Cerebral Palsy

What is cerebral palsy?

Cerebral palsy is a general term describing conditions that cause movement issues. The underlying cause is damage to, or faulty development of, part of the brain. This usually occurs sometime before birth. Cerebral palsy ranges from mild to severe. In some cases there are associated problems such as learning difficulties and epilepsy.

Cerebral palsy is not a single physical condition. Although the main problem is with the muscles in one or more parts of the body, the condition is caused by damage to the part of the brain which sends messages to the muscles, limiting movement and co-ordination. The damage or faulty development usually occurs as a baby is developing in the womb. Sometimes can also occur during, or shortly after, birth.

If someone has cerebral palsy, it means that they are not able to control some of the muscles in their body in the normal way.Depending on the type of cerebral palsy and the area of brain affected, a person may not be able to walk, move, talk, eat, or play in the same ways as other people.

Are there different kinds of cerebral palsy?

Cerebral palsy is classified into four main types - spastic, athetoid, ataxic and mixed. The type of cerebral palsy that occurs depends on the exact part of the brain that is affected. Spastic cerebral palsy

This type of cerebral palsy occurs in about 7 in 10 cases. Spastic means that the affected muscles are more stiff than normal. How stiff an affected arm or leg is, can vary greatly from case to case. Movements of an affected arm or leg are stiff and jerky. Some muscles may become permanently shortened and stiff. This is called contracted.

There are different words that are used to describe the type of types of spastic cerebral palsy. For example:

  • Hemiplegia - means the leg and arm of one side of the body are affected.
  • Diplegia - means that both legs are affected. Arms are not affected or are only mildly affected.
  • Quadriplegia - means that both arms and legs are affected

Athetoid or dyskinetic cerebral palsy

This type occurs in about 2 in 10 cases. Some people with this type of cerebral palsy have slow, writhing movements of the hands, arms, feet, or legs. Some people have sudden muscle spasms. These movements cannot be controlled and so are involuntary. Sometimes the tongue or facial muscles are affected. The stiffness (tone) of the muscles can vary from too high to too low.

Ataxic cerebral palsy

This type occurs in less than 1 in 10 cases. People with ataxic cerebral palsy have difficulties with balance and fine movement. This can mean loss of balance or being unsteady when walking. It could also make doing fine tasks with their hands difficult, such as writing. The muscle tone is usually decreased and they do not tend to be stiff.

Mixed cerebral palsy

People with mixed cerebral palsy have a combination of two or three of the above types.

What causes cerebral palsy?

In most cases the cause of the damage to the brain is not known. Many times it may simply be a chance error in the way the brain develops. However, some factors are known to increase the risk of developing cerebral palsy:

  • Preterm birth (premature babies) - in particular, babies born before 28 weeks of development.
  • Babies that are one of twins, triplets, or more.
  • Infections of the pregnant mother, such as rubella, chickepox and toxoplasmosis, may be a cause in some cases.
  • Severe jaundice in a newborn baby can be a cause.
  • There is an increased risk of having a child with cerebral palsy in mothers who smoke, drink a lot of alcohol, or take drugs such as cocaine.

It was thought that problems with labour and delivery were the main causes of cerebral palsy. However, it is now thought that less than 1 case in 10 is due to problems around the birth of a baby. For example, severe prolonged lack of oxygen during birth may be a cause in a small number of cases.

Problems can occur after birth. For example, meningitis or other brain infections that occur in young babies can cause brain damage resulting in cerebral palsy. Other accidental damage to the brain may result in symptoms that are very similar to cerebral palsy.

What is the treatment for cerebral palsy?

People with cerebral palsy should be under the care of a specialist team which includes various healthcare professionals such as doctors, nurses, physiotherapists, occupational therapists and speech therapists. There is no cure for cerebral palsy but much can be done to limit the degree of disability that may have occurred if treatment had not been given.

Physiotherapy: One main aim of physiotherapy is to (as far as possible) prevent or limit  the contractures and limb deformities that can occur with spastic cerebral palsy.

A physiotherapist may use various techniques such as exercises, mobility training, orthotics (braces, splints, etc), and other equipment. A physiotherapist can show parents and carers the correct positioning of joints and stretching exercises to do.

Medication: Medicines usually have a limited role. For example, botulinum toxin injections (in conjunction with physiotherapy) are used in some cases to relax spastic muscles. The most commonly injected muscles are the hamstrings, calf muscles and muscles that pull the hips together (hip adductors). The effect of a botulinum injection lasts 3-6 months.

Surgery: Depending on the type and degree of muscle contracture, an operation may help - for example, an operation to loosen tight muscles or to correct a joint deformity. The aim is to give more flexibility and control of the affected limbs and joints.

Other treatments and therapies

These may include: occupational therapy, speech therapy, vision aids, communications aids and nutritional advice. Assistive technology, such as special TV remotes and adapted computer equipment are being increasingly used, while standard and powered wheelchairs are still used. There are a range of devices and gadgets that can help with communication, mobility and daily tasks.

Sources:

Dr Tim Kenny (2015) Cerebral Palsy [Online] Available at: http://patient.info/health/cerebral-palsy-leaflet (accessed 31 January 2016)

Dr Laurence Knott (2015) Cerebral Palsy [Online] Available at http://patient.info/doctor/cerebral-palsy-pro (accessed 31 January 2016)

'What is cerebral palsy' - CP Cumbria v.1.3 - January 2016

Date for review: January 2017

 

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