Cerebral Palsy is a term we have heard a lot in recent times. There are organizations all around the world which offer support to patients with cerebral palsy and their caregivers. It might appear that the number of patients suffering from cerebral palsy is increasing day by day. However, a large portion of the increase in numbers can be attributed to the growing level of awareness in people. More parents these days are bringing their children in for treatment. This is leading to greater number of diagnosed cases of cerebral palsy.
Parents come in with their children with the hope that cerebral palsy can be cured. However, when they hear that the condition is permanent it is like a death sentence to them. They are willing to go to any extent to bring about a change in the status of their children. However, till date there is no known cure. At this juncture, they need support and information to decide their steps.
- The first step is proper diagnosis of cerebral palsy. For that, one must be aware of what exactly are the signs and symptoms of cerebral palsy, and how it differs from other disorders.
- The second step is acceptance of the condition (cerebral palsy.) Instead of running from one doctor to the next trying to change the diagnosis, patients need to move on to the next step.
- The following step is to focus on how to manage a child with cerebral palsy. Parents need to find out the types of therapy that can be extended to a child with the same to improve his/her level of functioning.
- The fourth step includes seeking out all the disability benefits that are extended to a child with cerebral palsy.
What Is Cerebral Palsy?
Cerebral Palsy can be defined as a group of diseases which affects the movement & posture of an individual. It is commonly diagnosed in infancy or in early childhood.
As the name suggests, cerebral palsy is cerebral in origin. It causes permanent physical disability that arises early in life. The hallmark of the condition is its non-progressive nature.
Even though the muscle movement of patients with cerebral palsy is affected, it is not caused by problems relating to the nerves or muscles in an individual's body. It is caused by damage to the brain areas that are responsible for the control of muscle movements.
Symptoms Of Cerebral Palsy
Every individual with cerebral palsy has different signs and symptoms. While some patients may only have mild problems, some others have very severe level of deficits.
Some of the symptoms of cerebral palsy are as follows:
- Muscle stiffness
- Muscle weakness
- Poor coordination
- Problems in gait
- Deficit in muscle tone
- Delay in attaining neck control and sitting balance.
Patients with cerebral Palsy might also experience some more symptoms depending on the area of damage in the brain. The other signs and symptoms of cerebral palsy might be:
- Presence of drooling
- Trouble in chewing or swallowing
- Difficulty in speaking
- Problems with sensation
- Vision deficits
- Hearing impairment
- Sub average level of intelligence
- Deficit in cognitive facilities like thinking, learning, memory, reasoning, decision making etc.
- Difficulty in performing daily self care activities.
Most of the children with cerebral palsy are born with the condition. However, the symptoms might not necessarily be visible at birth. During the first few months of life, the symptoms may get more noticeable.
Many parents are found to report that the condition of the child is deteriorating. Cerebral palsy might be mistaken with other progressive neurological disorders because of the apparent change in pattern and severity of movement problems. However, in cerebral palsy the underlying neurological problem does not worsen.
What Is The Prevalence Rate Of Cerebral Palsy?
According to the Centers for Disease Control and Prevention, in the year 2000 the prevalence rate of cerebral palsy in the United States was 3.1 per 1000 children. A report by the Indian Institute of Cerebral Palsy states that in India approximately 33,000 people suffer from cerebral palsy. They also report that when looking at the worldwide incidence rate, 1 in 500 born babies suffers from cerebral palsy.
Morbidity Of Cerebral Palsy With Other Disorders
"Case-ness" of other disorders is found more in patients suffering from cerebral palsy. Many children suffer from epilepsy and mental retardation. About 25% of children with cerebral palsy might have an intelligence quotient (IQ) of less than 50. Typically, the infant or child might reach developmental milestones (like rolling over, neck control, sitting, crawling etc.) later than other children. Autism spectrum disorder is also very prevalent among children suffering from cerebral palsy. Other mental health problems are also highly prevalent among them.
Can Apgar Score Indicate The Occurrence Of Cerebral Palsy?
