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About Cerebral Palsy

Posted on April 19, 2019 by All In

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What is Cerebral Palsy?

Cerebral palsy (CP) is a neurological disorder caused by permanent non-progressive damage or abnormal development of the brain. The damage may occur before birth, during birth, or during the first year of a child’s life. This means that CP is non-reversible and will not worsen over time.

The brain controls movement, thoughts, memory, speech, and the function of other organs in the body. CP mainly affects areas of the brain that control movement, which causes motor impairments such as: muscle weakness, muscle tightness, difficulties in controlling movement, and abnormal posture. These impairments may have an impact on a child’s ability to function in daily activities.

The effect of CP on a child’s life ranges in severity. The part of the body affected may also vary. Some cases affect only one side of the body, or the lower half of the body, while others affect all four limbs. Children with CP often have other symptoms that accompany the motor abnormalities, these include: seizures, impaired hearing or vision, pain, and issues with bladder and bowel control.

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How Common is Cerebral Palsy?

CP is the most common physical disability in children worldwide. It is estimated that 1 in 500 newborns in the world have CP. Most cases are diagnosed between ages 18 and 24 months, though some cases are detected earlier.

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How is Cerebral Palsy Diagnosed?

The symptoms of cerebral palsy are not usually evident right after a baby is born. They become more noticeable as the child grows and develops. Typically, the first signs of CP are severe developmental delays and problems with movement. A doctor would obtain an extensive history of the child’s birth and run tests to identify the cause of the symptoms. A scan of the child’s brain may be done to locate the area that has suffered damage and confirm the diagnosis of CP.

Types of brain imaging that may be used:

  • Magnetic resonance imaging (MRI): A scanner that uses a large magnet and radio waves to produce a detailed image of the brain.
  • Computed tomography (CT): A scanner that takes several X-ray pictures of the brain at different angles to create a detailed image of the brain.

There is currently no way of detecting CP during pregnancy.

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What Causes Cerebral Palsy?

The exact cause of CP is not clear. However, it is thought to be due to brain damage or abnormal brain development which occurs before, during or shortly after birth. Possible causes of brain damage are:

  1. Before birth: Infections – like rubella, cytomegalovius, or toxoplasmosis – caught by the mother during pregnancy.
  2. During birth: A lack of oxygen or physical trauma due to a difficult birth.
  3. After birth: Infections of the brain or a brain injury.

There are several factors that increases a child’s risk of having CP:

  • Premature birth, especially in babies born before 28 weeks of pregnancy
  • Low birth weight
  • Twin or multiple births
  • Breech presentation (During birth, the baby’s legs come out first before the head)
  • Seizures at birth or shortly after birth
  • Mothers who have health issues during pregnancy such as excessive bleeding, proteinuria (high levels of protein in their urine), thyroid disease, seizures

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Symptoms of Cerebral Palsy

The symptoms of CP vary from child to child. It depends on the severity of brain damage and parts of the body that are affected. These are some of the most common symptoms of CP:

  • Delays in reaching developmental milestones (such as not sitting by eight months or not walking by 18 months)
  • Poor feeding during infancy
  • Poor control of head (like difficulties turning head, or holding head upright when sitting)
  • Arms or legs seem too stiff (Hypertonia)
  • Weak arms or legs (Hypotonia)
  • Fidgety, jerky or clumsy movements
  • Random, uncontrolled movements
  • Shaking hands (tremors)
  • Walking on tiptoes

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Classification of Cerebral Palsy

There are several ways to classify cerebral palsy and its symptoms, which are according to the parts of the body affected and the severity of the effects.

As the child grows older, his/her symptoms usually point to a specific subtype of cerebral palsy.

CP SubtypesSpasticDyskineticAtaxic
FeaturesMuscles are stiff and tightInvoluntary movements like abnormal postures or repetitive movements occur when moving limbsLack of coordination of movements
Limited movement of the affected limbsMuscle spasmsMovements are unsteady, shaky, clumsy, or jerky
Muscle weakness (Hypotonia)
Language skills are typically delayed
Effects on armsFingers are fistedDifficulties holding objectsShaky movements
Wrist is bentInaccurate movements as a result of trying to control the unsteady movements
Elbow is bentDifficulties in performing tasks that require repetition (clapping) or precise finger movements (writing)
Effects on legsLegs tend to be pulled together at the knees and cross like scissorsDifficulties standing and walking due to involuntary movementsPoor balance: May fall without reason or when walking on uneven surfaces, or unable to regain balance when bumped into by another person
Ankle is bent with toes pointed downwards and inwardsWide-base gait: Walks with feet spread further apart than the hips when walking to compensate for instability and poor balance

CP may cause damage to different areas of the brain, which control different parts of the body. Three common ways the body is affected are classified as follows:

  • Diplegia: Both legs are affected. Both arms may be slightly affected.
  • Hemiplegia: The arm and leg of one side of the body are affected.
  • Quadriplegia: Both arms and legs are affected. Muscles of the face and body may also be affected.

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Physical and Medical Issues that May Accompany Cerebral Palsy

Aside from motor impairments, children with CP may also have a range of other problems that depend on the severity of the brain injury. Not all children with CP may have these issues, though some of them have a higher risk than others.

Eye Problems

  • Some children may have reduced vision, an eye with a squint, or uncontrollable eye movements

Ear Problems

  • Impaired hearing or hearing loss

Feeding Problems

  • Difficulties sucking, chewing, or swallowing
  • Uncontrollable drooling due to difficulties with swallowing or with lip closure
  • Feeding issues may result in poor nutritional status. A doctor may suggest the use of a nasogastric tube (feeding tube inserted through the nose to the stomach) or a gastrotomy tube (feeding tube is inserted surgically through the abdomen into the stomach) for feeding to improve the child’s nutritional status.

Digestive Issues

  • Acid reflux of the stomach, where acid from the stomach travels up into the throat. It is also known as gastro-oesophageal reflux disease (GORD).
  • Difficulties with bowel movement which may result in constipation

Respiratory Problems

  • Weakness or poor coordination of muscles used for breathing may result in ineffective breathing and difficulties in clearing secretions from the lungs

Speech Impairment

  • Difficulties with producing speech when muscles in the throat and mouth are affected

Spinal Deformity

  • Children with CP are prone to the development of an abnormally curved spine (scoliosis). It is very treatable when detected at an early stage.

Hip Displacement

  • Children with spastic CP have a risk of having hips that pop out of the joint easily

Osteopenia (Weakened bones)

  • Children with CP may have weakened bones that can result in frequent fracture
  • May be caused by lack of movement, poor nutrition, and the use of antiepileptic drugs

Neurological Problems

  • Epilepsy (seizures or fits) is common in children with CP. The first occurrence of epilepsy typically happens during the first two years of life.

Sleep Disorders

  • Children with CP have high rates of sleep disorders which may be due to an abnormal sleep-wake cycle, pain, or difficulties breathing

Chronic Pain

  • May be due to muscle tightness, hip dislocation, constipation, or other causes
  • Sometimes it is difficult for children with communication difficulties to express their pain

Intellectual Disability

  • Approximately half of children with CP have an Intellectual Disability (ID). The severity of ID is correlated with the extent of the child’s physical disability and varies substantially.

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