What is cerebral palsy?
Cerebral palsy is a neurological disorder caused by a brain injury or malformation that occurs while the child’s brain is under development. Cerebral palsy affects body movement, muscle control and coordination, reflex, posture and balance. It is one of the most common causes of chronic childhood disability.
Cerebral palsy has the following distinctive characteristics:
Incurable and permanent: The injury and damage to the brain is permanent and cannot be cured. The brain does not heal unlike other parts of the body. However, other associated conditions may improve or worsen over time.
Non-progressive: There is no further degeneration of the brain.
Chronic: An individual diagnosed with cerebral palsy will have to live with this condition for their entire lifetime.
The condition can include a range of related problems:
Language and perception deficit
Repeated seizures or fits
Cerebral palsy is the most common chronic physical/motor disability in childhood.
Globally, approximately 17 million people are affected with cerebral palsy.
What are the signs of cerebral palsy?
Signs are clinically identifiable results of brain injury or malformation. Signs are the primary method of recognizing the possibility of cerebral palsy because a child is too young to effectively communicate their difficulties. Although a parent may observe a delay in motor development, the doctor can rule out other conditions and diagnose the impairment through medical evaluation and clinical tests.
The physician will also determine the extent, location and severity of impairment, along with co-existing conditions. Signs may vary from one child to another depending on the severity of the brain injury.
Muscle tone: Increased or decreased muscle tone – floppy limbs, too relaxed or too tight limbs, involuntary muscle contraction, or joints that are fused together preventing proper motion. This affects walking, sitting, or standing without support.
Movement coordination and control: The impairment of muscle tone affects a child’s limbs, body movement and control. Impairment in muscle control can cause limbs to be perpetually extended or contracted, or the limbs may seem to be jerking. For example, a baby may not be able to sit up or roll over independently even at six months of age, may not able to walk within 12-18 months, or may not able to manage tasks like writing, brushing teeth, or wearing shoes.
Posture: Cerebral palsy affects posture and balance. Postural response is the expected reaction of babies when they are put in various sitting positions. Normally, the posture is symmetrical, that is, a baby sits with both legs in front. However, in case of children with cerebral palsy, it may be asymmetrical.
Balance: The impairment of gross motor function can affect a child’s ability to balance. Parents can observe these signs as a child learns to sit, rise from a sitting position, and when the child begins to crawl or walk. During the normal course of development, children use the support of their hands for sitting or walking and later on with strength and coordination, they learn to accomplish the task without any support. If a child is unable to sit or stand without support, then it could be a sign of cerebral palsy.
Gross motor function: The ability to make large, coordinating movements using multiple limbs and muscle groups is known as gross motor function. As a baby’s brain and body develop, they are expected to reach developmental milestones. Reaching the milestone later than expected, or reaching it but with low quality of movement (such as leaning on one side while crawling, not being able to walk without support, etc.), are possible signs of cerebral palsy.
Fine motor function: The ability to make precise and coordinated muscle movements is known as fine motor function. Fine motor control includes many activities that are learned, and involves a combination of both mental (planning and reasoning) and physical (coordination and sensation) skills. As a child grows, it reaches the typical fine motor skill milestones. Impaired or delayed fine motor skills are possible signs of cerebral palsy.
Oral motor function: The ability to use one's lips, tongue, and jaws for speaking, eating or drinking is due to proper oral motor function. A child with cerebral palsy has impaired oral motor function, which causes difficulty in speaking, swallowing, feeding and chewing. Oral motor impairment can affect breathing, articulation, and voice. Apraxia and dysarthia are types of neurological speech impairments caused due to cerebral palsy.
What are the symptoms of cerebral palsy?
Symptoms of cerebral palsy can be seen during the first three years of a child's life. Cerebral palsy can affect different parts of the body and vary in severity from one child to another. Also, some children may have minor problems while others may be severely disabled. A child may be slow in achieving important developmental goals, such as learning to crawl, sit up, walk or talk.
