Cerebral Palsy

Knowing that your child has cerebral palsy is heartrending, but learning more about this disorder can give you hope.  By educating and updating yourself with the condition and treatment options available can help you manage the condition in a better way.  Rest assured, your child can still lead a productive life.  Let’s first understand what actually cerebral palsy is.

Cerebral palsy is a neurological disorder that impairs a child’s muscle movement, muscle tone, coordination and motor skills.  Cerebral palsy is the most common cause of motor disabilities in children.  Studies have shown that it affects at least 1.5 to 4 out of every 1,000 children worldwide.

The word cerebral refers to “related to brain” and palsy means “weakness of body part”.  However, cerebral palsy is an umbrella term that covers a group of disorders and symptoms that can impair a person’s movements.

Symptoms of cerebral palsy:

What is to be understood is the symptoms of cerebral palsy are subjective.  While one child with cerebral palsy may end up developing certain symptoms and associated disorders, another child with cerebral palsy may have a completely different set of troubles.  For example, some people may have difficulty walking and sitting, whereas others may have spasms.  Symptoms can become mild or severe.  It depends on the part of the brain that got affected.

Some of the common signs of cerebral palsy include:

  • Delays in reaching motor skill milestones, such as rolling over, sitting up alone, or crawling
  • Variations in muscle tone, such as being too floppy or too stiff
  • Spasticity or stiff muscles and exaggerated reflexes
  • Ataxia or a lack of muscle coordination
  • Tremors or involuntary movements
  • Excessive drooling and problems with swallowing
  • Difficulty walking
  • Favoring one side of the body, such as reaching with one hand
  • Neurological problems, such as seizures, intellectual disabilities, and blindness

Apart from the above-mentioned bodily impairments, cerebral palsy can also lead to some medical conditions, depending on the severity of the disorder.  Some of them are speech problems, learning disabilities, problems with hearing and vision and emotional issues.

What causes cerebral palsy?

Abnormal brain development or injury to the brain leads to cerebral palsy.    In majority of cases cerebral palsy is caused by damage to the brain while the baby is in the uterus, during labor or delivery or shortly after birth.  The damage impairs that part of brain that controls body movement, coordination and posture.  In majority of the cases, the exact cause of cerebral palsy is difficult to pinpoint.

Some of the possible causes include:

  • Asphyxia neonatorum or a lack of oxygen to the brain during labor and delivery
  • Gene mutations that result in abnormal brain development
  • Severe jaundice in the infant
  • Brain infections, such as encephalitis and meningitis
  • Intracranial hemorrhage or bleeding into the brain
  • Head injuries as a result of a car accident, a fall, or child abuse

Pregnancy and birth-related causes of cerebral palsy:

  • Breech births
  • Complicated labor and delivery
  • Low birth weight
  • Multiple babies
  • Premature birth
  • Rh blood type incompatibility between mother and child

Risk factors of cerebral palsy:

A number of factors increase the risk of cerebral palsy.  Of which the most important one is maternal health.  Certain infections or health problems during pregnancy can greatly increase the risk of cerebral palsy in baby.  Infections of particular concern include:

  • German measles (rubella)
  • Chicken pox (varicella)
  • Cytomegalovirus
  • Herpes
  • Toxoplasmosis
  • Syphilis
  • Exposure to toxins
  • Zika virus infection
Certain infections in a new born baby can also significantly increase the risk of cerebral palsy.  Some of them are bacterial meningitis, viral encephalitis and severe or untreated jaundice.

Complications of cerebral palsy:

Muscle weakness, muscle spasticity and incoordination can give rise to a number of complications either during childhood or later during adulthood.
Contracture: Muscle tissue shortening due to spasticity is one of the major complications of cerebral palsy, which in turn can inhibit bone growth, leading bone to bend, resulting in joint deformities and dislocation.
Mental health conditions: People with cerebral palsy may have psychiatric conditions such as depression. Inability to go about and socialize and difficulties in coping with disabilities can contribute to it.
Malnutrition: Cerebral palsy may cause swallowing and feeding difficulties, which may affect the nutritional level of the infant, leading to impaired growth and weaker bones. Some children require a feeding tube for adequate nutrition intake.
Lung disease: People with cerebral palsy are prone to lung disease and breathing problems.
Neurological conditions: Being a neurological disorder, movement problems can occur and it may worsen over time.
Osteoarthritis: Painful degenerative joint diseases like osteoarthritis may set in quite early due to pressure on joints or abnormal alignment of joints due to muscle spasticity.
Osteopenia: Lack of mobility, nutritional shortcomings and antiepileptic drug use may affect the density of bones and as a result fracture may occur.
Eye muscle imbalance: Visual fixation and tracking may be difficult for people with cerebral palsy and the service of an ophthalmologist should be sought.

