About two out of every thousand children suffer from cerebral palsy. It is a congenital disease of the brain, in which the development of either both lower limbs or both upper and lower limbs is very slow, along with a degree of mental retardation and seizures, emanating from brain, therefore this disease is called cerebral palsy.
Thus cerebral palsy literally means – damage to the developing brain, as discussed in previous chapters. Different mental and physical activities are controlled by specific portions of the brain. Mental or physical disabilities including speech, memory, and learning defects relate to the part of the brain damaged. Hence, patients of cerebral palsy may have one or more disabilities and two patients with cerebral palsy may have totally different symptoms.
The unique characteristic of this disease is that it gets better with advancement of age. The disease does not progress further. Thus if the disease is progressing and worsening, over a period of time it cannot be cerebral palsy.
In some cases, cerebral palsy occurs due to oxygen deficiency during birth. In majority of the cases it occurs during pregnancy due to the environment in the womb or defects in development of the fetus. It is occasionally genetic.
As we have seen cerebral palsy results from brain damage, the causes are as follows:
Prenatal (before birth)
1. Premature delivery.
2. Viral infection to the mother during pregnancy.
3. Rh -Bloodgroup incompatibility.
4. Hereditory diseases.
5. Maternal diseases during pregnancy, problems of fetal development.
1. Prolonged labour or abnormality of fetal heart rate.
2. Injury to the baby’s scalp during delivery.
3. Umbilical cord around the baby’s neck leading to the brain damage during labour.
2. Pathological jaundice
4. Infection - septicemia .
6. Edema in the brain.
7. Meningitis, ‘’encephalitis.
Hence if required, incubator care should be made available for the newborn. However, it is not possible to define a cause in every patient. Many of these causes are preventable, for this, public awareness is a must.
This is the commonest type of Cerebral Palsy. The muscles remain tense and spastic and hence the affectedlimbs are difficult to stretch. Legs are crossed (scissored). The child tends to walk on toes. Depending on the part of the body affected, the sub-types are :
Hemiplegia :When one half of the body, i.e.hand, leg and half of the trunk are affected.
Diplegia :Both the lower limbs are weak. Theremay be some weakness in the hands.
Quadruplegia :When both hands and legs aswell as trunk muscles are affected.
Involuntary movements in different parts of the body, make it difficult for the patient to carry out intentional activities.
The patient finds it difficult to maintain balance. The muscles are flabby (hypotonic).
C.P. children may have one or more of the above mentioned features. Besides, following features may co-exist
a) Squint in 50%-60% children
b) Visual problem including field defect
c) Epilepsy - 66%
Mental retardation 66%
Cerebral Palsy may not necessarily be harmful for every child and it is not that improvement is not possible. In manychildren if the problem is minor, the patient can recover fast. In other cases extensive exercise (physiotherapy), along with appropriate drugs may offer little results after aalong period of treatment. 30% patients may suffer from a severe form of this disease where the possibility of complete recovery is less.
In the first month after the birth the child may appear normal but gradually it is seen that the development is very slow, becomes slow or the child is never able to learn to sit by himself. A normal child learns to walk in the first year, which is delayed due to this disease, and even if the child learns to walk he tries to stand on his toes and walking is very difficult.
Similarly, development of the brain and intelligence is low in most of these children. In addition to that they learn to speak very late and the pronunciations are not clear. In severe cases, mental retardation can be judged from the face of the child. Many children among these can be hyperactive and may suffer from seizures. Though one must not forget that in some children the disease may be very mild and the child may recover in due course of time, in cases where all the limbs are affected, there is considerable damage to the brain, and the IQ level of the child is low; the treatment is really difficult.
Cerebral Palsy can generally be diagnosed through physical examination of a child itself. In a few cases it becomes necessary to take the help of tests like MRI. The history about the delivery of the child like difficultdelivery, respiratory trouble in the newborn, late crying, or the baby turned blue after birth etc. can be very helpful in diagnosis.
There is no magical remedy or a surgery for cases of cerebral palsy. However, one should not be discouraged with this fact. One has to accept the reality and start special training from the day of diagnosis. Early diagnosis is a must. The training given to small children below age of 5 years, is called early intervention. Considering the exact damage to the child, combination therapy of following different therapists is advocated.
a) Developmental physiotherapist.
b) Child physiotherapist.
c) Speech therapist and audiologist.
d) Occupational therapist.
e) Special teacher.
f) Additionally, an orthopedic surgeon, eye specialist and neurologist as and when required. Tizanidine, Dantrolene are also used.
g) In selected cases, some minor-major surgery is also offered to lengthen or strengthen the limb etc. Thus the aim of this training and treatment is
· Independence in the, daily living/activities
· Social acceptance-
· Educational achievement
· Economical independence i.e. self earning
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