What is cerebral palsy
Cerebral palsy is a general term covering a wide range of physical disabilities present from birth or from early life. It is a non-progressive and non-inherited condition that most obviously affects body movement and posture, but that may also interfere with other bodily functions resulting in multiple disabilities.
The degree of severity may vary widely. In some affected children, the condition is so mild as to be hardly apparent; in others, the damage may be so severe that they cannot do anything for themselves.
Cerebral palsy especially affects movement of the legs, but in the most severe cases of the arms are also paralysed. It is thought cerebral palsy occurs in around 1:400 births.
What are the causes of cerebral palsy
Cerebral palsy results from damage to, or maldevelopment in, the portion of the brain which controls posture and movement.
Inadequate oxygen supply to the brain during foetal life.
Smallness for age of development before birth.
Poor foetal blood supply from the placenta (placental insufficiency).
Partial separation of the placenta before birth.
Bleeding within the uterus before birth (antepartum haemorrhage).
Inherited metabolic disorders.
Blood group incompatible with mother (rhesus factor incompatibility).
Defects present at birth (congenital malformations).
Compression of the umbilical cord during birth.
Prolonged or difficult labour.
Low blood sugar (hypoglycaemia) early in life.
Breathing difficulties, especially among premature babies (respiratory distress syndrome).
Low body temperature (hypothermia).
Early brain haemorrhage.
How many types of cerebral palsy are there
There are three main forms of cerebral palsy: spasticity, athetosis, ataxia.
A person with spasticity has disordered control of movement, muscle weakness and often disturbance of growth and development. Spasticity may affect both limbs on one side of the body (hemiplegia), both the lower limbs (paraplegia), or all four limbs (diplegia and quadriplegia).
Athetosis results in frequent involuntary movements which mask and interfere with normal movements of the whole body.
A person with ataxia has an unsteady gait and difficulty in balancing.
Spastic cerebral palsy is the most common form. Typically, the legs remain outstretched and permanently crossed or have a strong tendency to rub firmly together in a scissor-like action when the child tries to walk. This is the effect of constant spasm in the muscles which stay tightly contracted, so controlled movements are difficult or impossible.
Normally, when one muscle group contracts, the opposing group relaxes, but in spastic cerebral palsy there is no relaxation. Sometimes only one side of the body is affected and occasionally only one limb is involved. In the more severe cases, all limbs may be affected.
About 50% of children with cerebral palsy suffer epileptic seizures.
The more severe the brain damage, the more likely seizures are to occur.
Other effects of brain damage may include:
Degrees of deafness.
Problems with perception or understanding.
A combination of these. About 50% of children with cerebral palsy are mentally normal.
However, the other 50% have some degree of mental retardation: 25% being affected in a mild to moderate degree and 25% being severely retarded.
How is cerebral palsy diagnosed and treated
It is not always possible to diagnose cerebral palsy at birth, but babies who are found to be normal at birth and during the first year of life rarely develop the condition.
Affected babies may be seen to be obviously spastic or unable to move properly or may merely be unusually limp. It may take much longer than usual for the heart rate, breathing, muscle tone, response to stimulation, and skin colour to reach normal after birth.
In milder cases, there may be little immediate sign of problems and the first indication may be the development of uncontrolled movements or walking difficulties.
Unfortunately, the brain damage that causes the effects of cerebral palsy involves actual loss of brain substance, so once damage occurs treatment cannot reverse it.
However, much can be done, by way of special educational and physical therapy, to help children with cerebral palsy to minimize their disabilities and to live fuller and more satisfying lives.
Physiotherapy involves exercises to help maintain and hopefully improve movement.
It's one of the most important treatments for cerebral palsy.
The main goals of physiotherapy are to:
- encourage movement
- increase strength and stop muscles becoming weak
- stop muscles shortening and losing their range of movement (contracture), which can be painful and affect how the bones and muscles grow
A physiotherapist may also advise on walking aids (such as a walking frame or walking sticks) if needed, and arm or leg braces called orthoses to support the limbs.
Types of specialists a child with cerebral palsy may require include:
- Developmental pediatrician
- Occupational therapist
- Behavioral therapist
- Speech and language therapist
- Ophthalmologist (eye specialist)
- Otolaryngologists (ear, nose and throat specialist)
Surgeries that can improve mobility
There are multiple surgical treatments that can help correct movement problems in children with cerebral palsy. However, parents should keep in mind that surgery isn’t right for every child with cerebral palsy.
Surgery is most commonly prescribed for those with spastic cerebral palsy because their increased muscle tone can be reduced to relieve restricted movement.
For example, a child who walks on their toes due to high muscle tone in their legs can have those muscles or tendons lengthened, allowing for more normal walking.
Surgeries that can improve mobility in children with high muscle tone include:
- Muscle and tendon lengthening – A procedure used to correct contracted muscles or tendons, freeing up movement to walk or use hands.
