CEREBRAL PALSY
by Unknown Author is licensed under
Cerebral palsy (CP) is a group of movement disorders that appear in
early childhood.
Cerebral palsy is defined as "a group of permanent disorders of the
development of movement and posture, causing activity limitation, that
are attributed to non-progressive disturbances that occurred in the
developing fetal or infant brain.
Signs and symptoms
It varies among people and over time, often, babies with cerebral
palsy have delayed motor development like they do not roll over,
sit, crawl or walk as early as other children of their age.
Cerebral palsy is characterized by abnormal muscle tone, reflexes,
or motor development and coordination.
They have poor coordination, stiff muscles, weak muscles, tremors.
Babies born with severe cerebral palsy often have irregular posture;
their bodies may be either very floppy or very stiff.
Movement problems are the central feature of CP.
There may be problems with sensation, vision, hearing,
and speakingwhich can have a variety of impacts including social
rejection, impaired speaking etc.
Swallowing problems
Due to sensory and motor impairments, those with CP may have
difficulty preparing food, holding utensils, or chewing and
swallowing.
An infant with CP may not be able to suck, swallow or chew.
Gastro-oesophageal reflux is common in children with CP.
Drooling and mouth infections.is common among children with
cerebral palsy.
Dental problems can also contribute to difficulties with eating.
Pneumonia is also common where eating difficulties exist, caused
by undetected aspiration of food or liquids.
Speech and Language Disorders
Speech and language disorders are common in people with
cerebral palsy.
The incidence of dysarthria is estimated to range from 31% to 88%,
and around a quarter of people with CP are non-verbal.
Speech problems are associated with
poor respiratory control, laryngeal and velopharyngeal dysfunction,
and oral articulation disorders that are due to restricted movement
in the oral-facial muscles.
There are three major types of dysarthria in cerebral palsy: spastic,
dyskinetic (athetotic), and ataxic.
Overall language delay is associated with problems/difficulties of
cognition, thinking, feeling, behavior, deafness, and learned
helplessness.
Children with cerebral palsy are at risk of learned helplessness and
becoming passive communicators, initiating little communication.
Associated disorders
Associated disorders include intellectual disabilities,
seizures, muscle contractures, abnormal gait, osteoporosis,
communication disorders, malnutrition, sleep disorders, and mental
health disorders, such as depression and anxiety.
In addition to these, functional gastrointestinal abnormalities
contributing to bowel obstruction, vomiting.
Adults with cerebral palsy may have ischemic heart
disease, cerebrovascular disease, cancer, and trauma more often.
ETIOLOGIES:
Cerebral palsy is caused by abnormal development or damage to the
parts of the brain that control movement, balance, and posture.
PRETERM BIRTH
Typical causes include problems in intrauterine development (e.g.
exposure to radiation, infection, fetal growth restriction), hypoxia of
the brain (thrombotic events, placental insufficiency, umbilical cord
prolapse),
Risk factors include preterm birth, being a twin, certain infections
during pregnancy, such as toxoplasmosis or rubella, exposure
to methylmercury or breathing meconium into the lungsduring
pregnancy.
PERINATAL CAUSES
In babies that are born at term risk factors:
Between 40% and 50% of all children who develop cerebral palsy
were born prematurely before 28 weeks of gestation .
Birth trauma during labor and delivery, and complications around
birth or during childhood. A delivery requiring either the use of
instruments or an emergency Caesarean section
Most of these cases (75–90%) are believed to be due to issues that
occur around the time of birth, most often, the problems occur
during pregnancy, but they may also occur during childbirth or
shortly after birth.
Low birth weight between 1 kg and 1.5 kg
Genetic factors
Birth defects,
Birth asphyxia, seizures just after birth, respiratory distress
syndrome, low blood sugar, and infections in the baby.
POSTNATAL
After birth, other causes include toxins, severe jaundice, lead
poisoning, physical brain injury, stroke, abusive head traumaduring
the first few years of life, incidents involving hypoxia to the brain
(such as near drowning), and encephalitis or meningitis.
CLASSIFICATION:
CP is classified by the types of motor impairment of the limbs or organs,
and by restrictions to the activities an affected person may perform.
These classifications reflect the areas of the brain that are damaged.
Three main CP classifications by motor impairment:
Spastic: Spastic cerebral palsy is the type of cerebral palsy
characterized by spasticity or high muscle tone often resulting in
stiff, jerky movements. Commonly occurring CP.It affects the motor
cortexof the brain, a specific portion of the cerebral
cortex responsible for the planning and completion of voluntary
movement.
Spastic diplegia/diparesis―In this type of CP, muscle stiffness is
mainly in the legs, with the arms less affected or not affected at all.
Spastic hemiplegia/hemiparesis―This type of CP affects only
one side of a person’s body; usually the arm is more affected than
the leg.
Spastic quadriplegia/quadriparesis―Spastic quadriplegia is the
most severe form of spastic CP and affects all four limbs, the trunk,
and the face.
Ataxic:
The damage to the cerebellum, which is essential for coordinating
muscle movements and balance, patients with ataxic cerebral palsy
experience problems in balance and coordination, specifically in
their arms, legs, and trunk.
Ataxic cerebral palsy is known to decrease muscle tone.
Dyskinetic/ Athetoid:
Dyskinetic cerebral palsy (sometimes abbreviated DCP) is primarily
associated with damage to the basal ganglia and the substantia
nigra in the form of lesions that occur during brain development due
to bilirubin encephalopathy and hypoxic-ischemic brain injury.
DCP is characterized by both hypertonia and hypotonia, due to the
affected individual's inability to control muscle tone.
Dyskinetic cerebral palsy is an extrapyramidal form of cerebral
palsy and can be divided into two different groups: choreoathetosis
(involuntary movements) and dystonia (slow, strong contractions).
Additionally, there is a mixed type that shows a combination of features
of the other types.
Cerebral palsy is also classified according to the topographic distribution
of muscle spasticity which classifies children as:
Diplegic(bilateral involvement with leg involvement greater than arm
involvement),
Hemiplegic (unilateral involvement),
Triplegic (two upper limbs and one lowerlimb or vice versa)
Quadriplegic (bilateral involvement with arm involvement equal to
or greater than leg involvement).
