CEREBRAL PALSY

DEFINATION: Cerebral Palsy (CP) is a disorder characterized by neurologic, motor, and postural deficits resulting from non progressive abnormalities in the developing brain.

EXPLANATION: It is a non-progressive disorder caused by static lesion in the brain caused before, during or after birth and which interferes with the normal development of the immature brain.

A child with cerebral palsy is prone to develop problems in physical, sensory, perceptual, emotional, cognitive, cultural and social aspects. Also associated problems like feeding problems, visual problems, auditory problems, speech problems, mental retardation, seizure disorders.

PREVALANCE: Cerebral palsy is caused by complications prenatal in 30% of cases, natal in 60% of cases and postnatal in 10% of cases.

SEX BIAS: No bias seen

AGE OF ONSET: Always begins during childhood before the age of five with no sex and cultural bias.

ETIOLOGY: Prenatal causes:

  1. Acquired causes like infections during pregnancy
  2. prenatal anoxia(lack of oxygen)such as umbilical cord along the neck
  3. Prenatal cerebral hemorrhage (abnormal bleeding).
  4. Rh factor incompatibility.
  5. Metabolic disturbances like diabetes.
  6. Bleeding in first trimester.
  7. Drug toxicity.
  8. Harmful exposures to radiations.

Perinatal causes:

  1. Anoxia from respiratory obstruction, placental abnormalities, maternal anoxia hypotension or breech delivery
  2. Trauma or hemorrhage during delivery.
  3. induced labor leading to sudden pressure changes
  4. Prematurity, cesarean delivery, prolonged labor.

Postnatal causes:

  1. Trauma from skull fractures, wounds, vascular accidents.
  2. Any infections like meningitis, Encephalitis or brain abscesses
  3. Any toxicity
  4. Anoxia from CO2 poisoning, hypoglycemia and neoplasm.

CLASSIFICATION: Commonly used classification of CP by Medico’s:

Tone-Tone refers to muscle tension which is generally affected in cerebral palsy.

  1. Spastic Cerebral palsy-This type shows increased muscle tone leading to muscle strength imbalance.These children show marked affectations in using both upper and lower extremities.
  2. Athethoid Cerebral palsy-This type shows fluctuations in muscle tone and poor mid-range control.Weak proximal joints with inability to use distal joints is a characteristic feature of this group.
  3. Cerebral palsy with rigidity-This type shows marked increase in muscle tone in all muscles making any movement difficult.
  4. Ataxic Cerebral palsy-This type shows compromised balance and co-ordination issues with generally presence of low tone.
  5. Cerebral palsy with tremors-This type shows presence of involuntary movements making any task a challenge.
  6. Atonic or Hypotonic Cerebral palsy-This type shows markly low tone with poor head and trunk control,hyper mobility of joints and broad base of support is common.
  7. Mixed Cerebral palsy-This type of CP shows more than any of the type of features mentioned above.
  8. Unclassified Cerebral palsy-This type of CP shows features not resembling any of the above mentioned category.

Another type of classification commonly used speaks of distribution, location and involvement of body as follows:

  1. Monoplegia – Only one extremity is involved.
  2. Hemiplegia – Upper and lower extremities on one side is involved.
  3. Paraplegia – Both the lower extremities are involved.
  4. Diplegia – Both upper and lower extremities with significant impairment in the lower extremities.
  5. Quadriplegia – All four extremities involved.

SIGNS AND SYMPTOMS: According to type of CP Signs and Symptoms are as follows:

  •  Difficulty sucking of feeding.
  • Irregular breathing.
  • Limited range of movements/motions.
  • Spasticity.
  • Delayed development of motor skills, such as sitting, rolling, crawling and walking.
  • Mental retardation.
  • Speech abnormalities. (dysarthria)
  • Visual abnormalities.
  • Hearing abnormalities.
  • Seizures.

Other signs and symptoms includes deficit in sensory, perceptual, emotional, cognitive, cultural and social aspects. Feeding problems, visual problems (acuity, occulomotor control, visual perception), auditory problems, speech problems, mental retardation, seizure disorders.