Types of cerebral palsy:

Cerebral palsy can affect any muscle in the body, so possible complications include trouble with balance, eye problems, bladder or bowel problems, poor range of motion in joints, and difficulty swallowing.

Spastic cerebral palsy:

Spastic cerebral palsy is the most widely affected cerebral palsy.  Due to its distinct symptoms and characteristics, spastic cerebral palsy can be easily differentiated from other forms of cerebral palsy. Specific symptoms and characteristics of this type of cerebral palsy include:
  • Failure to reach milestones in walking, crawling, and sitting up
  • Abnormal movement
  • Movement inhibition
  • Stiff muscles
  • Muscles tend to become stiffer as the child moves
  • Difficulties with controlling individual muscles
  • Difficulties moving from one position to another
Spastic quadriplegia:  This type of cerebralpalsy affects a child’s entire body, putting them at risk of limb deformities.  Children with spastic quadriplegia tend to have seizures, so it is important to consult a health care teamin order to work out best possible treatment options. Spastic diplegia:  This is not as severe as quadriplegia as children are still able to walk.  However, they tend to walk on their toes, leading to balance and coordination issues.  Other signs of spastic diplegia include delayed milestones, fatigue, seizures, flexed knees and a crouched gait.  Legs are more prone to spastic diplegia than arms.

Dyskinetic cerebral palsy:

Dyskinetic cerebral palsy is also known as dystonic cerebral palsy and athetoid cerebral palsy.  It is the second most common cerebral palsy after spastic cerebral palsy.  Symptoms of dyskinetic cerebral palsy include:
  • Repetitive, twisting motions (dystonia)
  • Slow, writhing movements (athetosis)
  • Unpredictable, irregular movements (chorea)
  • Awkward posture
  • Movements can range from slow to rapid and can be accompanied by pain

Ataxic cerebral palsy:

Ataxic cerebral palsy is named after the word ataxia,which means “without order”.  However, it is the least common type of cerebral palsy.  Typical characteristics include poor balance and coordination, tremors and shaky movements that are hard to control.

Mixed cerebral palsy:

Mixed cerebral palsy is a combination of two or more types of cerebral palsies.  To be more specific, two or more types of symptoms and disabilities.Spastic-dyskinetic cerebral is the most common type of mixed cerebral palsy.  Children withmixed cerebral palsy may exhibit a combination of symptoms in accordance with the type of disorder they have.

Diagnosis of the condition:

If the baby is premature delivery and has an increased risk of developing the disorder, there is a chance that the medical team evaluating the child can zero in on the condition in the first few months of life.  While diagnosing cerebral palsy, doctors look for poor coordination skills, jerky movements, and uncontrolled muscle movements.  Based on the child’s physical exam, medical history and muscle movement test, a doctor will be able to arrive at a conclusion.

Development screening at specific intervals can throw light on cerebral palsy.  Development screening enables the doctor to see if the child lags behind in reaching developmental milestones.  It is important to understand that there is no single, easy test for diagnosing cerebral palsy.  It will take time to reach a proper diagnosis

Treatment for the condition:

The treatment completely depends upon the type and severity of the disorder. We at Plexus, believe in incorporating an all-inclusive treatment approach towards tackling the disorder. The aim is to maximise the individual’s independence in daily activities and improve the quality of life. The treatment at Plexus consists of stem cell therapy along with intensive rehabilitation program. This includes occupational therapy, physiotherapy and speech therapy and language therapy as the major domains of treatment apart from stem cell therapy.

Stem Cell Therapy

This includes the administration of autologous mesenchymal stem cells (which are extracted from the patient’s bone marrow). To know more details about the procedure please refer to our section under ”about stem cells”.

Occupational Therapy

Individuals with CP face major challenges in performing their daily living activities. Their participation in activities is severely compromised at home, school, work or in the community, ultimately affecting their quality of life. Occupational therapists focus at assisting these individuals improve their functioning at home, school or community. In general, promoting independence in their daily life and uplifting their quality of life. The major focus is enabling participation in daily activities such as eating, bathing, attending school/work, play, socialising.

Occupational therapists focus on achieving the developmental milestones through various techniques. Use of reflex integration therapy is a major treatment approach used by occupational therapists. Hand functions are affected in these individuals hindering their ability to feed themselves, bathe, dress, write etc. Occupational therapists use various techniques to improve hand functions.