Parents need to carefully observe their child for some of the symptoms such as choking, difficulty in grasping objects, difficulty in swallowing, fatigue, inability to sit or stand without support, inability to hear, or pain in some parts of the body, to list a few.
What causes cerebral palsy?
The exact cause of cerebral palsy still remains unknown. It is observed that brain damage during pregnancy or , birth or within the first three years of a child's life may cause cerebral palsy.
Doctors indicate that injury to the brain during pregnancy is the main cause for around 70 percent of children being affected with cerebral palsy. The nature and severity of the brain injury determines how much the child’s motor functioning and intellectual abilities are affected.
Some possible causes of brain injury include:
Infections during pregnancy: This may damage the developing nervous system of the fetus. Genetic problems, infections, or problems during labor or delivery could also cause cerebral palsy.
Premature birth: This may damage the brain if there is an internal bleeding. Another possible factor is jaundice. Jaundice is caused by excessive bilirubin in the blood. Normally, bilirubin is filtered out by the liver. The newborn's liver needs a few days to start filtering bilirubin effectively, so it is normal for infants to have jaundice for a few days after birth. Photo therapy (light therapy) is used to treat jaundice. But in rare cases, severe, untreated jaundice can damage brain cells.
Early infant years: Serious illness, injury, or lack of oxygen to the brain may damage brain cells.
What are the types of cerebral palsy?
There are four types of cerebral palsy:
Spastic cerebral palsy
This is the most common type affecting a large number of children and the condition can be either mild or severe. There are four sub-groups of spasticity:
Hemiplegia - involves both limbs on one side; the arm is usually more affected.
Paraplegia - involves both legs; the arms are minimally involved, or not at all.
Quadriplegia or Tetraplegia - involves all limbs, usually to the same degree.
Diplegia - an intermediate form between paraplegia and quadriplegia; both legs are involved.
Athetoid or dyskinetic cerebral palsy
This is characterized by low muscle tone, slow, writhing movement patterns and involuntary jerking of the head or arms and legs. The movements generally increase with emotional tension and decrease while the individual is at rest.
Ataxic cerebral palsy
It is rare and is characterized by weakness, uncoordinated movements, and unsteadiness. A wide gait and difficulty with fine motor skills is also common.
Mixed forms of cerebral palsy
A combination of cerebral palsy forms; however, spasticity and athetosis is the most common combination.
How is cerebral palsy diagnosed?
There is no definitive test for cerebral palsy. Diagnosis is mainly based on the child's medical history and physical examination. Although it is preferred to have an early diagnosis so that parents can get the required treatment, therapy or intervention for the child, delayed diagnosis does occur because the disorder is difficult to diagnose. Also, the diagnosis may take more time if infants are affected with some physical illness due to which the symptoms could change during the first few years. It is easier to diagnose children who are severely affected with cerebral palsy; the diagnosis is often made within the first month of the child's life. Some are diagnosed within the first year, and mildly affected children may not be diagnosed until the age of 3-4 years.
Doctors will test reflexes, muscle tone, posture, muscle coordination, and other factors, all of which can develop over months or even years. Primary care physicians may want to consult medical specialists, or recommend tests such as MRIs (magnetic resonance imaging), cranial ultrasounds, or CT scans (computed tomography scans) to obtain an image of the brain.
If the baby is premature, an early MRI scan may indicate that there is a brain injury, but it may be too early to predict the impact. In case doctors diagnose that the baby is “at risk of cerebral palsy”, then intervention can begin as early as one month from birth.
Tests and scans
Some more tests may be conducted to rule out other problems that have similar symptoms as cerebral palsy.
MRI scan: Uses radio and magnetic waves to study the brain.
Ultrasound scan: Uses sound waves to build a picture of the child's brain tissue.
CT scan: Uses a series of X-rays that are assembled by a computer to create a 3-D image of the brain.
Electroencephalogram (EEG): Small electrodes are placed on the scalp to monitor brain activity.
