Cerebral Palsy (CP) refers to a group of lifelong neurologic disorders that affect a person’s ability to move, coordinate and maintain balance and posture, especially during childhood. The ‘Cerebral’ is similar to the ‘cerebrum’ (a part of the brain) that regulates motor functions, and ‘Palsy’ means paralysis that results in muscle weakness. Abnormalities in the brain lead to CP during development, affecting a person’s ability to control their muscles. According to the CDC in the U.S.A., 1 in 345 children has been diagnosed with CP. The symptoms associated with CP can vary from patient to patient and change with age. A CP patient requires special equipment to walk and might need lifelong care. Let’s break this article to discuss Cerebral Palsy in detail:
Causes:
Several possible causes can initiate brain development abnormalities and lead to CP. Some people think it is mainly caused by a lack of oxygen to the brain during birth, but in reality, only a small number of cases are reported due to oxygen deficiency. Anyone can encounter CP:
- Before and after birth – It is known as Congenital CP, and the majority of CP is Congenital (85-90%)
- First five years of childhood
Risk factors such as low birth weight, medical complications, jaundice, infections such as chicken pox, and premature birth can increase the chance that a child will have Cerebral Palsy.
Types of CP:
There are four types of cerebral palsy based on severity and damage to motor areas of the brain:
- Ataxia
- Spasticity
- Dyskinesia
- Hypotonia
Some patients can have a combination of these (Mixed CP), and their symptoms can vary from time to time.
- Ataxic CP: This is characterized by voluntary but jerky or disorganized movement. Ataxic cerebral palsy is not common,but patients with this form can have trouble with coordination, balance, and motor functions such as writing and walking.
- Spastic CP: The most common type of CP is Spasticity which affects 80 percent of the patients. It can affect your entire or only one side of the body. Uneven muscle tone, stiffness, and exaggerated reflexes can result in awkward walking.
- Dyskinetic CP: People with dyskinetic CP can’t control their body movements due to unusual and involuntary movements in the hands, legs, arms, and sometimes around the facial region. A patient can experience rapid, jerky, or slow and twisting movements in dyskinetic CP that compromise swallowing, walking, and talking.
- Hypotonic CP: Relaxed muscles with decreased tone and floppy limbs are two common symptoms of Hypotonic Cerebral Palsy. A patient cannot control the movement of the head and may face trouble breathing and:
- Poor reflexes
- Abnormal walking
- Difficulty in speaking
Screening and Diagnosis:
Diagnosing CP earlier can speed up the treatment and recovery process. Screening and diagnosis usually have three steps:
- Developmental Monitoring or Surveillance tracks a child’s growth and development over a specific period.
- In Developmental Screening, different tests are performed by a physician to examine any developmental delay such as movement or motor delays in CP.
- The third step is Developmental and Medical Evaluation, in which a doctor diagnoses a specific disorder that affects a patient’s health. Patients can visit primary care doctors such as Neurodevelopmental Pediatricians, Child Neurologists, or Pediatric Rehabilitation Doctors for careful examination. Muscle tone, motor skills, posture, and reflexes are closely examined to evaluate developmental delays due to CP.
Following tests can also be performed for a detailed neurological examination and evaluation of specific symptoms associated with CP:
- MRI: Magnetic Resonance Imaging uses a strong magnetic field and radio waves to produce a clear brain image to identify injuries or abnormalities.
- EEG: Electro Encephalo Gram measures the brain’s electrical activity due to neurons and nerve cells. Disturbance in electrical activity can cause seizures and disorders like epilepsy.
- CT Scan: Computed Tomography or CT Scan uses X-rays at multiple angles to create robust and detailed images of structures inside the skull, such as the brain, sinuses, and eye sockets.
Treatment Options: There is no cure for CP, but different treatments, such as physical therapies and medications, help people with the condition be independent and active.
Medications that can reduce muscle stiffness and pain and improve functions are used. Nerve or muscle injections of OnabotulinumtoxinA (Botox) are administered every three months to reduce symptoms and manage complications.
Oral Muscle Relaxants such as Diazepam (Valium) are often administered through an oral route or, in some cases, through the spinal route to relax muscles.
Physical Therapy can help patients with CP to maintain balance, posture, and motor ability. For the first 1-2 years, physical and occupational therapists work on issues such as grasping, trunk, and head control. Supportive devices such as wheelchairs, splints, and braces might be recommended for patients with CP to improve muscle movement.
Speech and Language Therapists can help those patients who have trouble communicating. They provide communication exercises or alternative ways, such as sign language or special equipment that can generate speech.
Some patients with CP undergo Surgery to restore movements of body parts that are restricted due to stiffness and abnormalities in muscles. Some surgeries with extensive physiotherapy can take months and years to achieve full benefits.
Complications of CP:
Patients with Cerebral Palsy may experience certain complications, including:
- Spinal issues such as abnormal curvature of the spine (Scoliosis)
- Chronic joint conditions (Osteoarthritis)
- Stiffness in the connective tissues of the body (Contracture)
- Communication problems
- Poor bone density (Osteopenia)
- Incontinence due to weak bladder muscles can cause urine leakage
Conclusion:
Living with CP is difficult for every child, but parents should work closely with the healthcare team to develop a personalized treatment plan according to the child’s needs. CP, if diagnosed, cannot be prevented, but taking necessary measures at the right time can manage or delay certain complications. Regardless of the severity of the disorder, an effective treatment plan can improve motor and communication skills.