Cerebral Palsy

Cerebral Palsy is a group of neurological disorders that affect the part of the brain directing muscle movement. The condition appears during infancy or early childhood and permanently modifies body movement and muscle coordination. When damage or abnormalities occur to the brain in the development stage, the brain loses its ability to control movement and maintain balance or posture. This condition is known as cerebral palsy.

Associated Anatomy

Motor area of the cerebral cortex, the brain’s outer layer

Signs or Symptoms of Cerebral Palsy

Common signs and symptoms of cerebral palsy include-

• Stiff muscles
• Lack of balance or posture
• Jerky involuntary movements
• Difficulty in walking
• Difficulty in motor skills like picking up utensils, buttoning clothes, etc.
• Difficulty in speaking
• Problem swallowing food
• Delayed growth of the child
• Improper vision and eye movement
• Hearing difficulties
• Spasticity

Certain symptoms are observed when a child is

• Younger than 6 months

• When you pick up the baby, the head lags or the legs become stiff

• The baby feels stiff or floppy

• Between the age of 6 to 10 months

• The child is unable to roll over or join hands

• He finds it difficult to bring his hands to the mouth

• He reaches out with one hand only

• Older than 10 months

  • The child crawls lopsidedly, dragging hands and legs

  • He is unable to stand with support

Cerebral Palsy Causes

• Periventricular Leukomalacia (PVL)- Damage in the white matter of the brain responsible for transmitting signals in and out of the brain.
• Gene Mutation- Changes in the gene of the child resulting in genetic inheritance or difference in brain development in the child.
• Intracranial Hemorrhage- Bleeding in the brain.
• Abnormal brain development of the brain.
• Infant Infection- Infections before birth cause inflammation around the brain.
• Maternal Infections- The mother carrying the baby is affected by infections that damage the developing fetus.
• Traumatic Head Injury- The child suffers from accidents or falls at a young age
• Lack of Oxygen- Caused by interruption or poor oxygen supply to the developing child during labor or delivery.
• Fetal Stroke- Blood clots in the placenta block the blood flow to the child’s brain, causing a fatal stroke. Thus, resulting in bleeding in the brain or a severe lack of oxygen.

Possible Cerebral Palsy Treatment

Cerebral palsy is a disorder by birth and is permanent. It has no cure. However, certain Cerebral Palsy treatment options can help manage the disorders and help the child live a fulfilling life.

Assistive aids- Aids that can assist the child in performing better, such as:

• Eyeglasses

• Walking aid

• Hearing aids

• Wheelchairs

• Body braces

Medications- muscle relaxants that can help in better muscle movement like:

• Diazepam

• Baclofen

• Tizanidine

• Dantrolene

Therapy- Therapies that assist the child in understanding their limitations and how to deal with them:

• Speech therapy

• Occupational therapy

• Physiotherapy

• Psychotherapy

Surgery- Orthopedic surgery to relieve pain, release tight muscles, improve mobility, or correct bone abnormalities.

Risk Factors of Cerebral Palsy

• Premature birth
• Multiple births- Twins or triplets
• Low weight during birth
• Breech birth- Legs come first instead of the head at the time of birth
• Complications during delivery
• Rh incompatibility- Rh type of the mother’s blood is incompatible with that of child’s
• Exposure to mercury during pregnancy
• Mother’s health- Infections or diseases during pregnancy
• Infant illness- Infections to newly born child
• Accident or injury to a child’s brain within a year after birth

Possible Complication

Cerebral palsy causes muscle weakness, muscle spasticity, and coordination problems, leading to various complications during childhood or adulthood.

• Mental health conditions such as depression
• Behavioral problems
• Malnutrition
• Cardiovascular problems
• Lungs disease or breathing difficulties
• Abnormal bone growth due to contracture
• Osteoarthritis- Degenerative bone disease
• Osteoporosis- Fractures due to low bone density
• Other complications- Sleep disorders, chronic pain, intestinal problems, oral health problems, etc

Typical Test Required for Cerebral Palsy

Various tests are recommended and performed by doctors to understand the organs affected and the severity of the conditions.

Brain Imaging Tests- To understand the abnormalities, damage, or injuries in the brain

• Electroencephalogram

• MRI Scan

• CT Scan

• Ultrasound scan of the brain

Blood Tests- To rule out possible bleeding disorders

Neurological Tests- To understand cognitive and movement disabilities

Doctors recommend regular tests for cerebral palsy to make comparisons and determine developmental issues and the effect of ongoing treatments.

Prevention of Cerebral Palsy

While most cases of cerebral palsy cannot be prevented, risks can be reduced. When planning for pregnancy, the following steps must be considered.

• Vaccination- Vaccination for common diseases or infections that might cause damage to fetal health must be taken.
• Taking Care of Mother- Pregnant women must take complete care of themselves. Ensure a healthy lifestyle to avoid infections.
• Prenatal Care- Regular checkups during pregnancy reduce the health risks for mother and child. It also helps in preventing premature births and low birth weight.
• Avoid alcohol, tobacco, and other toxic drugs

Additional Types

Cerebral palsy is differentiated into different types based on the parts of the brain they affect. Every type is associated with a specific movement disorder.

• Spastic Cerebral Palsy- It causes muscle stiffness and involuntary reflexes leading to walking abnormalities.
• Dyskinetic Cerebral Palsy- It causes uncontrolled or abnormal movements in hands, arms and legs.
• Hypotonic Cerebral Palsy- It causes overly relaxed muscles leading to muscle weakness in adulthood. It also leads to floppy hands and legs.
• Ataxic Cerebral Palsy- It causes problems with balance and coordination, leading to difficulty in grasping objects or writing. It is the least common type of cerebral palsy.
• Mixed Cerebral Palsy- Having a combination of symptoms from different types of cerebral palsy.

Epidemiology

• Cerebral palsy is the most common motor disability in childhood ranging from 1 to nearly 4 per 1000 births.
• 3 per 1000 children in the United States have been identified with cerebral palsy, according to CDC’s 2010 estimates.
• Cerebral palsy has the highest prevalence among premature and low birthweight children.

Expected Prognosis

Cerebral palsy affects neurological functions leading to motor disabilities in early childhood. These inabilities have no cure but can be managed better with medications and therapy. However, cerebral palsy does not lead to death or severe health conditions in most cases. Many cerebral palsy patients are seen to live fulfilling lives.

Natural Progression

Cerebral palsy is non-progressive. Its severity does not increase with age. However, if not treated, managing the conditions may become difficult. The patient may require full-time assistance in performing daily activities.

Pathophysiology

Cerebral palsy affects the motor area of the cerebral cortex, the brain’s outer part, that directs muscle movement. Damage to the brain or abnormalities in brain development leads to cerebral palsy. Problems with body movements, balance and posture, abnormal physical sensations, and a few cognitive inabilities are seen in all types of cerebral palsy.