Definition & Causes - Cerebral Palsy.

Definition & Causes

Cerebral Palsy is a condition that affects thousands of infants each year. Though not contagious it does seem to be a mild epidemic.

The condition is a paralysis of the brain, causing limited movement, speaking ability, or muscle control for the afflicted child. In most cases the brain is unable to relay the information required for movement.

A permanent brain injury that occurs before, during or shortly after birth. Though once the injury has occurred it will not progress to a worse state. Unfortunately there currently isn’t any form of cure though treatments will be covered later on.

Some of the most prominent causes for CP are infections during pregnancy such as, rubella (a form of measles), and Cytomegalovirus (a herpes virus that causes cellular enlargement) causing damage to the developing nervous system. Also an untreated case of jaundice (yellowish pigment of the skin, tissues, and body fluids caused by the presence of excess bile), other situations leading to jaundice and the jeopardy of your child are, Rhincompatibility, along with kidney or urinary tract infections. You also have the possibility of negligence on the mothers’ part if the cause can be linked to toxicity (the use of drugs or alcohol during pregnancy). We also have the possibility of CP occurrence due to the mother suffering a stroke, or the fetus not receiving enough oxygen at the time of birth (which is a major reason for lamaze breathing techniques during birth). (cpf)

Types

CP has three categories of affliction, Ataxic CP occurs when the muscles are too weak. Children will be shaky, unsteady and have poor balance, approximately 10% of CP suffers have this form. (KH)

Athetiod CP, afflicts 20% of CP patients, it is the uncontrollable switch from tight to relaxed muscles often causing spasms in facial, arms or leg muscle. We also have a 20% occurrence of mixed CP where in the afflicted child suffers from more then one symptom. (KH)

However the most common form, afflicting a little more then half of the total patients is Spastic CP, in which muscles are too tight. Patience will have stiff and jerky movements and will often have a difficult time letting go of an object in there hand.(kh) Spastic Cp is also the only form divided into subcategories, such as Diplegia (which affects both arms or both legs), Hemiplegia (attacks limbs on one side of the body), Quadriplegia (affects all limbs), Monoplegia (effecting only one limb, though this is a rare event), and Triplegia (which effects three of the patients four limbs, also a rare case).(cpf)

Some of the other difficulties brought on by CP can include, incontinence a deficiency of muscle control that keep the bladder closed. This infliction can take the form of bed-wetting, uncontrolled urination during physical activities, or the slow leaking of urine from the bladder. There are some possible medical treatments such as, special exercises, biofeedback, prescription drugs, surgery, or implanted devices to replace or aid muscles. Patients can also find specially designed undergarments to help with the situation. (NIH)

Drooling can also be a side affliction connected with CP, often causing severe skin irritation and, because it is socially unacceptable, can lead to further isolation of affected children from their peers. Although numerous treatments for drooling have been tested over the years, there is no one treatment that can guarantee success. Drugs called anti-cholinergics can reduce the flow of saliva but may cause significant side effects, such as mouth dryness and poor digestion. Surgery, while sometimes effective, carries the risk of complications, including making it more difficult to swallow. Some patients benefit from a technique called biofeedback that can tell them when they are drooling or having difficulty controlling muscles that close the mouth. This kind of therapy is most likely to work if the patient is of a mental age of 2 or older, and is motivated to control their drooling.

Difficulty with eating and swallowing--also triggered by motor problems in the mouth--can cause poor nutrition. This in turn, may make the individual more vulnerable to infections, along with a lag in growth and development. When eating is difficult, a therapist, trained to address swallowing problems, can help by giving the child a special diet and teaching new feeding techniques. In severe cases of malnutrition, physicians may recommend a feeding tube, or Gastrostomy, in which a surgical opening allows a tube to be placed directly into the stomach.

...

This is a preview of the whole essay

Medical concerns

Seizures

Children with CP are at high risk for seizures because brain damage and scarring can interfere with the transmittance of electrical activities. There are two main types of seizures partial and generalized. (Geralis p62)

Partial seizures have to do with Focal Motor- causing muscle groups to jerk uncontrollably, Sensory- causing dizziness or disturbances in vision, hearing, taste, or smell. Though auditory hallucinations are the most common. We also have Autonomic seizures where in the patient suffers paleness, sweating, flushing or dilation of pupils, often accompanied by rapid heartbeat, fear or anxiety. Then we have Psychomotor or Temporal Lobe seizures where in the patient suffers an involuntary change in behavior, either becoming disenchanted with their current activity or a sleep walk simulation of movement away from their activities. (Geralis p62-63)

We also have the realm of generalized seizures such as, Absence seizures where in the patient temporarily loses all consciousness. There are Infantile Myoclonic seizures producing brief stints of muscle contraction of the legs trunk or arms often putting the patient through a jack-knife position. In reverse to this type we have Atonic seizures in which the child loses muscle tone where in all the muscles instantly go limp. Febrile Seizures become evident by the drastic increase in temperature, occurring most often in children under the age of ten. Yet the most common form of seizure is the Tonic-Clonic, which will briefly stiffen the muscles possibly causing the child to fall to the floor, this type also brings on short stints of unconsciousness, while adding a lose of bladder control and stoppage of breathing. (Geralis p 63-64)

