Cerebral palsy is a congenital disorder of movement, muscle tone or posture, due to abnormal brain development often before birth. Cerebral palsy also affects hearing, sensation and vision. However, it is the most common motor disabilities in childhood.
Causes of Cerebral Palsy
The causes of cerebral palsy are typically idiopatic (unknown). Unusual brain development or injury to the developing brain can result to cerebral palsy. Due to the damage in the development of the brain the part of the brain controlling body movement, coordination, and posture is affected. This brain damage usually occurs before and during birth. Although there are congenital and acquired cause
Congenital Causes of Cerebral Palsy
- Asphyxia neonatorum: This is a lack of oxygen to the brain during labor and delivery and can cause brain damage that leads to cerebral palsy.
- Gene mutations: Genetic mutations can lead to abnormal brain development.
- Infections during pregnancy: When infection that travels from a mother to a fetus can cause brain damage and cerebral palsy. Examples of infections that are linked with cerebral palsy include chickenpox, German measles (rubella), and bacterial infections.
- Bleeding in the brain: intracranial bleeding can lead to brain damage and cerebral palsy.
- Abnormal brain development: Infections, fevers, and trauma can cause abnormal brain growth that leads to cerebral palsy.
Acquired Causes of Cerebral Palsy
It is known as acquired cerebral palsy when it develops more than 28 days after birth
- Head trauma: A chronic head injury can lead to permanent brain damage. Common causes of head trauma include car collisions, falls, and assault.
- Infections: Occurrence of meningitis, encephalitis, and other infections can lead to permanent brain damage.
- Jaundice: Prolonged jaundice can lead to a type of brain damage called kernicterus. Which lead to cerebral palsy, vision problems, and hearing loss.
Risk Factors of Cerebral Palsy
The risk factor of cerebral palsy includes:
- Premature birth
- Low birth weight
- Low Apgar score
- Breech birth
- Rhesus incompatibility
- Substance abuse or certain medication
- being a twin or triple
Types of Cerebral Palsy
There are four mainly types of cerebral palsy according to the areas affected
Also there is combination of two types of cerebral palsy which is refers to as mixed cerebral palsy
Spastic Cerebral Palsy
Spastic cerebral palsy is the most common type of cerebral palsy, affecting higher number of people with the condition. It causes stiff muscles and exaggerated reflexes leading to difficulty in walking. It is characterized by unintentionally crossing their knees or making scissor-like movements with their legs, muscles weakness and paralysis.
Dyskinetic Cerebral Palsy
This condition causes unconscious, unusual movements in the arms, legs, and hands, inability to control their body movements. Which may also affects the face and tongue, characterized by slow or jerky movement leading to difficulty in sitting, walking, swallowing, and talking.
Ataxic Cerebral Palsy
This is the least common type of cerebral palsy. It is characterized by voluntary muscle movements that often appear disorganized, clumsy, or jerky. However, there is problem with balance, coordination, difficulty in walking and performing fine motor functions, such as holding objects and writing.
Hypotonic Cerebral Palsy
Hypotonic cerebral palsy lead to diminished muscle tone and overly relaxed muscles. The arms and legs move very easily and appear slacked. Difficulty in breathing and inability to control their head are most common in this type of cerebral palsy. As they grow, they struggle to sit up due to weakened muscles and poor reflexes, difficulty speaking, walking abnormalities may occur.
Mixed Cerebral Palsy
The combination of the different types of cerebral palsy is refers to as mixed cerebral palsy, people experience symptoms of both spastic and dyskinetic cerebral palsy.
Classification of Cerebral Palsy
Cerebral palsy is classified according to the Gross Motor Function Classification System (GMFCS for determining the physical capabilities of people with cerebral palsy. The system focuses on:
- The ability to sit
- The capability for movement and mobility
- Charting independence
- The use of adaptive technology
There are five levels of the GMFCS which includes:
- Level 1: This is characterized by being able to walk without limitations.
- Level 2: Level 2 cerebral palsy can walk long distances without range or limitations, but unable to run or jump. There are may be need for assistive devices like arm braces and wheel chair.
- Level 3: People under this level of cerebral palsy can sit with little support and stand without any support.
- Level 4: They are able to walk but with the use of assistive devices. They can move independently in a wheelchair, and need support when sitting.
- Level 5: Support to maintain their head, neck position, sit and stand is needed in this category.
Symptoms of Cerebral Palsy
Symptom of cerebral palsy varies in individual some of the more common symptoms include:
- The Delays in reaching motor skill milestones, such as rolling over, sitting up alone, or crawling
- Difficulty walking
- Changed in muscle tone, such as being too floppy or too stiff
- Lack of muscle coordination
- Tremors or involuntary movements
- Stiffness of muscle
- Prolonged in speech development and difficulty speaking
- Excessive drooling and problems with swallowing
- Favoring one side of the body, such as reaching with one hand
- Neurological problems, such as seizures, intellectual disabilities, and blindness
Diagnosis of Cerebral Palsy
To rule out cerebral palsy, medical history as well as physical examination that includes a detailed neurological exam, and evaluating the symptoms
Other test can be conducted which includes:
- Electroencephalogram (EEG): This is used to evaluate electrical activity in the brain. This procedure can be done when the patient shows the sign of epilepsy.
- MRI: An MRI uses powerful magnets and radio waves to produce detailed images of the brain which is used to identify brain irregularities or injuries.
- CT scan: It creates cross-sectional , clear 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 child brain. It’s relatively quick and inexpensive.
- Blood tests: A sample of blood is tested in order to rule out other possible conditions, such as bleeding disorders.
After confirmation of cerebral palsy, a neurological test id conducted to rule out associated neurological problems. These tests may detect:
- Vision loss and impairment, such as blurred vision in one or both eyes
- Speech delays
- Intellectual disabilities
- Movement disorders
Treatment of Cerebral Palsy
The goal of treatment is to prevent complications. Treatment may include
- Assistive aids
Assistive aids include:
- Hearing aids
- Walking aids
- Body braces
Spasticity symptoms are commonly treated by muscle relaxant which helps to relax the muscles and reduce pain from muscle spasm
- Dantrolene (Dantrium)
- Diazepam (Valium)
- Tizanidine (Zanaflex)
Surgery may be used as an option to relieve pain. This surgery can also be use to release tight muscles or correct bone irregularities caused by spasticity. Selective dorsal rhizotomy (SDR) will be used as a last method of treatment to reduce chronic pain or spasticity. This surgery involves the procedure of cutting to the base of the spinal column. Other Treatment
Other treatment therapy for cerebral palsy includes:
- Speech therapy
- Occupational therapy
- Physical therapy
- Recreational therapy
- Counseling or psychotherapy
Prevention of Cerebral Palsy
The most cause cerebral palsy cannot be prevented. However, during gestational period certain preventive measures can be done to minimize complications. Getting vaccine against German measles and all other conditions to prevents fetal brain damage, such as German measles. It is also important to receive adequate prenatal care by attending regular appointments during pregnancy can help prevent premature birth, low birth weight, and infections.
Complication of Cerebral Palsy
Potential complication of cerebral palsy includes:
- Premature aging
- Heart and lung diseases
- Chronic pain