Cerebral palsy is a group of conditions that affect movement and posture(1)
CP is the most common motor disability in childhood. Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles(2).
Cerebral palsy (CP) refers to a group of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination.(3)
Cause
CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles(2)
The damage disrupt the brain's ability to control movement and maintain posture and balance(3).
The cause of cerebral palsy and its effect on function vary from person to person.(1)
In some cases, the areas of the brain involved in muscle movement do not develop as expected during fetal growth. In others, the damage is a result of injury to the brain either before, during, or after birth. In either case, the damage is not reversible and the disabilities that result are permanent.
This damage can occur before, during, or shortly after birth.
Possible causes of congenital CP include genetic abnormalities, congenital brain malformations, maternal infections or fevers, or fetal injury.
In acquired cerebral palsy, the disorder begins after birth. Some causes of acquired cerebral palsy include brain damage early in life, brain infections, problems with blood flow to the brain, or head injury.
During pregnancy and delivery that may increase a baby's risk of being born with CP. These risks include:
-Low birthweight and premature birth.
-Multiple births—.
-Infections during pregnancy—Toxoplasmosis, rubella (German measles) cytomegalovirus, Zika virus, and herpes can infect the womb and placenta. .
-Exposure to toxic substances—.
-Female parents with thyroid abnormalities, intellectual disability, excess protein in the urine, or seizures—(3)
Types of Cerebral Palsy
Spastic
The most common type of CP is spastic CP. Spastic CP affects about 80% of people with CP.
People with spastic CP have increased muscle tone. This means their muscles are stiff and, as a result, their movements can be awkward.
Sub-types:
a). Spastic diplegia/diparesis (stiffness of legs)
b). Spastic hemiplegia/hemiparesis (affects one side and arms are more affected than the legs)
c). Spastic quadriplegia/quadriparesis ( most sever type affecting all for limbs, trunk and face) People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.)
2. Dyskinetic (also includes athetoid, choreoathetoid, and dystonic cerebral palsies)
have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk. The movements are uncontrollable and can be slow and writhing or rapid and jerky. There will be difficulty in sucking, swallowing, and talking if face and toungue are involved.)
3. Ataxic (have problems with balance and coordination. a hard time with quick movements or movements that need a lot of control, like writing and difficulty in reaching.)
4. Mixed. (Some people have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.)(2)
Symptoms
A person with severe CP might need to use special equipment to be able to walk, or might not be able to walk at all and might need lifelong care. A person with mild CP, on the other hand, might walk a little awkwardly, but might not need any special help. CP does not get worse over time, though the exact symptoms can change over a person’s lifetime.
All people with CP have problems with movement and posture. Many also have related conditions such as intellectual disability; seizures; problems with vision, hearing, or speech; changes in the spine (such as scoliosis); or joint problems (such as contractures)(2)
Children with CP exhibit a wide variety of symptoms, including:
Lack of muscle coordination when performing voluntary movements (ataxia)
Stiff or tight muscles and exaggerated reflexes (spasticity)
Weakness in one or more arm or leg
Walking on the toes, a crouched gait, or a “scissored” gait
Variations in muscle tone, either too stiff or too floppy
Shaking (tremor) or random involuntary movements
Delays in reaching motor skill milestones
Difficulty with precise movements such as writing or buttoning a shirt(3).
The main sign that a child might have CP is a delay reaching motor or movement milestones (such as rolling over, sitting, standing, or walking).
Developmental screening, monitoring and developmental medical evaluation helps in screening and diagnosing at an early stage.(2)
Can cerebral palsy be prevented?
Cerebral palsy related to genetic abnormalities cannot be prevented, but some risk factors for congenital cerebral palsy can be managed or avoided.
Treatment:
Cerebral palsy can't be cured, but treatment will often improve a child's capabilities. Many children are able to manage their disabilities; the earlier treatment begins, the better chance children have of overcoming developmental disabilities.
There is no standard therapy that works for every person with CP. It requires a multidisciplinary team work.
Drugs (usually used as the first line of treatment to relax stiff, contracted, or overactive muscles), Surgeries (recommended when spasticity and stiffness are severe enough to make walking and moving about difficult or painful), Assistive devices (can greatly help some individuals with CP improve communications skills. Other devices make it easier for people with CP to adapt to activities of daily living),Therapies, Prosthesis and Orthotics, etc play a major role as per the severity and requirement of the patient.(3)
Therapies
Physical therapy, usually in the first few years of life, is a cornerstone of CP treatment. Specific sets of exercises like stretching, resistive, or strength training programs and activities can maintain or improve muscle strength, balance, and motor skills, and prevent contractures. Special braces (orthotic devices) may be used to improve mobility and stretch spastic muscles.
Occupational therapy focuses on optimizing upper body function, improving posture, and making the most of a child's mobility. Occupational therapists help individuals address new ways to meet everyday activities and routines at home, school, and in the community.
Recreation therapy encourages participation in art and cultural programs, sports, and other events that help an individual expand physical and cognitive skills and abilities. Parents of children who participate in recreational therapies usually notice an improvement in their child's speech, self-esteem, and emotional well-being.
Speech and language therapy can improve a child's ability to speak, help with swallowing disorders, and learn new ways to communicate, such as using sign language and/or special communication devices such as a computer with a voice synthesizer.
Assistive devices such as computers, computer software, voice synthesizers, and picture books can greatly help some individuals with CP improve communications skills. Other devices make it easier for people with CP to adapt to activities of daily living.
Orthotic devices help to compensate for muscle imbalance and increase independent mobility.
Braces and splints use external force to correct muscle abnormalities and improve function such as sitting or walking. Other orthotics help stretch muscles or the positioning of a joint. Braces, wedges, special chairs, and other devices can help people sit more comfortably.
Wheelchairs, rolling walkers, and powered scooters can help individuals who are not independently mobile.
Vision aids include glasses, magnifiers, and large-print books and computer typeface. Some individuals with CP may need surgery to correct vision problems.
Hearing aids and telephone amplifiers may help people hear more clearly.(3)
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