Cerebral Palsy


What is Cerebral Palsy?

The cause of Cerebral Palsy (CP) is a non- progressive damage to certain areas of developing brain.

This damage can occur in the early stages of pregnancy when the brain develops, emerge in the process of birth, when the baby passes through the birth canal or after birth.

At early age Cerebral Palsy appears in limitation and deterioration of motion. Together with movement disorders, such defects may exist :
– Cognitive (eg. inability to count);
– Sensory disturbances (insensitivity to pain);
– Hearing loss;
– Blurred vision;
– Prejudiced perception (eg, failure to recognize colors, although eye function is normal);
– Emotional disorders;
– Convulsions.

Ben van der Stam “Help your child with Cerebral Palsy. Practical advice “ISBN-5-7707-8196-3 © Publishing House” Misioner”, Lviv, 1995.

Symptoms of Cerebral Palsy

When you look at children with Cerebral Palsy, there several characteristic features apppear. They can appear in many combinations and appear in different degree, they include:
– Immediately after birth, the child may have difficulty breathing;
– The baby may have problems sucking, swallowing and chewing food; sometimes problems with feeding may have serious after- effects (such as aspiration pneumonia, if food gets to the lungs through trachea);
– The child often cries and this seems like ‘something wrong with him/her”. The baby may be indifferent and inactive, seem like he/she is not willing to communicate with environment;
– A child with Cerebral Palsy may have difficulty coordinating movements. For example, a child can use only one hand (instead of two) or have no ability to crawl;
– Child hardly contacts with others. He/she is not responsive to other people, has problems with speaking ;
– The child has problems with daily life activities: not able to eat, dress or take care of themselves;
– Generally, growth slowly in comparison to other kids of the same age.

Sometimes it takes months or even years to identify a child with Cerebral Palsy, especially in milder cases.

Ben van der Stam “Help your child with Cerebral Palsy. Practical advice “ISBN-5-7707-8196-3 © Publishing House” Misioner”, Lviv, 1995.

Development of children with Cerebral Palsy

Again it must be emphasized that a child with Cerebral Palsy suffered irreversible brain damage. Further development of the child with Cerebral Palsy depends on factor such as:
– Volume and location of lesion. These factors determine the severity of developmental delays. Detailed medical examination can evaluate a degree of brain damage;
– The level of development, which has to be achieved by a child under various stimuli. The more baby is encouraged, the better he/she will acquire sensory- motor experience;
– Therapy is very important for stimulation of development. It does not take way the underlying cause of brain damage, but the child can learn the most out of own body.

Ben van der Stam “Help your child with Cerebral Palsy. Practical advice “ISBN-5-7707-8196-3 © Publishing House” Misioner”, Lviv, 1995.

Causes

In general, it is believe that Cerebral Palsy can occur under various types of damages: those that occurred before birth, during or shortly after birth.

Before births:
– Infection;
– Rh incompatibility;
– Diabetes or poisoning during pregnancy;
– Heredity;
– Increased intra-cranial pressure.

During birth:
– Lack of oxygen;
– Birth trauma.

After birth:
– Hypoxia.

Ben van der Stam “Help your child with Cerebral Palsy. Practical advice “ISBN-5-7707-8196-3 © Publishing House” Misioner”, Lviv, 1995.

Symptoms of Cerebral Palsy

While inspections and check- ups of children with Cerebral Palsy special attention to following symptoms must be paid:
– Muscle tone;
– Reflexes;
– Neuro-psychological development.

1. Muscle tone can be:
– Lower than normal;
– Normal;
– Higher than normal.
A child with Cerebral Palsy can have reduced or increased muscle tone.

2. Reflexes
Reflex- an automatic involuntary response to certain exciter (stimuli). Some of them stay for lifetime, others disappear during normal development. These reflexes disappear later or remain indefinite (pathological) in a child with Cerebral Palsy.

3. Development
The development is delayed in compression with healthy children. Sometimes some stages of development (e.g. ability to walk) can not be reached. Often the baby depends on mobility disorder.

Ben van der Stam “Help your child with Cerebral Palsy. Practical advice “ISBN-5-7707-8196-3 © Publishing House” Misioner”, Lviv, 1995.

Secondary problems that children with Cerebral Palsy have

Secondary problems include:
– Forced position of limbs, due to lack of movements (because of muscle spasticity);
– Curvature of the spine (scoliosis). If a child with Cerebral Palsy moves, sits or lays asymmetrically then it increases the risk of skeletal deformity;
– With asymmetrical sitting increases risk of dislocation of the hip joint.

Ben van der Stam “Help your child with Cerebral Palsy. Practical advice “ISBN-5-7707-8196-3 © Publishing House” Misioner”, Lviv, 1995.

Classification of Cerebral Palsy

CP is classified according to location and manifestations.

Manifestations:
– Spasticity;
– Involuntary movement, especially seen on face, hands and tongue (athetosis);
– Shaky movements and walk (ataxia);
– Muscle atonia.

Where is evident:
– Half of the body (hemiplegia);
– Both halves of the body (diplegia);
– Both arms and legs (quadriplegia).

