Cerebral Palsy
From Holoprosencephaly
Definition of Cerebral Palsy
Cerebral Palsy is a chronic, non-progressive neuromuscular disorder that affects the movement and coordination of muscles. The origin of cerebral palsy lies in the brain, not in the muscles or nerves. It is caused by abnormalities in parts of the brain that control muscle movements. Many children with cerebral palsy have a congenital malformation of the brain. Some have cerebral palsy as a result of brain damage caused by infection, trauma, hypoxia, metabolic disease, chemical toxicities or other factors prior to birth. Effects range from mild to severe dysfunction. Typically, the greater the injury to the brain, the more severe the cerebral palsy.
Types of Cerebral Palsy
- Spastic- Increased muscle tone or tightness with poor control of posture, balance and coordinated motion. This may involve one or both sides of the body. Movements are stiff, especially in the legs, arms, and/or back. Children with this form of CP move their legs awkwardly, turning in or scissoring their legs as they try to walk. This is the most common form of CP.
- Athetoid or Dyskinetic- Involves abnormal involuntary movement. Characterized by slow, writhing, wormlike, uncontrolled body movements that usually involve the extremities, trunk, neck, facial muscles and tongue. May also include chorea (involuntary, irregular, jerking movements) or dystonia (disordered muscle tone). These disturbances are usually absent during sleep and aggravated by stress.
- Mixed Type- This is a combination of the symptoms listed above. A child with mixed type has both high and low tone muscle. Some muscles are too tight, and others are too loose, creating a mix of stiffness and involuntary movements.
- Atonic- This type is characterized by very low tone, little active movement and brisk reflexes.
More words used to describe the different types of CP include:
- Diplegia--This means only the legs are affected.
- Hemiplegia--This means one half of the body (such as the right arm and leg) is affected.
- Quadriplegia--This means both arms and legs are affected, sometimes including the facial muscles and torso.
Symptoms of Cerebral Palsy (Presence of these vary among different children)
- Delayed gross motor development (This is a universal manifestation)
- Uncoordinated or involuntary movements
- Persistent primitive infantile reflexes
- Persistent infantile resting and sleeping posture- arms abducted at the shoulder, elbows flexed and hands fisted
- Poor sucking/ feeding difficulties
- Increased/ decreased resistance to passive movements
- Exaggerated arching of the back
- Feels “stiff” while handling
- Feels “floppy” while handling
- Rigid and unbending at the hip and knee joints when pulled to a sitting position
- Scissoring and extension of the legs, with the feet pointed downward while lying down
- Hyperreflexia, ankle clonus and stretch reflexes elicited in many muscle groups on fast passive movements
Treatment for Cerebral Palsy
Treatment focuses on maximizing the child’s physical capabilities and developmental potential. Assessments should be completed by a developmental pediatrician, neurologist and orthopedic specialist. Typically, children with cerebral palsy receive physical, occupational and speech/language therapy. The broad aims of therapy are to establish locomotion; gain optimum appearance and integration of motor function; to correct associated defects as effectively as possible and to provide educational opportunities adapted to the individual child’s needs and capabilities.
Children younger than three years old can benefit greatly from early intervention services. Early intervention is a system of services to support infants and toddlers with disabilities and their families. For older children, special education and related services are available through the public school to help each child achieve and learn. Other special equipment may be helpful. For example, braces (also called AFOs) may be used to hold the foot in place when the child stands or walks. Custom splints can provide support to help a child use his or her hands. A variety of therapy equipment and adapted toys are available to help children play and have fun while they are working their bodies. Activities such as swimming or horseback riding can help strengthen weaker muscles and relax the tighter ones.
Sometimes surgery, Botox injections or other medications may be used to alleviate painful symptoms.
Prognosis
Prognosis is individualized. While one child with severe cerebral palsy might be unable to walk, have severe cognitive impairments and need extensive, lifelong care, another with mild cerebral palsy might be only slightly awkward, have normal intelligence and require no special assistance. A more precise life expectancy can be estimated by evaluating the type of cerebral palsy present, its severity, and the impact of any conditions that are often related to this condition.
Other Considerations
Complications from immobility may be a concern for those more severely affected by cerebral palsy.
Problems may include:
- Disuse muscle atrophy and decreased joint mobility Suggestions: Isotonic exercises may help prevent contractures and muscle atrophy. Isometric exercises help maintain muscle tone. Passive exercises help maintain joint mobility
- Weak back muscles and secondary spinal deformities Suggestions: Good alignment prevents contractures and maintains structural integrity of muscles and joints. Special supported seating is essential. Braces may be used to help prevent or reduce deformity.
- Weak abdominal muscles Suggestions: These muscles may be strengthened by exercising in a prone position on the floor or on an exercise ball.
- Increased risk for aspiration Suggestions: Feed in upright position and have suction readily available for someone that frequently aspirates.
- Slowed digestive motility-risk for constipation Suggestions: Maintain adequate hydration and electrolyte balance, change position frequently and seek guidance of physician/GI specialist for medication management
- Decreased chest expansion and vital capacity Suggestions: Change position frequently and seek guidance from pulmonary physician for additional assistance with oxygenation needs
- Bone demineralization and osteoporosis Suggestions: Weight-bearing helps maintain healthy bones. Calcium supplementation may also be needed for advanced problems. Guidance should be sought from an orthopedic physician.
- Skin alterations-pressure sores Suggestions: Regular inspection of skin surface is necessary, frequent position changes recommended and seek treatment from physician and/or wound care specialist for open, slow healing or persistent reoccurring wounds.
To learn more about movement problems and treatment options in children with Holoprosencephaly, also see:
[Do all children with HPE have movement problems?]
[How will I know if my child has Dystonia?]
You may also find this external link beneficial:Brain Connection
It describes what areas of the brain control muscle tone and movement.
Sources:
http://www.nichcy.org/pubs/factshe/fs2txt.htm http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm http://gait.aidi.udel.edu/res695/homepage/pd_ortho/clinics/c_palsy/cpweb.htm http://en.wikipedia.org/wiki/Cerebral_palsy
Resources:
http://www.ucp.org http://www.cerebralpalsy.org http://www.pathwaysawareness.org
