Cerebral Palsy, CP for short, describes a group of brain disorders affecting muscle tone, posture, mobility and hand use. CP results from a wide range of genetic or other medical problems which disrupt developing areas of the brain that control movement. Motor disorders of cerebral palsy are often accompanied by disturbances of sensation, cognition, communication, perception, behaviour, and/or seizure disorders. Some children walk independently while others require walkers or wheelchairs for mobility. Children with CP range broadly in their abilities to speak and think, but CP itself does not directly affect intelligence. The majority of children with CP grow into adulthood, and can lead successful lives with appropriate treatment and support.
Cerebral palsy is neither progressive nor communicable, however, it is a lifelong condition that requires medical and rehabilitation interventions. Rehabilitation focusses on preventing or minimizing deformities and maximizing the child’s capability to function optimally and successfully in her/his home, school and community. Ultimately the goal is to improve the child’s quality of life.
Causes/Risk Factors
The majority of children with cerebral palsy are diagnosed with congenital cerebral palsy, meaning their condition was caused by brain injury or malformations of the brain during fetal development. In a small number of children, cerebral palsy is caused by problems or complications during the birthing process. In most cases, the cause of congenital cerebral palsy is unknown. Overall, factors present before birth are related to the underlying cause in 70-80% of children with CP, with a lack of oxygen at birth playing a role in 10-20%. Ten percent of children have "acquired" cerebral palsy, meaning they suffered brain injury in the months or early years after birth, due to an infection or a head injury, such as a fall, car accident or abuse.
Risk factors for cerebral palsy include, but are not limited to, the following: premature birth; low birth weight; child is small for gestational age; breech presentation; child has low Apgar scores; child has severe jaundice or seizures; maternal infections during pregnancy; multiple births; maternal exposure to toxic substances; blood type incompatibility; maternal thyroid abnormalities, intellectual disability (mental retardation) or seizure disorder. However, having one or more of these factors does not mean that a child will always develop CP, but rather that the risk for CP is increased.
Types of Cerebral Palsy
There are three main types of cerebral palsy - spastic, athetoid, and ataxic. A fourth type can be a mixture of the previous three for any individual. Doctors classify cerebral palsy according to the type of movement disturbance that the patient exhibits.
Spastic cerebral palsy affects 70 to 80 percent of patients. This type of CP is characterized by stiff, contracted muscles in the individual’s arms and legs. Forms of spastic CP include: spastic diplegia (just the legs), spastic quadriplegia (arms and legs) or hemiplegia (either the left or right side of the body is affected).
Athetoid, or dyskinetic cerebral palsy affects 10 to 20 percent of patients. It is characterized by uncontrolled, slow, writhing movements of the hands, feet, arms, or legs and face.
Ataxic cerebral palsy affects 5 to 10 percent of patients. Individuals have poor coordination, balance, difficulty with precise movement and/or quick movement.
Mixed forms of CP; many patients exhibit symptoms of more than one of the aforementioned forms of CP. For example, individuals may have both spastic and athetoid movements.
Incidence
1 in 268 children have cerebral palsy. Approximately 800,000 Americans manifest one or more of the symptoms of cerebral palsy.
Treatment
Cerebral palsy is a lifelong condition which requires a “team” of individuals to help the child reach his/her utmost potential. This “team” approach should be started immediately upon diagnosis and includes: physicians, therapists (physical therapy, occupational therapy, speech therapy), early intervention specialists, educators, psychologists and social workers. Individuals with cerebral palsy may benefit from medications (e.g. for epilepsy, or spasticity), braces (e.g. to prevent contractures or improve functional movement), specialized seats, wheelchairs, walkers, and standers, or surgeries (e.g. to lengthen or relax muscles).
Because the child’s family is the central part of this team, support should also be provided to educate and assist the family; helping them learn how to best care for their child, as well as encouraging them to take breaks or “respite.”
As the child grows up, and depending on his/her needs, support/treatment services may include continued therapies, educational and vocational training, independent or group living services, counseling, modified transportation, recreation/leisure programs, and employment opportunities. Ultimately, services for individuals with cerebral palsy should focus on opportunities for participation that allow them to thrive in society.
Research
Medical specialists work to establish the underlying cause which results in CP. This knowledge is useful in determining treatment, prognosis and likelihood to occur again, as well as in addressing common feelings of parental guilt. Dramatic innovations in diagnosis using MRI and new treatment modalities offer improved diagnosis, treatment options, educational opportunities and overall quality of life.