Occupational therapists at Plexus customise splints for children with CP. These splints are corrective in nature which help to correct poor limb attitude, relieve tightness and contracture and reduce the influence of reflexes that interfere with daily functioning. Apart from corrective splints, functional splints and adaptive devices are provided that help carry out daily activities with the available strength and coordination. Examples of splints and adapted devices used in CP include – resting hand splint, wrist cock-up splint, knee gutter splint, elbow gutter splint, adapted pen, adapted cup, straw holder, plate guard, adapted spoon.

CP is often accompanied by cognitive impairment that affects the attention, basic understanding and executive functions. This poses major difficulties in performing simple and complex daily living activities. Occupational therapists at Plexus perform a detailed cognitive assessment and a tailor made treatment approach is implemented based on the deficits and existing cognitive abilities. In general, individuals are encouraged to have a structured routine comprising of various activities to be performed regularly. For children with CP, the focus is on improving attention and preparing the child for school. Basic concept formation, understanding is the mainstay of the treatment. In adults with CP, the focus completes shifts to improving the higher cognitive functions, thus enabling participation in complex activities such as money management, meal preparation, socialisation etc. Vocational rehabilitation plays a major part in the treatment for individuals with CP.

Physiotherapy focusses on improving movement and balance, in order to facilitate independent walking or with use of walking aids.

Physiotherapy

Contractures are one of the common aspect observed in an individual with CP. Physiotherapists at Plexus mainly focus on stretching and flexibility exercises to ease this aspect. They improve the range of motion of the joints, increase the strength and conditioning of the affected muscles and improve coordination.

Postural training is an important treatment aspect in physiotherapy. Due to severe contractures, the entire posture of the individual gets affected causing debilitating effects on the individual. Physiotherapists use various modalities to help in reducing pain caused by various symptoms in CP. Endurance training forms another important treatment method in physiotherapy. Majorly, the goal in physiotherapy is to train the individual with CP in walking independently or with the use of walking aids. The entire treatment focus is on improving the standing and walking balance using   various techniques.

Speech and Language Therapy

Individuals with CP may severe deficits in their oral structures causing swallowing and speech difficulties. Speech therapists at Plexus use various techniques to enhance the oral-motor function and facilitate communication. Various swallowing exercises are taught to improve chewing, eating and drinking.

Articulation therapy forms an integral part of the treatment process, wherein the individuals are shown how the mouth and tongue work together to produce sounds, words. Various jaw, lip, tongues exercises are taught to strengthen the oral musculature. Blowing and breathing exercises help the individuals with CP in controlling their breathing.

Prevention of cerebral palsy:

In most cases, cerebral palsy cannot be prevented, but you can lessen the risks.  If you are pregnant or planning to get pregnant, you can take some simple steps to keep healthy and minimize pregnancy-related complications.  Some of them are the following:

  • Make sure you are vaccinated on time against diseases such as rubella
  • Take care of yourself. The healthier you are heading into pregnancy, the less likely you will be to develop an infection
  • Seek early and continuous prenatal care. Periodic visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby.
  • Practice good child safety. Prevent head injury by providing your child with a car seat with safety harness, bicycle helmet, safety rails on beds and appropriate supervision.

Commonly asked questions on Cerebral Palsy

What if my child exhibits cerebral palsy symptoms?

In the unlikely event, if you notice obvious symptoms of cerebral palsy in your child, book an appointment with us!! During appointment you should brief to the doctor as to the signs and symptoms that you have observed in the child. 

Is cerebral palsy a disease?

No, cerebral palsy is not a disease.  In fact, it is a neurological condition which affects movement and muscle control.

Is the child intellectually impaired?

It is a misconception in the society that children with cerebral palsy are intellectually impaired.  Most children with cerebral palsy have average or above-average intelligence.  There are doctors, teachers and lawyers in our society who carry out demanding careers despite affected with cerebral palsy.  Remember, part of the brain that gets affected is the one that controls movement only, NOT cognition.

For questions related to Cerebral Palsy and its treatment options, send a message to www.plexusnc.com

Glimpses of Rehabilitation Program at Plexus for Cerebral Palsy

Case Studies

Cognitive Rehabilitation in Cerebral Palsy

Mr. P, a 26 year old boy from Andhra Pradesh came to us with deficits in his cognitive functioning that affected his daily life. As per the parents, he had difficulty in reading time, balance was affected as he had difficulty in maintaining an upright posture on different surfaces, among his daily living skills he had difficulty in eating (there was spillage of food), money management and community mobility was also impaired.

Child with Cerebral Palsy starts walking…

Childs’s first steps are a moment of exhilaration for the parents. The joy they feel when the child comes running to them only to crash into their unconditionally loving arms cannot be explained. But joy is an understatement when it comes to the first independently taken steps of a 1 year old child from Chennai affectionately known as Mani.

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