(CP)
Definition
Cerebral palsy is a group of chronic disorders impairing control of movement that appear in the first few years of life and generally do not worsen over time. These disorders are caused by faulty development of or damage to motor areas in the brain that disrupts the brain's ability to control movement and posture.
Cerebral palsy may be congenital or acquired after birth. More than 80% of people with cerebral palsy developed it either before they were born or before they were a month old. In many instances, the cause of the brain abnormality is unknown.
Several of the causes of cerebral palsy that have been identified through research are preventable or treatable, including head injury, jaundice, Rh incompatibility, and rubella (German measles).
Some people with cerebral palsy are also affected by other medical disorders, such as seizures or mental impairment, but cerebral palsy does not always cause profound impairment.
Although its symptoms may change over time, cerebral palsy by definition is not progressive. If a patient shows increased impairment, the problem may be something other than cerebral palsy.
Each year, about 5,000 American babies and infants are diagnosed with cerebral palsy. Cerebral palsy isn't curable. However, getting the right therapy for your child can make a big difference in reducing the long-term impact of the condition.
Child's Brain
Causes
Damage to areas of the brain that direct movement interferes with the brain's ability to control movement and posture. Cerebral palsy may develop before, during, or after birth.
Causes include:
• Brain tissue may not develop correctly during pregnancy. The growing fetus may experience a lack of oxygen or nutrients.
• Child sustains a head injury or brain infection.
• Mother's and baby's blood types are not compatible.
• Mother has rubella while pregnant.
• Stroke or bleeding occurs in the baby's brain during development or after birth.
• Baby is deprived of oxygen during or after birth.
• There are abnormalities of the umbilical cord or placenta, or the placenta separates too early from the wall of the uterus.
• Child has meningitis, encephalitis, seizures, or head injury.
• Genetic/metabolic abnormalities
• Unknown
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
• Infection or blood clotting problems during pregnancy
• Vaginal bleeding during the last three months of pregnancy
• Protein in the expectant mother's urine
• Expectant mother has an overactive thyroid, seizures, or mental retardation.
• Complicated or premature delivery
• Breech birth
• Low Apgar score (a rating of the baby's condition just after birth)
• Low birth weight
• Premature birth
• Multiple births, twins, or triplets.
• Small head
• Seizures
Symptoms
Symptoms of cerebral palsy include difficulty with fine motor tasks (such as writing or using scissors), difficulty maintaining balance or walking, and involuntary movements. The symptoms differ from person-to-person and may change over time.
Cerebral palsy first shows up in children age three and younger. Symptoms vary depending on what areas of the brain have been affected. Some children may have severe disabilities. Although symptoms may change as the child grows older, his or her condition is not likely to worsen.
Symptoms include:
• Late to turn over, sit up, smile, or walk
• Trouble writing, closing a button, or other fine motor activities
• Difficulty walking or standing
• Tight, spastic muscles
• Weak muscles
• Poor balance
• Speech problems
• Tremors
• Unintended body movements
• Difficulties with sucking, swallowing.
• Drooling
Some people with cerebral palsy suffer from other medical disorders as well, including:
• Seizures
• Mental retardation
• Learning disabilities
• Vision or hearing problems
• Failure to thrive
• Decreased ability to feel pain or identify items by touch
• Problems with bowel and bladder control
• Breathing problems
• Skin breakdown
Diagnosis
Doctors diagnose cerebral palsy by testing motor skills and reflexes, looking into medical history, and employing a variety of specialized tests.
Tests may include:
Electroencephalogram (EEG) – a test that records the brain's activity by measuring electrical currents through the brain
CT Scan – a type of x-ray that uses a computer to make pictures of structures inside the body
Ultrasound– a test that uses sound waves to make pictures of structures inside the body
MRI Scan– a test that uses magnetic waves to make pictures of structures inside the body
Treatment
There is no treatment to cure cerebral palsy. The brain damage cannot be corrected. Therapy aims to help the child reach his or her full potential. Children with CP grow to adulthood and may be able to work and live independently.
Medication
Drugs help control muscle spasms and seizures. While muscle relaxants have long been used in an attempt to relieve spasticity, recent success with implantable pumps delivering the medication baclofen has been thought by some to be a significant advance in the care of persons with cerebral palsy. There is, as yet, little evidence supporting the use of baclofen pumps in improving measurable outcomes such as quality of life.
Surgery
Certain operations may improve the ability to sit, stand, and walk. Injection of botulinum toxin (perhaps better defined as a medication, but administered expertly as a therapeutic procedure) has been shown to temporarily relieve spasticity. Whether these injections have a long-term benefit also remains to be seen.
Physical Aids
Braces and splints help keep limbs in correct alignment. They decrease deformities that can develop due to shortened muscles. Positioning devices enable better posture. Walkers, special scooters, and wheelchairs make it easier to move about.
Special Education
Programs designed to meet the child's special needs may improve the odds of learning. Some youngsters do well attending regular schools with special services. Vocational training can help prepare young adults for a job.
Rehabilitation Services
Speech, physical, and occupational therapies may improve the ability to speak, move, walk, and perform activities of daily living. Physical therapy helps strengthen muscles. Youngsters learn different ways to complete difficult tasks.
Family Services
Professional support helps a patient and family cope with cerebral palsy. Counselors help parents learn how to modify behaviors. Caring for a child with cerebral palsy can be very stressful. Some families find support groups helpful.
Prevention
Several of the causes of cerebral palsy that have been identified through research are preventable or treatable:
• Before getting pregnant, receive a vaccination for rubella.
• Seek out early prenatal care.
• Receive testing for blood-type problems and treatment if tests reveal incompatible blood types.
• Do not smoke, drink alcohol, or use drugs while pregnant.
• Put the baby in a child safety seat when in the car.
• Insist that the child wear a helmet when on a bicycle.
• Seek help if you have or want to hurt the child.
• Prevent access to poisons.
• Closely supervise bathing.
• Get your child immunized at the recommended time.
• Seek medical care when the baby becomes sick.
