Cerebral Palsy (CP) | Causes, Types, Symptoms & Treatment - ASLPclick

CEREBRAL  PALSY

Ø Definition of Cerebral Palsy –

·        A medical condition, usually caused by brain damage before or at birth, that causes the loss of control of the arms & legs.

·        Cerebral Palsy is a group of disorders that affects movement & muscle tone or posture.

                It caused by damage that occurs to the immature, developing brain, most often before birth.

·        Cerebral Palsy is considered a Neurological disorder caused by a Non-progressive brain injury or malformation that occurs while the child’s brain is under development, Cerebral Palsy primarily affects body movement & muscle coordination.

·        Cerebral Palsy is a blanket term commonly by referred to “CP” and described by loss or impairment of motor function, cerebral palsy is actually caused by brain damage.

                         The brain damage is caused by brain injury or abnormal development of the brain that occurs while a child’s brain is still developing – before birth, during birth or immediately after birth.

·        Cerebral Palsy affects body movement, muscle control, muscle coordination, muscle tone, reflex, posture & balance.

Ø Types of Cerebral Palsy –

               There are five types of motor effects from cerebral palsy, depending on which areas of the brain are affected –

> Spastic cp 

> Dyskinetic

> Ataxic cp

> Hypotonic cp

> Mixed cp 

1. Spastic Cerebral Palsy  (65%)

                  Spastic CP is the most common type of cerebral palsy, it affecting approximately 80% of people with condition. It causes stiff muscles & exaggerated reflexes, making it difficult to walk or movements.

2. Dyskinetic Cerebral Palsy  (10%)

                   People with dyskinetic cerebral palsy have trouble controlling their body movements. The condition causes involuntary, unusual movements in the arms, legs, and hands. In some cases, dyskinetic cerebral palsy also affects the face and tongue.

3. Ataxic Cerebral Palsy  (5%)

                  People with this form of cerebral palsy usually have trouble with balance and coordination. They may have difficulty walking and performing fine motor functions, such as grasping objects and writing.

4. Hypotonic Cerebral Palsy  (1%)

                      Hypotonic cerebral palsy causes diminished muscle tone and overly relaxed muscles. The arms and legs move very easily and appear floppy, like those of a rag doll.

5. Mixed Cerebral Palsy  (12%)

                    Some people have a combination of symptoms of the different types of cerebral palsy. This is called mixed cerebral palsy.

                          In most cases of mixed cerebral palsy, people experience symptoms of both spastic and dyskinetic cerebral palsy.

Ø Classification of Cerebral Palsy –

# Severity :-

             Cerebral Palsy is often classified by Severity Level as –  

                              Mild, Moderate & Severe.

               These are board generalization that lack a specific set of criteria.

·        Mild –

        Mild CP means child can move without assistance; his/her daily activities are not limited.

·        Moderate –

         Moderate CP means a child will need braces, medication & adaptive technology to accomplish daily activities.

·        Server –

         Severe CP means a child will require a wheel chair & will have significant challenges in accomplishing daily activities and will need important supports.

# Topographical Classification :–

è It describes body parts affected

è Term used to classification methods :

§  Plegia/Plegic : means paralyzed

 

1.      Mono-plegia

Means only one limb is affected.

 

2.     Di-plegia

Usually indicates the Legs are affected more than Arms; primarily affects the lower body.

3.     Hemi-plegia

  Indicates the Arm & Leg; one side of the body is affected.

 

4.     Tri-plegia

   Indicates Three limbs are affected. This could be both arms & a leg OR a leg or both arms.

 

5.     Quadri-plegia

                 Means that All Four limbs are involved.

