Cerebral palsy is a neurological disorder inherited before birth which affects the normal muscular movement of the child. It is caused due to abnormality in brain development during the developmental stage of the fetus. Initial symptoms of cerebral palsy appear even during infancy or preschool stage for the child. The muscles can become either too stiff or floppy and it causes serious disturbance in normal movement. Some children may have difficulty in walking and in many cases it may affect the normal intelligence also.
Facts on Cerebral Palsy :
- More than 17 million people are affected with cerebral palsy worldwide
- One out of 500 babies are diagnosed with CP globally
- CP is one of the worst type of motor disability problem in childhood
- For reasons unknown, more boys have CP than girls
- Out of 100 children with CP, about 77 children have spastic CP
- Out of 100 children with CP, more than half (58%) can walk independently
- About 40% of the children with CP develop epilepsy and 7% can develop ASD
- In the United States alone, about 10,000 babies born each year have CP
- Exact cause of CP is not known, but it is believed to occur due to genetic disorder
- Pregnant women should take certain precautions to reduce the risk of CP
- CP is often detected during infancy or early childhood
- CP cannot be cured but the severity of symptoms can be managed with medications and therapy.
Symptoms of CP vary widely with respect to each child, depending on the damage done to the brain. Children with CP may have problems in movement with varying degree. Muscle tone becomes very stiff or very floppy. They show exaggerated reflexes or insufficient muscle coordination. Such children may show involuntary movements in hands and legs. They have difficulty in performing simple tasks like sitting or crawling due to delay in muscle coordination. Such children often have delay in completing developmental milestones like crawling, sitting and walking.
Some children may develop crouched position while walking and some may show scissors like gait. Many children with CP may develop problems in sucking and swallowing and hence may not reach expected weight. Some may have difficulty in speaking also. The brain lesions occur before birth does not progress over age and so the symptoms will not get worse over age. Intellectual disability and epilepsy are common in children with CP.
Exact cause of CP is not clear, but it is believed to be caused due to lack of oxygen supply to the brain before the child is born. Abnormality in healthy development of the brain due to maternal infections, random gene mutation, and disruption of blood supply or oxygen supply to the brain can cause CP. In some cases the growing fetus may develop head injury due to accidental fall. Having premature birth definitely increases the risk of CP.
Any kind of CP will show impairment in motor coordination and based on this observation cerebral palsy can be categorized into 3 major types namely spastic, dyskinetic and dystonic CP.
- Spastic CP :
This type is marked by rigidness in muscle tone in one side of the body affecting arms or legs. It can cause rigid posture in one hand or leg causing difficulty in using extremities. In some children spasticity may develop in both the legs causing scissoring gait like posture. The range of spasticity differs greatly with children and accordingly some children may have only little restriction in motor function while others may have severe rigidity.
- Dyskinetic CP :
These children will show abnormal movements in legs and arms that occur involuntarily. In children with Ataxic type of CP abnormal rhythm of motor movements occurs affecting the use of legs and hands.
- Dystonic CP :
This kind of CP is marked with slow movements wherein the child may take few seconds or even minutes to raise his hand or move his leg.
Risk Factors :
Any infections or serious health problems developed during pregnancy can increase the risk of CP for the child. Pregnant women developing rubella or chickenpox or other viral infections have more chance of delivering a child with CP. Bacterial meningitis or viral encephalitis in newborn child can cause CP. Similarly premature birth and low birth weight can increase the risk of CP.
Apart from varying severity in motor coordination, the child may develop certain complications like malnutrition (due to difficulty in sucking), contracture, and mental illness (social isolation and depression) and neurological problems like epilepsy.
An expert doctor can identify CP symptoms even during the first 3 months of the developing baby. Depending on the signs, he may order for imaging tests like CT scan or MRI scan, cranial ultrasound to get clear picture of the brain. EEG may be done if your child develops epilepsy. In addition blood profile will be done for detecting any other abnormality. A child with vision or hearing problem will have to undergo other suitable procedures for detecting the degree of impairment.
There is no cure for CP but the severity of symptoms can be decreased. The child would require prolonged treatment from expert team of doctors like pediatrician, neurologist, orthopedics, therapist and psychiatrist. Medications are prescribed to improve muscle tone due to spasticity. Botox injection is given to improve symptoms of drooling. Muscle relaxants like diazepam or baclofen are prescribed to improve flexibility in stiff muscles.
These drugs can cause side effects and should be given with doctor’s supervision only. Physiotherapy can improve muscle strength and improved motor development. The child will be taught to do daily tasks like bathing and eating etc. Splints are helpful in children with walking difficulty. The child can use electric wheelchairs or specialized seating devices based on his problem. Language therapy is effective in improving the child’s ability to speak and communicate.
- Surgery :
Orthopedic surgery is done for repairing severe deformity in bones and joints so that the child can attain improved usage of affected bones. In some cases the nerves that cause spasticity are cut off during surgery for gaining muscle relaxation.
Nothing can be done to prevent cerebral palsy. However pregnant women can reduce the risk of CP by taking certain precautions like getting vaccinated and regular screening.