Apgar score is a score given at birth, at five minutes, and again at ten minutes. It summarises the health status of the baby. Higher the score is, healthier the baby would be. Previously it was thought that a low Apgar score at birth could predict cerebral palsy. Surprisingly many research findings indicate that a low Apgar score alone is a poor predictor of cerebral palsy. Again those babies who had a complicated birth and had an Apgar score of 3 or less at 5 minutes after birth had more incidences of cerebral palsy (Nelson and Ellenberg, 1984). Survivors with an Apgar score of 0 at 10 minutes after birth had long-term disabilities (Harrington et.al., 2007).
Types Of Cerebral Palsy
Cerebral Palsy Can Be Classified Based On The Type Of Neurological Dysfunction As:
- Spastic Cerebral Palsy – Tightness of muscles in the body
- Dyskinetic Cerebral Palsy – This is further divided into two sub-types: Athetoid (involving excessive involuntary movements) and Dystonia (trunk muscles being more affected than limbs leading to a fixed and twisted posture)
- Ataxic Cerebral Palsy – Difficulty in coordinating movements.
Classification and Type of Cerebral Palsy Can Also Be Done Based On The Number And Distribution Of Limbs Involved-
- Monoplegia Cerebral Palsy – One Arm or one leg is affected
- Diplegia or Diplegic Cerebral Palsy – Both the legs are affected
- Hemiplegic Cerebral Palsy – One side of the body with one arm and leg is affected
- Quadriplegic Cerebral Palsy – Both the arms and legs are affected
- Triplegic Cerebral Palsy – Affects three limbs
- Double hemiplegia Cerebral Palsy – Affects all the four limbs but one side is more affected compared to the other
- Tetraplegia or Tetraplegic Cerebral Palsy – Affects all four limbs but one is less affected compared to the other three.
- Pentaplegia or Pentaplegic Cerebral Palsy– All the four limbs along with the head and neck
The Cerebral Palsy Classification and Type Can Also Be Done Based On The Severity:
- Mild Form of Cerebral Palsy– The child can move without any assistance and can accomplish all daily life activities
- Moderate Form of Cerebral Palsy – The child needs braces, clutches and other adaptive technologies for carrying out daily life activities
- Severe Form of Cerebral Palsy – The child is restricted in a wheelchair and needs assistances in daily activities to be carried out
- No CP – The child might display symptoms of cerebral palsy after a traumatic brain injury or an encephalopathy that happened after the brain development process has completed.
The Major Types of Cerebral Palsy and their Frequencies According to Williams (1930) are:
- Spastic Quadriplegia- It has been found to have a strong association with mental retardation and seizure disorder. About 20% of Cerebral Palsy cases fall in this category.
- Diplegia- This is common in preterm infants or in infants with low-birth weight. About 30% of the individuals suffering from Cerebral palsy fall in this category.
- Hemiplegia- Another 30% of Cerebral Palsy belong to this category
- Choreoathetoid Types- 15% of the cases with cerebral palsy are of this type.
- Mixed Varieties.
The type of cerebral palsy must be kept in mind when chalking out the management plan for the patients.
Causes Of Cerebral Palsy
Researchers have been trying to find out the causative factors of cerebral palsy for the last few decades. Given below is a list of various factors that have been found to have a direct correlation with cerebral palsy.
- Genetic Abnormalities- like maternal mental retardation, fetal microcephaly, fetal congenital malformations, inherited thrombophilias etc.
- Birth weight less than 2000grams
- Gestational age at birth less than 32 weeks
- Obstetrical complications like perinatal asphyxia or oxygen deprivation
- Low placental weight
- Placental abruption or placental lesions
- Abnormal fetal position
- Type 1 diabetes
- Preeclampsia in mother
- Maternal age older than 40 years
- Chronic fetal hypoxemia
- Stroke of the individual after 1 month of age
- Rh or ABO blood type incompatibility of mother and baby
- Severe neo-natal jaundice.
