Cerebral Palsy

Cerebral palsy is a neurological disorder that occurs in infants or in early childhood and affects body movements, balance, posture, and muscle coordination. It is the result of damage to one or more parts of the brain that controls movements. Most often, the disorder is present at birth but the signs may not be detected until 3 years.

Types of Cerebral Palsy

The three types of cerebral palsy are:

Spastic cerebral palsy —involves muscle stiffness causing difficult jerky movements. It is the most common type (70-80% of cases) and is classified further based on the parts of the body affected as:

• Diplegia (both the legs are affected)
• Hemiplegia (half side of the body is affected)
• Quadriplegia (entire body is affected)

Athetoid cerebral palsy —causes slow, involuntary and uncontrolled movements. It accounts for about 10-20% of the cases and affects any part of the body, including the face, mouth and tongue.

Ataxic cerebral palsy — causes an unsteady gait and affects balance and coordination. It is seen in about 5-10% of cases.

The early signs and symptoms of cerebral palsy include:

• Delayed developmental milestones such as head control, roll-over, sitting, crawling and walking in infants.
• Infantile reflexes such as sucking reflex and startle reflex, which usually disappears within 3-6 months, may persist for a long time.
• Muscles may become very stiff or unusually relaxed. Body movements may be jerky or abrupt, or slow and uncontrolled.
• Joints may become very stiff because of differing levels of pressure exerted on them by muscle of different tones.
• Seizures may occur in early years with some cases of cerebral palsy.
• Speech may not be clear in some individuals as they are unable to control the muscles of the tongue, mouth and throat which help in speech.
• Drooling of saliva and difficulty in swallowing may be seen.
• Child may not react to sound or may have a delayed speech.
• Dental cavities may occur more commonly because of defective tooth enamel and difficulty in maintaining good oral hygiene.
• Bowel and/or bladder control may be difficult because of lack of muscle control.

Cerebral palsy may be caused due to one or more factors listed below:

• Brain damage in the early years of life
• Infections such as bacterial meningitis or viral encephalitis
• Head injury following an accident, a fall, or child abuse
• Fetal brain damage because of infections during pregnancy
• Birth injuries during delivery

A risk factor is something that increases your chance of developing a disease.  Risk factors for developing cerebral palsy include the following:

• Maternal health problems such as infections, seizures, or thyroid disorder may increase the risk of fetal brain damage.
• Rh factor incompatibility (condition in which pregnant woman has Rh-negative blood and the baby in her womb has Rh-positive blood) may cause fetal brain damage.
• Complications during childbirth
• Pre-term delivery
• Infants weighing less than 2 pounds at birth (low birth weight)
• Severe physiologic jaundice which may develop after birth
• Lack of adequate supply of oxygen to the brain either at the time of delivery or after birth

If any of the signs or symptoms discussed is present in your child, then a thorough medical evaluation by your physician is necessary. The diagnosis of cerebral palsy is made based on information gathered from the family medical history and any problems that occurred during pregnancy and labor. Some of the tests your doctor may order include:

• Laboratory studies: Blood and urine tests may be ordered to check for any hormonal and metabolic conditions. DNA testing and chromosomal analysis may be done to rule out genetic disorders.
• Imaging techniques: These tests help to detect the cause and extent of cerebral palsy.

• Ultrasound of the brain – done to detect any abnormality such as bleeding or brain damage
• Computed tomography (CT) scan of the brain clearly reveals any abnormalities.
• Magnetic resonance imaging (MRI) of the brain helps to define the internal structure of the brain more clearly than other methods.
• Your doctor may order MRI of the spinal cord in children with spastic leg muscles and lack of bladder and bowel control.

• Other tests:

• Electroencephalography (EEG): This test is done to detect the types of seizures.
• Electromyography (EMG) and Nerve Conduction Studies (NC’S): These tests help to rule out other nerve and muscle disorders.

Conservative Treatment

Rehabilitation: A rehabilitation program includes physical therapy, use of special equipment, and treatment for spasticity.

• Physical therapy (PT): It involves stretching exercises, and other activities that can develop flexibility and strengthen the muscles. PT helps to develop skills such as holding the head up, sitting unsupported, or walking. Use of braces, splints, and casts may be recommended.
• Special equipment’s such as walkers, positioning devices, and wheelchairs help to improve function in children with cerebral palsy.
• Treatment for spasticity includes direct injections into the muscles or oral medications.

 Occupational therapy: OT helps teach physical skills needed to function independently in life such as eating, dressing, and teeth brushing.

Speech/language therapy: This type of therapy helps the child to improve speech and overcome problems of communication.

Drug therapy: Drug therapy helps to reduce the effects of cerebral palsy and prevent complications.

Surgical treatment for cerebral palsy includes dorsal rhizotomy, implantation of a baclofen pump, and tenotomy.

Prevention

Some of the causes of cerebral palsy which include pre-term birth, low birth weight, infections and head injuries can be prevented with the following measures:

• Prenatal care with regular checkups helps to maintain a healthy pregnancy and avoid preterm labor.
• Avoid smoking, alcohol consumption, and medications during pregnancy as these can increase the risk of premature delivery.
• Immunization against rubella (measles) during pregnancy protects you from the disease and the risk of cerebral palsy in your child.
• Routine vaccinations are given to your children to prevent infections such as meningitis that can cause cerebral palsy.