CEREBRAL PALSY PREVENTION

What is cerebral palsy?

Cerebral palsy (CP) is not a disease or an illness but a physical impairment affecting muscle control and movement. A person with cerebral palsy has difficulty controlling movement and posture; they may have problems walking, talking, eating and playing. Cerebral Palsy may be mild, affecting one limb, or it may affect the whole body. There may be associated abnormalities such as mental retardation and sensory problems such as deafness and visual defects.

The prevalence of cerebral palsy is on the increase mainly due to the increase in survival of very pre-term babies. The incidence is one to three in every thousand births.

Cerebral palsy does not get worse over time.

What causes cerebral palsy?

It is not always possible to identify the cause of CP. In fact, a cause is not found in up to fifty percent of all cases. However, some known causes of CP include illness during pregnancy and insufficient oxygen during the baby's birth and delivery as a result of complications. Other risk factors are:

Prenatal (before birth) Risk Factors

•	Structural abnormalities or congenital malformation in brain;
•	The development of cysts or other destructive lesions in the brain;
•	There may be a genetic component;
•	Exposure to toxins.

Perinatal (after birth) Risk Factors·

•	Prematurity;
•	Low birth weight;
•	Haemorrhage in the brain;
•	Asphyxia.

CP may also develop later in the child's life as a result of a serious accident or injury or following an infection of the brain.

What are the typical signs of cerebral palsy?

Children with CP have damage to the part of the brain that controls muscle tone and movement. Muscle tone may be too tight (hypertonia) or too loose (hypotonia) or mixed. Infants with CP are often slow to reach developmental milestones such as learning to roll over, sitting, crawling and walking.

CP is classified into different types depending on the part of the body affected and the abnormal movement involved. Symptoms vary from person to person. The three main types of CP are:

•	Hemiplegia. This means that one side of the body is affected. The arm is usually more affected than the leg. People with hemiplegia can walk and run but their movement is awkward. This is the most common form of cerebral palsy and the child often has learning difficulties and below average IQ. Around fifty percent have seizures and many also have visual abnormalities.
•	Diplegia. In this instance two limbs are involved, usually the lower limbs. The level of intelligence is usually normal.
•	Quadraplgia. This is a severe form of cerebral palsy affecting all four limbs, the trunk of the body and the head and neck. The child is unable to control movement of any part of the body. Learning difficulties are often severe. Many of these children have seizures and other complications such as squints, feeding difficulties, and incontinence.

The physiological abnormality in movement may involve spasticity, dyskinesia or ataxia.

•	Spasticity. This is the most common motor disorder. The muscle tone is too tight and reflexes are exaggerated. These children have stiff, jerky movements and they find it difficult to change position.
•	Dyskinesia. This refers to involuntary writhing-like movements that cause severe disability. It is also called choreiform or athetoid movement. Muscle tone in people with dyskinesia is variable i.e. too tight at times and too loose at other times. They have trouble sitting upright or walking.
•	Ataxia. Ataxia is the inability to control and co-ordinate muscles to make voluntary movement. These children have low muscle tone and their movement is unsteady and shaky and their balance is poor.

Other problems associated with cerebral palsy include:

•	Talking is difficult if control of the muscles in the lips, jaw, tongue and other muscles involved in speech is affected.
•	Visual problems such as squint, short or long sightedness and, less commonly, visual field defects.
•	Deafness.
•	Problems communicating because of deafness, difficulty pronouncing words (dysarthria) or mental retardation.
•	Eating difficulties may arise because of problems with biting, chewing and swallowing. There may be poor growth due to inadequate nutrition. If the child has difficulty closing his mouth he may have a problem with drooling.
•	Poor bladder control resulting in incontinence.
•	Epilepsy occurs in about thirty to fifty percent of children with cerebral palsy.
•	As many as sixty percent of these children have some degree of learning difficulty.

How is cerebral palsy diagnosed?

Many specialists are involved in the diagnosis and assessment of children with cerebral palsy. A multidisciplinary approach is important if the child is to reach his full potential. Family support is also vital. Doctors, nurses, social worker, physiotherapist, occupational therapist, speech therapist and many others have important roles to play in providing care and treatment.

A full history of pregnancy, birth, early development and family history will be taken. This is followed by a careful examination of the child's appearance, growth and movements. Muscle tone and power are assessed. Posture, gait and joint movement are studied. Examination of the eyes for squints or visual problems is carried out. Hearing is checked. The child is also assessed for learning difficulties.

Cerebral palsy is not a progressive disorder so if there is any evidence of progression further investigation is required.

An EEG (electroencephalogram looking at brain waves) and brain scan may be performed.

Can cerebral palsy be cured?

CP cannot be cured. Prognosis depends on the severity of the disability. However, with treatment, many people with CP learn to walk and to perform everyday skills; they live full, independent lives.

As with assessment, treatment requires a multidisciplinary approach. Physiotherapy should be started early to improve posture and reduce abnormal movements. It is important that the child achieves as much mobility as possible. Walking aids such as sticks, crutches, walking frame, trolleys, clippers etc may be required. Some children will need wheelchairs adapted for their use such as moulded seats or chair inserts. They may also need adapted knives, forks and spoons to help them feed themselves.

Speech therapy may improve the child's communication skills. Sometimes aids such as books with pictures, an alphabet board, or electronic devices are needed to improve communication. They may need to learn sign language.

Some children with cerebral palsy will need surgery to deal with contractures (chronic loss of joint motion) or scoliosis (abnormal curvature of the spine) etc.

Drug treatment may alleviate some symptoms. Certain drugs such as Dantrolene, Diazipam and Baclofen are used to help reduce spasticity. Oxybutinin may help with bladder instability that is causing frequency and urgency. Anti-epilepsy therapy is required for children who have seizures. Anticholinergic drugs can reduce the flow of saliva thus reducing drooling.

CEREBRAL PALSY RELATED ITEMS

	CEREBRAL PALSY DEFINITION
	CEREBRAL PALSY DESCRIPTION
	CEREBRAL PALSY CAUSES
	CEREBRAL PALSY SYMPTOMS
	CEREBRAL PALSY DIAGNOSIS
	CEREBRAL PALSY TREATMENTS
	CEREBRAL PALSY PROGNOSIS
	CEREBRAL PALSY INFORMATION
	CEREBRAL PALSY PREVENTION