Cerebral Palsy

Overview

Cerebral palsy is a group of disorders affecting movement and muscle tone or posture. It results from damage to the developing brain, usually before birth. Symptoms include impaired movement, exaggerated reflexes, floppiness or spasticity of limbs, abnormal posture, involuntary movements, unsteady walking, and issues with swallowing and eye muscle coordination. The severity and specific symptoms vary among individuals, and there is no cure, but treatments can help improve function. Cerebral palsy can also lead to other complications such as heart and lung disease, osteoarthritis, osteoporosis, sleep disorders, chronic pain, skin breakdown, intestinal problems, and bladder/bowel issues.

Understanding the disease

Symptoms

The symptoms of cerebral palsy include impaired movement associated with exaggerated reflexes, floppiness or spasticity of the limbs and trunk, unusual posture, involuntary movements, unsteady walking, or some combination of these. People with cerebral palsy may also have problems swallowing, eye muscle imbalance, reduced range of motion at various joints, and mental health conditions such as depression. Other complications can include heart and lung disease, osteoarthritis, osteoporosis, sleep disorders, chronic pain, skin breakdown, intestinal problems, and issues with oral health.

Risk Factors

Risk factors for developing cerebral palsy include:

1. Bacterial meningitis and viral encephalitis: These bacterial and viral infections cause inflammation in the membranes surrounding the brain and spinal cord.
2. Severe or untreated jaundice: This condition, marked by yellowing of the skin, occurs when certain byproducts of "used" blood cells aren't filtered from the bloodstream.
3. Bleeding into the brain: This condition is often caused by a stroke in the womb or early infancy.
4. Low birth weight: Babies who weigh less than 5.5 pounds (2.5 kilograms) have a higher risk of developing cerebral palsy, with the risk increasing as birth weight drops.
5. Multiple babies: The risk of cerebral palsy increases with the number of babies sharing the uterus, especially if there is a likelihood of premature birth and low birth weight.
6. Premature birth: Babies born prematurely are at a higher risk of cerebral palsy, with the risk being greater the earlier the baby is born.
7. Delivery complications: Problems during labor and delivery may increase the risk of cerebral palsy. Several other factors can contribute to the risk of cerebral palsy, such as maternal infections like German measles, herpes, syphilis, or toxoplasmosis, exposure to toxins like methyl mercury, and other maternal conditions like thyroid problems, preeclampsia, or seizures. It is important to note that while these factors can contribute to the risk, they do not always cause cerebral palsy.

Development

Cerebral palsy develops as a result of damage to the immature, developing brain, most often before birth. The cause of this damage can be from various factors, including:

1. Prenatal factors: Certain infections during pregnancy, such as bacterial meningitis or viral encephalitis, can cause inflammation in the membranes surrounding the brain and spinal cord, leading to cerebral palsy. Untreated or severe jaundice can also contribute to the risk.
2. Perinatal factors: Complications during delivery, such as a lack of oxygen (asphyxia) or severe blood loss, can result in brain damage and lead to the development of cerebral palsy.
3. Genetic factors: In some cases, genetic conditions or abnormalities can contribute to the risk of cerebral palsy.
4. Postnatal factors: While less common, cerebral palsy can also develop in the first few years of life due to illnesses, injuries, or infections that affect brain development. It is important to note that the specific cause of cerebral palsy varies from person to person, and in many cases, the cause remains unknown.

Assessment and Diagnosis

Triage

You should see a doctor if you have concerns about episodes of loss of awareness of surroundings, unusual bodily movements or muscle tone, impaired coordination, swallowing difficulties, eye muscle imbalance, or other developmental issues in your child. If cerebral palsy is suspected, it is important to get a prompt diagnosis to explore possible causes and discuss appropriate treatment options.

Diagnosis

To diagnose cerebral palsy, a doctor will evaluate the child's signs and symptoms, medical history, and conduct a physical exam. The doctor may also refer the child to specialists such as a pediatric neurologist, pediatric physical medicine and rehabilitation specialist, and child developmental specialist. Tests that may be ordered include an electroencephalogram (EEG) to evaluate for seizures, and laboratory tests to screen for genetic or metabolic problems. If cerebral palsy is diagnosed, additional tests may be performed to identify problems with vision, hearing, speech, intellect, development, movement, and other medical conditions.

Management and Treatment

Complications

Cerebral palsy can lead to several complications, including heart and lung disease, breathing disorders, osteoarthritis, osteoporosis, sleep disorders, chronic pain, skin breakdown, intestinal problems, and issues with oral health. Muscle weakness, muscle spasticity, and coordination problems can contribute to contracture, malnutrition, and other complications. Common movement disorders associated with cerebral palsy include stiff muscles and exaggerated reflexes (spasticity), variations in muscle tone, and lack of balance and muscle coordination (ataxia). Cerebral palsy is caused by damage to the developing brain, usually before birth, and there is no cure. However, treatments can help improve function and manage symptoms.

Treatment

There is no cure for cerebral palsy, but treatments can help improve function and manage symptoms. Some of the common treatments for cerebral palsy include:

1. Physical therapy: This helps improve muscle tone, strength, coordination, balance, and flexibility. Physical therapists work with individuals to develop customized exercise programs and teach adaptive techniques for daily activities.
2. Occupational therapy: Occupational therapists help individuals develop skills for daily living, such as dressing, feeding, and using the bathroom. They also work on fine motor skills and provide assistance with adaptive equipment and techniques.
3. Medications: Various medications can be prescribed to help manage symptoms, such as muscle spasms, pain, and muscle stiffness. These may include botulinum toxin injections (Botox), muscle relaxants, and anti-seizure medications.
4. Surgery: Surgical interventions might be considered to correct deformities, improve mobility, or manage complications. Examples include tendon lengthening, bone realignment, and selective dorsal rhizotomy.
5. Assistive devices: Wheelchairs, braces, walkers, and other assistive devices can help with mobility and support.
6. Communication and learning aids: These may include augmentative communication devices, computer software, or special education services to help individuals with cerebral palsy communicate and learn effectively.
7. Nutritional support: For those with swallowing or feeding difficulties, specialized feeding techniques, modified textures, or feeding tubes may be necessary to ensure adequate nutrition and prevent malnutrition. It is essential to involve a team of healthcare professionals, including neurologists, physical therapists, occupational therapists, and other specialists, to develop a comprehensive treatment plan tailored to the individual's unique needs and goals.

Preparing for medical consultation

To prepare for an appointment for a child with cerebral palsy, you should:

1. Make a list of concerns: Note down any symptoms that worry you and when they started.
2. Gather medical history: Compile your child's medical history, including previous diagnoses and any problems during pregnancy or delivery.
3. List medications and supplements: Include all medications, vitamins, and other supplements your child is taking, along with doses.
4. Prepare questions for the doctor: Compile a list of questions to ask the doctor about tests, specialists, monitoring, educational materials, and support services.
5. Bring a support person: Consider bringing a relative or friend to help you remember the information discussed during the appointment.
6. Be prepared for the doctor's questions: Anticipate that the doctor will inquire about your child's growth, eating habits, response to touch, and any signs of favoring one side of the body.
7. Seek additional support: Consider joining a support group and accepting help with daily tasks or seeking academic support if needed. Remember to be well prepared and proactive in communicating with your healthcare provider to ensure the best care for your child with cerebral palsy.