Cerebral Palsy

Cerebral palsy refers to a group of non-progressive disorders that affect the control of movement and posture.  These disorders are caused by brain damage before or during birth.  The lesion does not produce an ongoing degeneration of the brain, so the condition does not worsen.  The children can improve their functioning abilities with rehabilitation management.

The common finding in cerebral palsy is the developmental delay of motor skills, such as reaching, sitting, rolling, crawling, walking and so on. In addition, there may be associated defects, such as seizures, speech disorders, hearing impairments, visual problems and mental retardations. Cerebral Palsy can be divided into four categories: spastic, athetoid, ataxic and mixed forms. These classifications reflect the type of movement disturbance displayed by the patient. Spastic CP is the most common type. It afflicts somewhere between half and three-quarters of all patients with cerebral palsy, causing the muscles to be stiff and permanently contracted. Doctors often further subdivide spastic cerebral palsy into one of five types, describing the limbs that are affected. These names combine a Latin prefix describing the affected limbs with the term plegia (or sometimes "paresis"), meaning paralyzed or weak: diplegia affects either both arms or both legs; hemiplegia affects the limbs on only one side of the body; quadrapelgia affects all the limbs; monoplegia affects only one limb; and triplegia affects three limbs. Children with spastic quadriplegia have other problems due to extensive brain damage. These include swallowing difficulties, speech abnormalities, visual impairment, hearing impairment, intellectual dysfunction and seizures. Athetoid cerebral palsy occurs in about 20% of the cases. Symptoms include: Loss of control and fluctuation of muscle tone including facial muscles (twisting, jerking, grimacing, speech difficulty) Uncontrolled movements -- more severe during stress, and disappear entirely during sleep. Ataxic cerebral palsy accounts for about 5 to 10% of all cases, and is characterized by an unsteady gait (ataxia), tremors and difficulty with fine movements resulting from a loss of balance and coordination.

Cerebral palsy affects approximately 1.5 to 5 newborns per 1000. Most brain damage occurs before birth, although it can occur at the time of delivery or in the first years of life.  In many cases, the cause of cerebral palsy is unknown. Prematurity is an important risk factor.  The premature brain is at a higher risk of intracerebral bleeding, infection and is more susceptible to hypoxia. Maternal Infection during pregnancy (especially rubella) Meningitis or Encephalitis after birth Obstetric problems that cause brain Injury and asphyxia (insufficient oxygen supply to the brain)  Blood (Rh) incompatibility between a mother and her fetus Brain malformations, genetic disorders, or strokes due to abnormal blood vessels or blood clots.

Early diagnosis is important for effective treatment and prevention of complications.  An examination indicates the delayed development of motor skills, abnormal muscle tone and persistent primitive reflexes that generally disappear by 6 to 12 months of age.  Some specialized tests help to diagnose cerebral palsy. Brain imaging test (MRI, CT scan or ultrasound)   Auditory evoked potential (AEP) -- screening test for hearing impairment Visual evoked potential (VEP) -- screening test for visual impairment

There is no specific cure for cerebral palsy, but proper management helps to prevent complications and maximize functional independence.  Physical therapy and occupational therapy enhance motor skills (such as sitting and walking) and functional skills required for daily living.  Physical therapy also improves muscle strength and prevents contractures (shortening of muscles that limits joint movement).  Braces, splints, casts or orthopedic surgery may prevent or release contractures, improving the function of the hands or legs.  Mechanical aids include walkers and wheelchairs Management of spasticity -- oral drugs, botulinum injection directly into spastic muscles, or a surgery called selective dorsal rhizotomy. Drugs for Seizure control Feeding tube placement for serious swallowing impairment

Cerebral palsy is not a curable disease.  The extent of the disability depends on the severity of brain damage.  It is extremely difficult to predict your child's prognosis.  Children who can sit without assistance within 2 years of their birth can usually walk independently.

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