Ø Causes of Cerebral Palsy –

·        Prenatal (70%)

·        Peri-Natal (5-10%)

·        Post-Natal

> Prenatal

               - Maternal infections (Eg. Rubella, Herpes Simplex)

               - Inflammation of Placenta

               - RH Incompatibility

               - Diabetes during pregnancy

               - Genetic Causes

               - Maternal Jaundice

> Peri-Natal

                   - Prematurity (Immature respiratory & cardiac function)

                   - Asphyxia

                   - Anoxia

                   - Low Birth Weight

                   - Coagulopathy

                   - Breech Delivery

> Post-Natal

                   - Brain Damage

                   - Motor accident/Damage

                   - Drowing

                   - Lead exposure

                   - Trauma

                   - Anoxia

                   - Toxicity

                   - Neoplasms

Ø Causes of Cerebral Palsy –

Cerebral palsy is caused by abnormal brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. In many cases, the cause isn't known. Many factors can lead to problems with brain development. Some include:

·         Gene mutations that result in genetic disorders or differences in brain development

·         Maternal infections that affect the developing fetus

·         Fetal stroke, a disruption of blood supply to the developing brain

·         Bleeding into the brain in the womb or as a newborn

·         Infant infections that cause inflammation in or around the brain

·         Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical abuse

·         Lack of oxygen to the brain related to difficult labor or delivery, although birth-related asphyxia is much less commonly a cause than historically thought

Ø Cerebral Palsy Sign & Symptoms –

 

Physical  Symptoms	Neurological  Symptoms
Contractures (shortening of muscle)	Buildup of cranial pressure due to fluid imbalance (hydrocephalus)
Drooling	Behavioral Problems
Exaggerated or jerky reflexes	Delayed motor skill development
Floppy muscle tone	Difficulty with speech & language (dysarthria)
Gastrointestinal problems	Sensory impairments
Incontinence	Visual/hearing impairments
Lack of coordination & balance
Involuntary movements or tremors
Problem Swallowing or Sucking
Problems in movement with one side of body
Stiff muscles (spasticity)

 

Ø Diagnosis of Cerebral Palsy –

A doctor will diagnose cerebral palsy by taking a complete medical history, performing a physical exam that includes a detailed neurological exam, and evaluating the symptoms.

The following additional testing may also be used:

• Electroencephalogram (EEG). An EEG is used to evaluate electrical activity in the brain. A doctor may order it when someone is showing signs of epilepsy, a primary cause of seizures. 
• MRI. An MRI uses powerful magnets and radio waves to produce detailed images of the brain. A healthcare professional may perform an MRI in order to identify brain irregularities or injuries.
• CT scan. A CT scan creates clear, cross-sectional images of the brain. It can also reveal brain damage.
• Ultrasound. A cranial ultrasound is a method of using high-frequency sound waves to get basic images of a young infant’s brain. It’s relatively quick and inexpensive.
• Blood tests. A healthcare professional may take and test a sample of blood in order to rule out other possible conditions, such as bleeding disorders.

If a doctor confirms a cerebral palsy diagnosis, they may refer you or your child to a specialist who can test for neurological issues that are often associated with the condition. These tests may detect:

• Vision loss and impairment, such as blurred vision in one or both eyes
• Deafness
• Speech delays
• Intellectual disabilities
• Movement disorders

Ø Associated Disorders of CP –

1.      Seizures

2.    Dysphagia

3.     Vision Impairment

4.    Hearing Impairment

5.    Cognitive & Behavioral Problems

6.    Oral & Health Issues

7.    Digestive Problems

8.    Skin Infection/Skin Problems

9.    Respiratory Problems

10.Behavioral & Emotion Problems

11.   Autism

12. ADHD

Ø Screening of CP –

1.     Prenatal Screening

-         Routine check up for mother during pregnancy is benefited for the mother & the Foetus

-         Health Education

-         Diet Advice (avoid tobacco & alcohol)

-         Sleep & working habits

 

·        Clinical Examination

-         Breast condition

-         Height of uterus

-         Position of Foetus

-         BP

-         Samples of blood & urine

          For Special Test

-         Glycosuria

-         RH Incompatibility

-         Rubella

-         AIDS

-         Neural Tube Defect

 

2.    Post-Natal Screening

-         Start in the immediate neonatal period & during the first two years

-         To find Biochemical Defects

-         Hearing & Visual problems

 

·         Clinical Method (at Birth)

-         Examination of weight, height, head circumference

-         Gestational Age

-         Musculoskeletal defects

-         At 6 weeks report test

·         Electronic Scanning

-         USG, CT Scan, MRI

    To find out – AVM, Hemorrhage, Leukodystrophies etc.