Electromyogram (EMG): Muscle activity and function of peripheral nerves (network of nerves that run from the brain and spinal cord to other parts of the body) is tested.
How is cerebral palsy treated?
Parents are first to notice their child has missed one of the developmental milestones. If any developmental milestone is delayed, parents may think that their child is a slow starter who will eventually learn. However, parents should inform the pediatrician about this delay.
There is no cure for cerebral palsy but a range of treatments are available to treat the symptoms. Since cerebral palsy varies in type, location and severity of impairment, a team of expert medical specialists work together to provide a comprehensive treatment plan for children with cerebral palsy. Pediatricians, physiotherapists, orthotists (specialists in using devices to correct deformities and support weakened joints), speech and language therapists, occupational therapists, special education teachers, and psychologists, all work in coordination to help the child manage their symptoms and be as independent as possible.
Physiotherapy: Normally started when the child is diagnosed with cerebral palsy. The objective of physiotherapy is to prevent the weakening of muscles, and prevent muscle shortening and losing their normal range of movement. A physiotherapist will teach your child several physical exercises to strengthen and stretch their muscles. Special arm or leg braces (orthoses) may also be used to help stretch their muscles and improve posture.
Speech therapy: Helps children improve their communication. Children are taught a series of exercises that can help them speak clearly. In case of severe speech difficulties, children are taught alternative method of communication, such as sign language. Special equipment to help a child communicate are available, such as a computer connected to a voice synthesizer.
Occupational therapy: The therapist identifies problems that a child may have in performing daily tasks, and advises the best possible ways to carry out tasks that require movement, such as going to toilet, getting dressed, eating, etc. Occupational therapy can be extremely useful in boosting your child's self-esteem and independence, especially as they get older.
Play therapy: An innovative process for children to have fun with play, which in turn has a positive effect on their emotional well being. It is a therapeutic and psychological intervention that allows children to learn how to interact with others and develop relationships. Play therapy incorporates the child’s physical abilities, cognitive functioning levels and emotional needs in a safe, supportive environment. Play therapy is often performed when the child is young (0-2 years), but is also used in early adolescence when there is peer pressure and acceptance is crucial. The earlier the play therapy is advised, the sooner a child benefits from it. Early interventions also greatly increase the possibility of the child implementing learned behavior into their interactions with other children, friends and family.
Counseling: A counselor or psychologist can help the child and the child's family cope with the condition and obtain needed services.
Specially designed educational programs: Used to teach and train children who have learning disabilities or mental retardation.
Caring for a child with cerebral palsy
The birth of a child is a period filled with hope, excitement, happiness and joy. When parents come to know that their child has been diagnosed with cerebral palsy, it can be devastating, and the parents vision of the future changes completely. It may take some time, but they need to learn to cope with the unexpected circumstances and take the next steps. The first among these is to have a clear understanding of their child’s condition, which aids in seeking early intervention, and obtaining the necessary treatment or therapy.
Raising and caring for a child with cerebral palsy can be tough and overwhelming, but there is hope. You can be your child's best advocate and support. Knowledge about cerebral palsy will make you better prepared to help the child in every possible way. Joining a support group where you can share your learning and experiences, and also learn from other parents can be helpful.
Maximize the potential of those suffering from cerebral palsy
Cerebral palsy is a non-progressive condition and currently, there is no cure. However, individuals with cerebral palsy have met enormous challenges, and have learned how to use their abilities and fulfill their aspirations. Nowadays, there are several alternatives and assistive tools that help individuals with cerebral palsy complete their academics, pursue hobbies and interests, and participate in sports and recreational activities.
There is evidence that children with cerebral palsy far exceed initial assessments. A child that was diagnosed being unable to walk, or who has not learned to walk, has also climbed mountains. Others that were never expected to communicate have spoken, written books, and inspired others with words of wisdom.
Parents can play a very important role in helping the child pursue his or her interests and master basic living skills, which in turn enables the child to lead a better quality of life.
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