Respiratory problems

While all children have bouts with the common cold it is different for those who also suffer from CP. In their case they my not be able to clear the congestion from the upper airway and can end up suffering from aspiration where in the child gets mucus, food, or bacteria in there lungs, often leading to Pneumonia. (Geralis p 73)

Urinary infections

Children with cerebral palsy are three times more likely to get urinary tract infections causing fever, vomiting, diarrhea, failure to gain weight, abdominal pain, increased frequency or more urgent trips to the bathroom. And if not properly treated these symptoms can lead to a case of chronic infections or kidney damage. (Geralis p71-72)

Gastrointestinal problems

Gastrointestinal problems often plague children with CP do to their poor muscle control. The GI system includes the mouth, esophagus, stomach, and intestines as well as the gall bladder, liver and pancreas all of which produce digestive enzymes.

The oral reflexes most likely to cause problems for children with CP are the bite reflex and the gag reflex. For example a child will bite down on a spoon when stimulated by it, a child with CP wont have the proper timing to do so. Or they may not have the right timing when it comes to swallowing due to an underdeveloped gag reflex often leading to aspiration. (Geralis p68-69)

Another problem occurring in children with CP is Gastroesophageal Reflux. Where in the child has an uncontrollable urge to spit up, choke, gag, cough, or vomit, while occasional episodes are only tiresome frequent occurrences can lead to sever damage of the esophagus, and can cause pain or bleeding. These symptoms often lead to aspiration or pneumonia. (Geralis p69)

Although constipation is a periodic ailment of children it becomes increasingly more difficult for those suffering from CP. This difficulty can take on several forms one of which is caused by the child’s in ability to sense the fullness of the rectum a signal to contract their muscles. Another problem may appear in the lack of muscle tone by which even if a child did recognize the need they wouldn’t have the ability to produce enough pressure needed to help with elimination. (Geralis p71-71)

Treatments

Although cerebral palsy is incurable there are steps a patient can take to make the situation more productive. While each case is different there are several possible members to each treatment team, such as your basic physician or team captain, an individual trained in treatments for developmentally challenged youths. He will point you in the right direction. Often to an orthopedist, a doctor specializing in bone, muscle and tissue issues, this will also work hand in hand with a physical therapist. Another option a family has is with a speech-language therapist, who helps a child learn to speak more clearly. A patient may also need the added guidance from a psychologist or social worker to help a family get in touch with community resources, or to help them coup with the unique situation. (cpf)

Physical and Behavioral Therapy

Therapy, whether for movement, speech, or practical tasks, is an integral part of cerebral palsy treatment. The skills a 2-year-old needs to explore the world are very different from those of a child, teen or adult, and therapy should be tailored to reflect these changing demands.

Physical therapy usually begins in the first few years of life. These programs use specific sets of exercises to work toward two important goals: Preventing the deterioration of muscles that can happen from lack of use and avoiding contracture, in which muscles become fixed in a rigid, abnormal position.

A third goal of some physical therapy programs is to improve the child's motor development. A widespread program of physical therapy that works toward this goal is the Bobath technique, named for a husband and wife team who pioneered this approach in England. A program based on the idea, that primitive reflexes retained by children with cerebral palsy will present major roadblocks to learning voluntary control. A therapist using the Bobath technique tries to control these reflexes by positioning the child in an opposing movement. So, for example, if a child with cerebral palsy normally keeps his arm flexed, the therapist would repeatedly extend it. (NIH)

A second such approach to physical therapy is "patterning," which is based on the principle that motor skills should be taught in more or less the same sequence that they develop normally. For example, the child is first taught elementary movements like pulling himself to a standing position and crawling before he is taught to walk--regardless of his age. Some experts and organizations, including the American Academy of Pediatrics, have expressed strong reservations about the patterning approach, because there is no documented proof that it is any more effective then any other method.

Behavioral therapy provides yet another avenue to increase a child's abilities. It might include hiding a toy inside a box to reward a child for learning to reach into the box with his weaker hand. Likewise, a child learning to say his "b" words might be given a balloon for mastering the word. A system of concrete rewards for hard work, making it easier for a child to make the connection between effort in to product out. (cpf)

Regardless of the patient's age and which forms of therapy are used, treatment does not end when the patient leaves the office or treatment center. In fact, most of the work is often done at home. The therapist functions as a coach, providing parents and patients with the strategy and drills that can help improve performance at home, at school, and in the world.

Drug Therapy

Physicians usually prescribe drugs for those who have seizures associated with cerebral palsy, and these medications are very effective in preventing seizures in many patients. In general, the drugs given to individual patients are chosen based on the type of seizures, since no one drug controls all types. However, different people with the same type of seizure may do better on different drugs, while others need a combination of two or more drugs to achieve seizure control.