[Reference- Nelson and Ellenberg (1984, 1985, 1986a,b); Torfs et.al. (1990); Goepfert et.al. (1996); Thorngren-Jerneck and Herbst (2006); Wu et.al. (2006); Barbu et.al. (2009); Redline (2005, 2008); Gibson et.al. (2005)]
Treatments Available For Cerebral Palsy
Till date no cure for cerebral palsy has been found. For this reason, a symptomatic treatment is necessary.
The most important thing to be kept in mind in the treatment of cerebral palsy is that earlier the detection, better the results. By the time, the child reaches 1 or 2 years of age, movement patterns (especially athetosis and spasticity) are strongly established and are resistant to change. Earlier efforts at shaping motor patterns yield greater benefit.
Some of The Treatment Options Available for Cerebral Palsy are as Follows:
- Surgery of the spine is being done since a long time to correct spasticity in individuals with cerebral palsy. Surgically the severely unstable hip can be corrected. Operating on the knee has been found to improve gait and knee-stiffness. Many organizations these days do multiple surgeries at a single time to prevent repeated surgeries, hospitalizations, bed rests which might delay the progress of the child. The multiple surgeries that are done are hip surgeries for subluxation or dislocation (medically known as Varus Derotation Osteotomy) or the surgical alignment of the Knees (medically known as Tibial Derotation Osteotomy) and of the ankle (known as Calcaneal Osteotomy) along with surgeries for muscle release in the arms and legs to reduce spasticity.
- Botulinum Toxin Type A Neuromuscular Blockade has been found to be effective in lowering the extreme spasticity and improves gait.
- Orofacial Regulation Therapy for Cerebral Palsy by Castillo-Morales - It studies the effect of posture and movement on the head, neck and the jaw positions. Effects on the activities of the mimic, oral, and the pharyngeal muscular system are also studied. The motive is to reduce drooling, improve communication and other oro-facial activities like eating, drinking, swallowing.
- Cooling cap can be used to minimise a newborn baby's brain damage suffered due to oxygen deprivation prenatally
- Physiotherapy from a very early age can help shape better motor functions in kids with cerebral palsy. The child with therapy can be helped to reach various motor developmental milestones.
- Occupational therapy in a clinic or home setup has been found to help children with cerebral palsy function better.
- Speech and Language Therapy by an experienced Speech and Language Practitioner can help in improving verbal and non-verbal communication skills of cerebral palsy patients.
- Psychotherapy is aimed at controlling aggressive behaviour and acting out and training the individual with cerebral palsy in more adaptive forms of behaviour. Behaviour modification can reduce the stress upon caregivers. Counselling and training for caregivers helps in improving coping skills and thus relieves the caregiver's burden.
- Developmental Therapy – Although it has still not received much recognition, a trained developmental therapist can help in giving the age appropriate therapy to the cerebral palsy child for better growth and development according to the developmental milestone.
- Special Education can help children with cerebral palsy with their educational need.
- Vocational Training can teach an individual skills which can lead to gainful employment later in life.
Prevention Of Cerebral Palsy
Since many factors have been identified as being responsible for cerebral palsy some preventive measures have been arrived upon. A few of them are discussed below.
- Immediate attention from highly experienced and efficient Neonatologist or Paediatrician could somewhat prevent Cerebral Palsy.
- Corticosteroid Therapy in preterm infants might reduce the incidence of intra-ventricular hemorrhage.
- Aggressive or prophylactic treatment of infection might protect against neurological injury.
- Meta-analysis of various studies revealed that maternal magnesium sulphate therapy reduces the incidence of moderate or severe levels of cerebral palsy.
Since cerebral palsy happens due to damage in the brain cells and it is irreversible in nature, there is no definite cure to repair the damage. However, with the promptness of attention that the child with cerebral palsy gets, the early diagnosis and appropriate and regular treatment can help the child in growing up better. Moreover, when a combination of the above mentioned treatments for cerebral palsy are done, much improvement can be seen in them.