1. Spasticity
While spasticity increased muscle tone of flexor and extensor can be observed. In children with spastic muscle lesions, frequently lack of coordination and balance can noticed.
Due to the fact that these children have increased muscle tone and variety of movements are inadequate, often they have muscle and joint contractures, eventually leading to even greater limitation of movements. In the case of spastic muscle weakening (spastic paresis) there are associated reactions that occur always. Those reactions are abnormal muscle tensions, that appear all over the body. These reactions accompany every conscious movement, preventing its normal implementation. Associated reactions occur mainly when movement require an effort. Thus, children with spasticity of muscles often move in a global model, that is monotonous.

2. Uncontrolled involuntary movement (athetosis)
It means literally “failure to stop”. Children with this disease are always moving (especially their limbs). Movements are uncoordinated. Muscle tone changes from hypertonic to hypotonic.
For those children, it is very difficult to be in a certain position, for example, keep head and body in balance or to grasp something and hold it. To stop a movement is a problem also.
Sometimes joints can be hypermobile. These children often have asymmetrical reflex tone of a neck, lack of concentration and hypersensitive reaction to stimuli.
There are many differences among children with such movements. The child may be flabby and strains only when he/she tries to act or being worried. Another may be rigid for a longer period of time and relaxes only when pushes head forward.
Early diagnosis
Possible signs of athetosis: problems with feeding, ptyalism and long periods of increased muscle tone.

3. Shaky movements and walk (ataxia)
This is disorder of coordination of voluntary movements. Unlike children with athetosis, children with ataxia do not move constantly. However, their movements are uncontrolled and uncoordinated. Defect of coordination is noticeable in conscious movements.
Symptoms: trembling hands, tremors (shaking) and sharp, aimless and uncoordinated movements. Equilibrium is also disturbed.

4. Debility, weakness of muscles
Atony of muscles is seen in children with Cerebral Palsy during first years of life. This condition can go into athetosis or muscle hypertonicity. Longer children remain in this state, the worse the prognosis may be.
Children with muscular hypotonia inherent in excessive leakage of saliva. It is difficult to capture them by something or excite. There is increased mobility of joints due to very low muscle tension around them.

5. Hemiplegia
This is paralysis of one half of the body. These children can have stereotyped position and movements of hands and feet from one side (e.g. bent arm and which doesn’t work). Movement is unbalanced. The child uses only one half of the body, which is not paralyzed.
Other features:
– Muscle tone of paralyzed half of the body increases while any kind of activity;
– Associated reactions are present (tone increases while movement of healthy hand or feet);
– Hemianopsia (section of visual stimuli is not active in the brain, although eyes are functioning normally);
– Growth disorder and poor circulation of the affected side;
– Speech, learning and behavior disorders.
Early diagnosis
Around the age of four months, it is clear that the child always grabs something only with one and the same hand (compare it with normal development: habit developed when child has few years).

6. Diplegia – bilateral paralysis of a body
– With diplegia whole body is affected, but legs more than arms. These children usually can use own head and have no speech disorders. Muscle tone of legs ranges from high to normal; Actions of hands are accompanied with associated reactions of legs (and to a lesser extent – on the contrary);
– Some leg movements are relative hampered in comparison to the body (sitting with a straight back) and some leg movements are not simultaneous (walking);
– There is a significant limb flexion at the knee and elbow joints, while the tendency to bend the arms, torso and head.
Early diagnosis
Diplegia begins to manifest itself somewhere in the first year of life, when there is visible slow development of ability to stand or walk. Children have already developed many pathological habits.

7.Tetraplegia
This destruction of entire body. Thus, both sides of the body can be affected differently. This can lead to a certain asymmetry of posture and movement. There is a lack of balance head control, affected ability to speak and coordination.
Other features include:
– During physical efforts tone ranges from high to normal or it is elevated at rest;
– Can be difference in muscle tone between the right and left side;
– In the case of asymmetry, the likelihood of hip dislocation and scoliosis increses.
– Stereotyped pattern of posture and movement;
– Overall rigidity of movement;
– Associated reactions.
Early diagnosis
Those children can be identified by the presence of feeding problems and stiffness of movements in the first year of life. Due to the high muscle tone it is very difficult to take care for such children.

Ben van der Stam “Help your child with Cerebral Palsy. Practical advice “ISBN-5-7707-8196-3 © Publishing House” Misioner”, Lviv, 1995.

Principles of treatment of Cerebral Palsy

As it was mentioned earlier, Cerebral Palsy – after-effect of damage. With help of therapy, we can reduce the after-effects of CP by:
1) regulating muscle tone and relief of active movements;
2) Promoting of general development;
3) decrease of derivative problems.

Some short tips for parents:
– It is important that trainings were always pleasant for the child and for those who trains with child.
– use variety in practice;
– Speak with your child as much as it is possible and when you are teaching, give simple advice;
– Direct movements of your child, which they can not do on their own;
– Start with the exercises that child can do alone and encourage him/her to do a little more;
– Child aslo learns by watching others;
– Be patient, no matter how long it takes.

Ben van der Stam “Help your child with Cerebral Palsy. Practical advice “ISBN-5-7707-8196-3 © Publishing House” Misioner”, Lviv, 1995.