- Tendon transfer – Transferring tendons from one bone to another is intended to give better alignment and motor control, especially in the feet and ankles.
- Tenotomy/myotomy – Cutting the tendon/muscle can relieve pain and restrictive movement caused by contractures—a permanent tightening of tendons or muscles.
- Neurectomy – Cutting the nerve that controls a specific muscle group can reduce spasticity or rigidity in that area. It is generally used to correct hip dislocations.
- Osteotomy – A procedure to realign joints by removing part of the bone.
- Arthrodesis – Fusing two bones together can produce stability in some cases.
- Selective dorsal rhizotomy – This aggressive procedure involves cutting specific nerves in the spinal column to correct spasticity in various muscle groups throughout the body.
Surgery is most effective when the child is old enough that doctors can determine where their movement issues are stemming from, but young enough that there is still time to correct movement.
This window is usually between 3-8 years of age.
Surgery may also be used to treat other conditions associated with cerebral palsy, such as hearing impairment and difficulties with feeding.
Spastic cerebral palsy causes spasms and stiff muscles. Medications to control these symptoms may either be given orally or through an injection, depending on the location of movement issues.
Generalized spasticity is typically treated with muscle relaxants or benzodiazepines such as Valium. Baclofen, another drug used to treat generalized spasticity, may carry a lower risk of increased tolerance than benzodiazepines. Baclofen may be given orally or injected directly into the patient’s spinal fluid.
If spasticity is localized to a specific area, nerve blocks may be injected into the muscles where movement is affected. Botox is also used in certain cases to reduce localized spasticity.
Common side effects from medications that reduce spasticity include:
- Loss of coordination
Medications for Involuntary Movement
Athetoid cerebral palsy is characterized by low muscle tone and involuntary movements. Children with athetoid CP may be prescribed medications to keep uncontrollable movements to a minimum.
Anticholinergic drugs ease symptoms by blocking nerve impulses that cause uncontrollable movements. They may also help control drooling, a common symptom of athetoid cerebral palsy.
Common side effects include:
- Dry mouth
Medications for Seizures
Injuries to the brain increase the likelihood of developing seizures. Therefore, it isn’t surprising that many children with cerebral palsy develop some form of epilepsy.
A report by the Centres for Disease Control in 2008 found that 41 percent of children with CP across multiple states had co-occurring epilepsy. There are several medications that reduce the frequency of seizures.
The two common types of drugs used to treat seizures are barbiturates and benzodiazepines, although the latter is more commonly used. Benzodiazepines that are often prescribed include Dilantin, Klonopin and Valium.
These drugs are useful anticonvulsants, muscle relaxants and anti-anxiety drugs.
Some of the common side effects of these drugs include:
What is the outlook for those with cerebral palsy
In children with severe cerebral palsy, especially with frequent seizures and mental retardation, the outlook is not good. Up to half die before the age of 10, usually from infection.
However, in almost 30% of cases of mild cerebral palsy the problem with walking has gone by the age of seven. In general, the outlook depends on the degree to which mental function is affected.
Cerebral palsy is a difficult condition to treat, and an even harder one to fully comprehend. The hope for a cure lies in getting a better understanding of cerebral palsy, but it’s important to understand that the current goal of most research is to learn new ways to reduce symptoms and limit brain damage.
Stem Cell Transplantation
Stem cell transplantation for cerebral palsy is still in the early phases.
More research is needed to determine how effective it could be. However, there are some clinical trials testing the effectiveness of using umbilical cord blood infusions to introduce stem cells into the body.
How Does Stem Cell Transplantation Work
Cerebral palsy is caused by damage to the brain’s motor control centre, which consists of several parts of the brain and billions of different brain cells. Understanding how all the networks of cells in these parts of the brain work together is the reason treating CP is so hard.
Stem cells can develop into specific types of brain cells, replacing those which are damaged. Theories suggest that stem cells placed into a person’s body can stimulate a response that mends damaged cells, or that the stem cells can be used to create new brain cells in a lab to replace the damaged cells.
The goal of stem cell transplantation is to protect and repair these damaged cells before they are completely useless, causing permanent damage. This could reduce the extent of mobility issues in children with CP.
Can Stem Cell Therapy Offer a Cure
Contention is strong in the scientific community over the efficacy of stem cell transplantation, but most experts agree that further research is required.
Even though stem cell therapy may not offer a cure, it is possible that it may reduce symptoms and increase mobility for people with cerebral palsy.
For the time being, treatment of cerebral palsy is most effective when it’s geared toward managing movement problems and other symptoms.
Cerebral palsy (CP) is a neurological condition caused by brain damage, and it is the most common motor and movement disability of childhood. If your child has been diagnosed with cerebral palsy, you need to know what to expect. Get the answers to all of your questions so that you can make informed decisions about diagnosis, treatment, therapies, and legal action USA.