motion , stretching and strengthening exercises to improve  cardio vascular condition. Stretching exercises should be done to prevent contractures. It should not be done in order to tear muscle fibres and cause pain. Night splints should be used. Sports activities are helpful in decreasing stiffness and contractures by using wheel chair. Balancing training should be beneficial for independent walking.  Strengthening of muscles emphasizing efficient motor functions. When forced to change position for fear of contracture , the  child  needs to use his hands for balance .

 

Cerebral palsy treatment with occupational therapy

An occupational therapist specializes in improving the development of small muscles of body such as hands,  feet, fingers and toes. They teach daily living skills such as dressing and eating , make proper positioning for the use of wheel chair. They teach child better or easier ways to write , draw, cut with scissors, brush their teeth dress and feed themselves. They help the child to find special equipments to make everyday jobs, a little easier.

 

Cerebral palsy treatment with speech and language therapy

Speech and language therapist develop better control of jaw and mouth muscles to improve speech and language skills and eating abilities of the children. They create communication methods for the patients who can’t speak . speech therapist work on making their speech clearer or building their language skills by learning new words, learn to  speak in sentences.

 

 

 

Article publié pour la première fois le 20/06/2011

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