Definition of Cerebral Palsy, Its Types and Methods of Treatment

Definition

‘Cerebral’ attributes to the brain whereas ‘palsy’ attributes to loss or impairment of motor function and muscle coordination. A group of neurological disorders appearing in infants or children affecting movement and posture that often occurs before birth is known as Cerebral Palsy (CP).

Epidemiology

Being one of the most severe physical disabilities in childhood, current estimated incidence is 2-3 per 1000 live births in developed countries, 1.5-4 per 1000 infants worldwide and 4 million people in India annually.

Causes

Maternal and fetal infections causes damage to the developing brain disrupting its ability to control movement and maintain balance. It occurs before birth, though it could also occur during and after birth. Many children have congenital CP (born with it; undetected for months/years) whereas few have acquired CP (brain damage in initial months/years, brain infections- bacterial meningitis or viral encephalitis, problems with blood flow to the brain from an accident/fall/child abuse). Though there have been many cases till date but actual cause of CP is not known.

Types of cerebral palsy

On basis of predominant motor (type of movement) disorder, classification involves: spastic (stiff muscles and awkward movements), athetoid (writhing movements), or ataxic (poor balance and coordination) occurring with other symptoms like weakness (paresis) or paralysis (plegia). The most common type of disorder is Spastic CP.

Common signs and symptoms

Poor balance and muscle coordination, stiff muscles and exaggerated reflexes; weakness in limbs; walking on the toes; a crouched/scissored gait, muscle tone variations; excessive drooling, swallowing or speaking difficulty; shaking or random involuntary movements; writhing movements; sucking or eating difficulty; delays in speech development; learning difficulties; delays in reaching motor skill milestones; difficulty with precise movements such as writing or buttoning a shirt.

How is it diagnosed

Diagnosis is done during the first 2 years of life where development, growth, muscle tone, age appropriate motor control, hearing, vision, posture, and coordination is monitored to rule out other disorders through a series of tests. In the brain, imaging technologies can reveal areas of damage or abnormal development. Magnetic resonance imaging (MRI) scan detects and identifies lesions or abnormalities in a child's brain indicating a potentially treatable movement disorder whereas cranial ultrasound provides a valuable preliminary assessment of an infant brain. Laboratory tests identify other conditions causing symptoms similar to CP. Blood, urine or skin test aid in screening of genetic or metabolic disorders and identify problems with vision, hearing, speech, intellect, development, and movement.

Management

• After diagnosing and determining the type of CP, strategies to tackle core disabilities are developed. Therapies include:
• Physical therapy: starts immediately on diagnosis or first few years of life.
• Occupational therapy: optimizes upper body function and improves posture.
• Recreation therapy: encourages participation in art, cultural programs, sports, and other events to improve physical and cognitive abilities.
• Speech therapy: aids with communication abilities and swallowing disorders.
• Treatment with drugs: first line of treatment; relaxes contracted, stiff or overactive muscles eg. Diazepam, tizanidine, baclofen, etc.
• Nerve injections: tightens a specific muscle.
• Orthopedic surgery: recommended only when walking and moving around is very painful.

Selective dorsal rhizotomy (SDR): surgery to cut nerves; practiced only when spasticity is very severe and when treatmentment with drugs, injections and surgery have failed.

Devices for assistance: Computers, voice synthesizers and images improve communications skills.

Alternative Therapies: used in some form for children and adolescents.

Prognosis

CP can’t be cured, but a child's capabilities to enjoy near-normal adult lives is improved by treatment, however, early treatment increases chances of overcoming developmental disabilities. Although, predicting prognosis in a child before the age of two is difficult because there is no standard therapy but the case does not worsen much since the disorder is non-progressive. Continuous mental and physical development makes accurate prediction of prognosis difficult. Prognosis is done based on neuro-imaging, clinical assessment and evaluation.

The child's physical and mental disabilities help in predicting the outcome and life expectancy of the condition where most children with CP live longer, happy and normal lives with regular visits to the health care professionals and require therapy, medications or surgery. To select appropriate treatment and develop, target, and evaluate interventions, early identification and management of factors mediating efficient long-term results is critical to assist health care professionals.