Cerebral palsy is the term applied to a cluster of disorders that affect the brain and nervous system. People with cerebral palsy demonstrate abnormal motor function, which is caused by lesions on the brain. The motor system is responsible for the body’s ability to control movement and muscle tone. It is the location and size of the lesion that determines the severity of this condition. It is believed that because lesions are the result of a once-off injury, they cannot cause any further harm or progress any further, but by the same token, they cannot be reversed.
Some of the different kinds of cerebral palsy include dyskinetic, spastic, atoxic, mixed and hypotonic.
Causes of Cerebral Palsy
Cerebral palsy is usually caused by some sort of injury to the brain, and in most cases, the damage usually happens in utero. It is possible for the brain to be affected during the first two years of life as a result of a severe head injury. In older people, cerebral palsy may be caused by hypoxia or insufficient oxygen levels in the brain, which can happen after someone has had a stroke.
Premature and low birth weight babies have a higher risk for developing cerebral palsy and respiratory illnesses. Genetic disorders, injuries to the brain during its crucial developmental phase, complications during pregnancy and birth or strokes that prevent oxygen circulation to the brain are all potential causes of this condition.
Other conditions that can cause cerebral palsy to develop in babies include infections of the brain like encephalitis, herpes or meningitis. Sometimes it can be caused by bleeding in the brain, jaundice or injury to the head. Mothers who have rubella during their pregnancy have an elevated chance of giving birth to a baby with this condition as well.
Symptoms of Cerebral Palsy
Symptoms of cerebral palsy may vary between individuals and can range from mild to severe. It can affect one or both sides of the body, the arms or legs, or be present in both sets of limbs.
In babies, parents might notice that milestones for physical development are not being reached in reasonable time from as young as three months of age. Babies with cerebral palsy may not start sitting up, crawling and walking at the right times in their lives and may lag behind in terms of reaching developmental milestones.
People with cerebral palsy usually have tight and stiff muscles that they battle to stretch. Because of different kinds of muscle tone, a person with this condition usually walks with a rigid posture. Their arms may be tucked in close to the sides of their bodies and their legs may cross over. The person may also walk on their toes.
The joints of people with cerebral palsy are also usually very tight and may not open up completely, a painful condition known as contracture. Sometimes a sufferer may have paralysis in a particular group of muscles.
Other symptoms that may present include twisting and jerking movements of the limbs, which may become more pronounced when the person is under stress. The person will probably have difficulty with muscle coordination and may have floppy muscles or an unsteady way of walking.
Learning difficulties are common amongst some people with cerebral palsy, but there are people who display no problems with learning at all. Some people may also have speech difficulties, depending on the severity of their condition. Speech may be affected and delayed by weaker tongue and jaw muscles.
Other common problems include impaired vision and hearing, both of which can be enhanced through glasses and hearing aids. In some people, seizures can be common and may require separate treatment.
Eating can be particularly challenging for people with this condition. Babies may display problems in sucking or latching, and children and adults frequently battle to chew and swallow their food. Vomiting and constipation could also present as problems.
People who have cerebral palsy usually dribble a lot and have an irregular breathing rhythm. They may also grow slower than people who do not have the condition. Urinary incontinence is also a common challenge for people living with more severe forms this disorder.
People with cerebral palsy also tend to have weaker tooth enamel and may require more intensive dental treatment to practice good oral hygiene. Loss of control over bladder and bowels is common, and incontinence is one of the big stepping stones towards independence.
Diagnosis and Testing
Doctors usually perform a full neurological exam when they suspect cerebral palsy. In older patients, it may also be necessary to screen their cognitive function. Other tests likely to be ordered include MRIs and CT scans of the head, blood tests, EEGs (electroencephalogram) and hearing and vision testing to determine where aids need to be administered.
Ultrasound has become increasingly popular, as it gives medical professionals a view of parts of the brain that have been damaged because of inadequate oxygen or those affected by hemorrhaging. It is a less invasive test than MRI or CT scans and is preferable for cerebral palsy testing on newborns.
Treatments for Cerebral Palsy
While cerebral palsy cannot be cured, a cooperative team work approach from medical specialists is usually the most effective way to foster independence and improve quality of life. The kind of treatment adopted will largely depend on the severity of the condition and the faculties that are impaired as a result of it.
People with cerebral palsy will usually need consistent help from a primary care physician, social workers, speech, physical and occupational therapists, dentists and nurses to take care of themselves and to be able to enjoy a comfortable quality of life.
Home routine and support is also important, and people who care for others with cerebral palsy may suffer a lot of stress from the high demands of the job. The people who care for someone with this condition are likely to need emotional support as well.
Responsible home care consists of good nutrition, constant hydration and regular exercises as prescribed by the medical team. The home environment also needs to be safe and secure enough for the person to feel free but without too much risk of getting hurt.
