Cerebral palsy (CP) refers to a group of disorders that affect muscle movement and coordination. The word “cerebral” is related to the brain. The word “palsy” means weakness or problems with body movement. CP is the most common cause of motor disabilities in childhood. In a few cases, vision, hearing, and sensation are also affected. According to the Centers for Disease Control and Prevention (CDC), it affects at least 2.3 to 3 out of every 1,000 children in India.
The early signs and symptoms appear during infancy or preschool years (3 to 5 years of age). Some children might have a reduced range of motion, specifically due to muscle stiffness.
Types of Cerebral Palsy
CP is classified according to the main type of movement disorder involved. The four main types of CP are:
Spastic cerebral palsy: Spastic CP is the most common type of CP, which usually results in walking abnormalities. Sometimes, muscle weakness and paralysis (the loss of muscle function in part of your child’s body) may also be present.
Dyskinetic cerebral palsy: Dyskinetic CP makes it difficult for your child to sit and walk since he/she may have problems controlling the movement of his/her hands, arms, feet, and legs.
Hypotonic cerebral palsy: In a hypotonic variant of CP, the arms and legs of your child appear loose and floppy. As a result of weakened muscles, your child might find it difficult to sit up straight as he/she grows.
Ataxic cerebral palsy: Ataxic CP can result in unsteady movements. Your child might have a hard time while walking or writing since these are fast quick movements or movements that need a lot of control.
Mixed cerebral palsy: Mixed CP is a combination of one or more of the above variants.
Causes of Cerebral Palsy
Cerebral palsy is caused by an abnormality or disruption in brain development, usually before or just after your child is born. Your child can either have congenital cerebral palsy CP (your child was born with it) or acquired cerebral palsy (disorder begins after birth).
In most cases, the exact trigger isn't known. Factors that may lead to problems with brain development include:
1. Mutations (series of changes) in genes that lead to abnormal brain development.
2. Maternal (relating to a mother) infections that affect the developing fetus (baby-to-be).
3. Fetal stroke, also known as a cerebrovascular accident or brain infarct, is the disruption (blockage) of blood supply to the developing brain.
4. Infant infections that cause inflammation in or around your child’s brain. These infections include viruses such as chickenpox, rubella (German measles), and cytomegalovirus (CMV), and bacterial infections such as infections of the placenta or fetal membranes, or maternal pelvic infections.
5. Traumatic head injury to an infant from a motor vehicle accident or fall.
6. Lack of oxygen to the brain (asphyxia) related to difficult labor or delivery.
7. Bleeding into the brain in the womb (a hollow, pear-shaped organ located in a woman’s lower abdomen where a baby develops) or as a newborn.
Early Signs of Cerebral Palsy
The most significant sign that your child might have CP is a delay in exhibiting movements like rolling over, sitting, standing, or walking. Other signs and symptoms include:
Your baby feels stiff.
Your baby feels floppy.
Your baby overextends his/her back and neck whenever you try to cradle him/her.
Your baby’s legs get stiff and they cross like a scissor.
Your baby finds it difficult to roll over in either direction.
Your baby reaches out with only one hand while keeping the other fisted.
Your baby cannot bring his/her hands together or finds it difficult to bring hands to his/her mouth.
Risk Factors Associated With Cerebral Palsy
Certain factors can put your baby at an increased of:
1. Premature birth is a birth that occurs before the 37th week of pregnancy. Studies show that premature babies are at a major risk factor for developing CP. However, this does not mean that all premature babies will develop the condition.
2. Low birth weight (LBW) is when your child weighs less than 2500 grams at birth.
3. Being a twin (two babies produced by the same pregnancy, that may or may not look identical) or triplet (three babies born at the same birth).
4. A low Apgar score, which is used to assess the physical health of babies at birth. The Apgar score is a method to quickly summarize the health of newborn children against infant mortality. It is based on a total score of 1 to 10.
5. Breech birth, which occurs when your baby’s buttocks or feet come out first. In simple words, breech birth happens when your baby comes out bottom first instead of head first.
6. Rh incompatibility, which occurs when your blood Rh type is incompatible with your baby’s blood Rh type.
"Rh-negative" and "Rh-positive" refers to whether your blood has Rh factor. Rh factor is a protein on red blood cells (RBCs).
7. Maternal exposure to toxic substances, such as methylmercury (an organic form of mercury that is highly toxic), while pregnant.
Diagnosis of Cerebral Palsy
An early diagnosis of CP can help improve your child’s condition. Your paediatrician will understand your child’s complete medical history and ask you questions about the most recent symptoms. After taking your child’s medical history, your doctor will conduct a few physical examinations to such as an MRI (Magnetic Resonance Imaging) scan, a CT (Computer Tomography) scan, a cranial ultrasound (a technique for scanning the brain using high-frequency sound waves) and certain blood tests to identify any bleeding disorders.
Treatment for Cerebral Palsy
The goal of treatment is to improve limitations and prevent complications. Treatment may include assistive aids, medications, and surgery.
- Assistive aids: These are external devices designed, made, or adapted to assist a person to perform a particular task and includes eyeglasses, hearing aids (a battery-powered electronic device that amplifies sound and transmits it into your child’s ears), walking aids, body braces (a device designed for the purpose of supporting an area of the body such as the back of an elbow) and wheelchairs.
Medications: Oral anticonvulsants (these drugs work by calming hyperactivity in your child’s brain) and muscle relaxants are commonly used as first-line treatments for CP.
Injections: Your doctor might also suggest intramuscular injections or intrathecal injections (a route of administration for drugs through an injection into the spinal canal). Consult your paediatrician to understand more about this.
- Surgery: Orthopaedic surgery may be used to relieve pain and improve mobility. It may also be needed to release tight muscles or to correct bone abnormalities caused by spasticity (a condition in which muscles stiffen or tighten).
Other types of treatment for CP also include:
1. Speech therapy is advised to improve communication interactions and is also used to strengthen and improve facial and oral muscle control.
2. Physical therapy can help reduce the muscle tension and shaky movements associated with spastic cerebral palsy.
3. Occupational therapy (OT) can assist your child master the basic activities of daily living, by improving muscle coordination.
4. Recreational therapy, also known as therapeutic recreation, will help your child develop and expand his/her physical and mental capabilities.
5. Counseling or psychotherapy is mainly offered to your child and to you to reduce anxiety and stress that can come along with the diagnosis of such a condition.
If you notice a delay in the development of your child’s movement, it is recommended to visit your paediatrician to discuss the same. Waiting too long for natural recovery and indulging too long in different therapies can be harmful to your child. It is always better to start “Early Interventions” under the expert guidance of your paediatrician.
Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.