Drugs are also sometimes used to control spasticity, particularly following surgery. The three medications that are used most often are diazepam, which acts as a general relaxant of the brain and body; Baclofen, which blocks signals sent from the spinal cord to contract the muscles; and Dantrolene, which interferes with the process of muscle contraction. (NIH)

Some patients with Athetoid Cerebral Palsy may be given drugs that help reduce abnormal movements. Most often, the prescribed drug belongs to a group of chemicals called Anticholinerics that work by reducing the activity of Acetylcholine. Acetylcholine, a chemical messenger, helps brain cells communicate and trigger muscle contraction. Anticholinergic drugs include Trihexyphenidyl, Benztropine, and Procyclidine hydrochloride. (NIH)

Surgery

Surgery is often recommended when contractures are severe enough to cause movement problems. Finding problem muscles that need correction can be a difficult task. To walk two strides with a normal gait, it takes more than 30 major muscles working at exactly the right time and exactly the right force. A problem in any one muscle can cause abnormal gait. Furthermore, the natural adjustments the body makes to compensate for muscle problems can be misleading. A new tool that enables doctors to spot gait abnormalities, pinpoint problem muscles, and separate real problems from compensation is called gait analysis. Gait analysis combines cameras that record the patient while walking, computers that analyze each portion of the patient's gait force plates that detect when feet touch the ground, and a special recording technique that detects muscle activity (known as electromyography). Using these data, doctors are better equipped to intervene and correct significant problems. They can also use gait analysis to check surgical results. (NIH)

Another method is Selective Dorsal Root Rhizotomy, which reduces spasticity in the legs by reducing the amount of stimulation due to nerves. Though the technique is highly controversial it has been effective for those patients suffering from Spastic Diplegia.

Experimental surgical techniques also include, Chronic Cerebellar Stimulation where in electrodes are implanted on the surface of the cerebellum and are used to stimulate selected areas. Effectiveness of this procedure have been inconclusive. Stereotaxic Thalamotomy on the other hand involves the cutting off of reception of stimuli from the thalamus to muscles and sensory organs. (NIH) Though effective in reducing tremors, I am personally uneasy about the severing of sensory receptors.

Mechanical aids

Computerized communication devices, special machines and gadgets in the home, school, and workplace can help any child or adult with cerebral palsy overcome limitations. The computer is probably the most dramatic example of a device that can make a difference. For example, a child who is unable to speak or write but can make head movements may be able to learn to control a computer using a special light pointer that attaches to a headband. Equipped with a computer and voice synthesizer, this child could communicate with others. Likewise, technology has led to new versions of old devises, such as the traditional wheelchair and its modern offspring that runs on electricity. (NIH)

Over coming Cerebral Palsy

Christy Brown

Christy Brown was born in Crumlin, Dublin, in 1932. He was one of twenty-three children, thirteen surviving, and was the only one afflicted with cerebral palsy and was considered mentally disabled. His mother didn't believe a word of it and said of her son "It is his body that is shattered and not his mind, I'm sure of it".

Christy's condition meant that he couldn't control his speech or his movement, except for his left foot. One day whilst his sister was playing with some chalk and a blackboard, he picked up a piece of the chalk with his left foot and made some marks with it. From that point on his mother taught him the alphabet, a slow and frustrating process for the young Christy. He started to sign his initials C.B., then moved on to his name and gradually began to write. He also found and developed a talent for painting, again using his left foot and when he was 12 years old won a Sunday Independent children's painting competition. (Brown)

His autobiography, My Left Foot was later expanded into the novel Down All The Days, and became an international best seller, being translated into fourteen languages.

There followed other novels including A Shadow on Summer. He also published a number of poetry collections including Come Softly to My Wake, published in America as Poems of Christy Brown; Background Music: Poems; Of Snails And Skylarks; and Wild Grow the Lilies.

He settled with his wife Mary Carr, in Ballyheigue, Co Kerry, and also in Parbrook, Somerset, UK, where he died in 1981. (Brown)

Dan Keplinger

Dan was born on January 19, 1973 in Baltimore, Maryland. He was born with cerebral palsy. At the age of 18 months, he enrolled in Delray School run by United Cerebral Palsy of Central Maryland. It was here that he began his education and therapies. When he turned 6, he enrolled at Ridge; a level five special education school. At age 16 Dan began attending Parkville high where he was completely main- streamed by his sophomore year. Dan graduated from Parkville in 1993 and went to Towson University the following fall. He graduated in May of 1998 with a B.S. in Mass Communications. He returned to Towson in the fall of 2000 for a second B.S. in Art. Through school Dan participated in many Art Department shows. In addition, his work was shown all across Maryland sponsored by Very Special Arts. In 1993 he was a featured artist in a show at the University of Boston, and he had his first solo show in May 2000. (Keplinger)