People with cerebral palsy need to ensure they practice good bowel care to prevent constipation. A good management program to promote healthy bowel movements would consist of lots of water and dietary fiber, as well as administering stool softeners when required.
A person with this condition may also need help and support with glasses or a hearing aid, or using a walking aid or wheel chair, depending on the symptoms they present with.
Medication may be prescribed to relieve some symptoms. Sometimes, muscle relaxants are required to reduce muscle tremors and relax stiff muscles. Botulinum toxin can be helpful in reducing dribbling, and anticonvulsants may also be prescribed if the person is susceptible to seizures.
For some people, surgery may be required to help with gastro-esophagul reflux, to insert feeding tubes or to prevent joint contracture. In some cases, it may be necessary for pain relief by cutting through certain nerves in the spinal cord.
Common complications that can affect a person with cerebral palsy include obstructions in the bowel, osteoporosis, injuries from falling down, pneumonia, dislocated hips and arthritis of the hip joints and seizures.
Managing Seizures
Seizures are common in people with cerebral palsy, and it is believed that up to a third of patients suffer from them. Seizures can affect the whole body or they can occur on a smaller scale where they interrupt the person’s activities but not have the same physical impact on the person. Atonic seizures occur when the person has decreased muscle tone and slums forward in a floppy manner. Tonic seizures take place when the person has a stiff and rigid posture. Sometimes, partial seizures which only affect one part of the body can occur. For some patients, doctors may prescribe anticonvulsant medication to keep seizures under control.
Managing Eating and Feeding
Sometimes vomiting and gastro-esophagul reflux can stop a person with cerebral palsy from putting on weight. Children with choreoathetoid cerebral palsy may also be burning calories all the time as they move around. Conversely children with limited motility and hypotonic muscle may put weight on and become overweight. Underdevelopment and loss of muscle coordination in the neck, jaw and tongue can make feeding very difficult. Problems with chewing and swallowing food can make vomiting a problem as well.
Other Complications and Areas Requiring Support
People with this condition may be susceptible to cataracts, which may need surgery to be managed. They may also have frequent urinary tract and ear infections. Poor eyesight means that many people with cerebral palsy also need to wear glasses to improve their vision.
Patients with severe hypotonia may develop scoliosis or spine curvatures. Physical training and regular exercise is important for a person with cerebral palsy to avoid joint contractures. It can also assist with posture, promoting balance and the person’s gait. Occupational therapy may offer some benefit in developing social skills like eating and writing.
Types of Cerebral Palsy
The type of cerebral palsy depends on the extent and type of motor impairment present. Some people have characteristics from different types. The three most common types include hypotonic cerebral palsy, spastic cerebral palsy and choreoathetoid cerebral palsy.
Hypotonic Cerebral Palsy
Hypotonic cerebral palsy is characterized by low muscle tone. The person is likely to have a floppy posture and little muscle control or coordination. This can be the most debilitating form of this condition for a child as they do not have the physical resources to make learning easier.
It is believed to be caused by an injury to the brain very early on in the child’s development. Some children may go through a short period of hypotonic cerebral palsy before presenting with symptoms of other types.
Spastic Cerebral Palsy
With spastic cerebral palsy, the person has a rigid muscle tone and posture. Their arms and legs are likely to be stiff, and the person probably cannot coordinate their movements very precisely. Spasticity usually affects one side of the body, but can also affect all four limbs or both legs in some cases. When it affects the legs the person usually holds them in a scissor-like position where they are held out straight and crossed over.
The person will also display muscle weakness, increased muscle tone and deep tendon reflexes, as well as impaired fine and gross motor skills.
The severity of cerebral palsy can determine whether a function is just moderately affected or if the person is not able to use it at all. If spasticity is not managed effectively, the person could end up with permanently serious contractures which can inhibit the opening of the joints.
Significantly, muscles in the face and neck can also be affected by cerebral palsy, making chewing and swallowing more challenging for a person with the condition and the person may struggle with speech.
Choreoathetoid Cerebral Palsy
Choreoathetoid cerebral palsy is characterized by uncontrollable twisting movements in the arms and legs. The person will have a mixed muscle tone and will be less likely to suffer from contractures. Emotional responses like laughter and stress can set the movements off, and they can make it difficult for the person to live a ‘normal’ life as their daily activities are constantly interrupted. They are also physically draining, and people with choreoathetoid cerebral palsy need to make sure they consume enough calories to keep up with the body’s nutritional requirements.
Cerebral palsy does not affect a person’s life span and treatments should be focused on overcoming side effects and building independence so that the person with this condition can enjoy a normal quality of life. It is important that they have a good support structure as it can become challenging to care for someone with cerebral palsy over the long term. The condition may be made easier with certain medications administered for pain, seizures and gastro-esophagul reflux and a cooperative management approach.
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