Imagine a world where a simple task like tying
your shoelaces becomes an extraordinary achievement.
That's the daily reality for individuals living with Cerebral
Palsy. Cerebral palsy (CP for short) is the most common cause
of childhood disability and occurs in around 2 in 1,000 births.
CP describes a group of permanent disorders of abnormal movement, tone, and posture,
causing activity limitation attributed to
non-progressive disturbances that occurred in the developing,
fetal or immature
Brain. There are different types of CP
Classifications based on the predominant motor syndrome.
However, mixed presentations are not uncommon. Some types of CP are,
spastic hemiplegia CP, where the patient has spasticity,
which means stiffness and tightening of the muscles,
and motor difficulties affecting one side of the body with the arms
Often more involved than the legs. Spastic diplegia CP, where the patient
has spasticity and motor difficulties affecting the legs,
more than the arms. Spastic quadriplegia
CP, where the patient has spasticity and motor difficulties affecting all four
extremities, with often more involvement of the upper extremities than the legs
Dyskinetic CP,
Where the patient has excessive involuntary movements characterized
as a combination of Rapid dance-like contractures of muscles and slow writhing movements.
CP occurs due to an injury to the
Developing brain in the prenatal through neonatal period.
Essentially when the baby is growing
Inside of the mother. Prenatal and perinatal causes include congenital
Brain malformations, where intracerebral hemorrhage and periventricular leukomalacia
Are the main pathologic findings. Post-neonatal onset CP can also occur and are usually due to traumatic Central Nervous System
Infections, stroke, anoxic insults, brain injury, near drowning and meningitis.
Prematurity and low birthweight, maternal infections, and pregnancies with more than one baby are all also risk factors for CP.
A diagnosis of
CP is first suspected when there is a failure to reach certain key milestones
at expected ages. Early diagnosis is possible by looking at patients medical history, checking how well they can move, running
Genetic tests to find any metabolic issues and
using special images called MRIs to see if the brain,
has any unusual problems or damage from birth.
Finding out about CP in kids when they're very young,
can help make their health better because
we can do things to help the brain learn and change.
Doctors usually become more certain about CP
when a child is around two years old, but
if they can't be sure when the child is even younger,
They might say it's high risk
Of CP, so that they can start special treatments early. All children with cerebral
palsy have, by definition motor impairment and
difficulties with tasks involving Motor Performance.
The clinical features of CP vary across a broad range of abnormalities.
Although the initial neuropathologic Lesion of CP is non-progressive,
these children may develop secondary conditions
over time that will variably affect their functional abilities.
The motor disorders of CP are often accompanied by disturbances of sensation,
perception, cognition, communication, behavior, epilepsy,
feeding problems and by secondary musculoskeletal problems.
Common related conditions include seizures restrictive, lung disease.
Chronic lung disease, obstructive sleep apnea, oral motor
dysfunction, and feeding difficulty, drooling, poor
nutritional status and growth, ulcers and hearing impairments.
Some more related conditions are poor dental
hygiene, a bad bite, speech and language impairment, migraines,
hip dislocations, muscle spasms, sleep disturbances,
and also lots of Psychosocial, behavioral and
cognitive issues. With regards to musculoskeletal conditions,
studies show, That one in three children in high-income countries,
experience progressive hip displacement
as a complication of their cerebral palsy, except in the Nordic countries, where
rates are substantially lower. Spastic quadriplegic
CP is a permanent neuromuscular disorder causing limitation
on all four limbs following a lesion on the developing brain. Lesions in CP,
especially in spastic quadriplegic
Children often cause damage to more than one system,
resulting impairments that influence movement control and other functions.
Most children with spastic quadriplegic
CP have more comorbidities compared to the other types.
Spastic quadriplegic CP is characterized by weak and inactive postural muscles of the neck and trunk.
Thus, a child with spastic quadriplegic CP would have trouble moving their head to the midline
and keeping it there. They also can't tuck their
chin when lying on their back. To make up for this,
They might stretch their whole body,
which causes them to move in a strange way. This can lead
to problems in many parts of the body. The way a child with spastic quadriplegic
CP, tries to make up for the movement difficulties causeds their body,
to be off balance, which negatively affect how they
breathe and can lead to problems with their chest and lungs.
Furthermore, the movement of the diaphragm in spastic quadriplegic CP is restrained
due to lesions in the motor regions of the brain and spine causing decreased muscle strength.
As a result, the mechanics of breathing may be impaired as well as induce multisystem consequences: limited function of mouth and throat
muscles, drooling, swallowing difficulty, acid reflux, constipation, sleep disorder and pain.
Due to the use of many exceptional prevention treatments,
The rate of cerebral palsy has fallen by 30% in some high-income countries.
Prevention of premature and low birth weight
births is the most significant consideration in reducing the
overall incidence of CP. Multiple Associated and secondary medical condition.
Its management requires a multidisciplinary team approach.
Although, in most cases of CP,
no treatable underlying etiology is identified, an
etiological evaluation should be considered to identify
certain treatable conditions associated with disturbances of neuromotor development.
Early intervention is very important. examples of CP specific
early intervention is found to be effective in improving
neuromotor function
include the use of constraint-induced movement therapy in hemiplegic CP,
and early, intense, enriched, task specific
training-based interventions
at home. Physiotherapy and occupational therapy by ages 4
to 5 have been shown to be relatively more effective than if started at a later
age. Medicines like botulinum toxin can be helpful for kids with spasticity in their legs.
They work best when kids are between 1 and 6 years old for leg
spasticity, and between 5 and 15 years old for spastic hemiplegia.
There are also other medications like baclofen, intramuscular phenol shots,
Valium, clonazepam, tizanidine, clonidine and dantrolene that can be used to help with spasticity.
These medicines come in different forms liked pills or injections,
and it can be beneficial for managing muscle tightness.
Nonpharmacologic treatments also exist! Examples of these
treatments range from physiotherapy, occupational therapy,
use of adaptive equipment and orthoses, orthopedic surgical procedures,
and surgeries that removes problematic nerve roots
in the spinal cord. Physiotherapy helps by enhancing muscle strength, endurance,
joint flexibility and preventing joint problems.
It involves regular resistance exercises
to make muscles stronger, and higher repetition exercises,
to improve endurance. Specific exercises also
target balance, posture, walking and movement
from one place to another, like from a bed to a wheelchair. Constraint-Induced
Therapy is a method for helping children with CP make the weaker arm stronger.
The idea is to encourage the child to use their weaker arm more and limit the
use of the stronger arm. However, if the stronger arm is restricted for too long,
it can become weaker because it is not being used.
Fine motor function of upper extremities to assist a child
In performing activities of daily living more efficiently. Occupational therapists
also works in organization of child’s play
areas, providing adaptive equipment for self-care
and learning and to modify child's learning environment
to facilitate attention and information processing.
For surgical procedures, a common practice consideration is to fix multiple issues in one surgery to avoid multiple exposure to anesthesia risk
and other operative risks. Also, this approach allows for a planned course of post-operative
rehabilitation. In the long-term management of children with CP,
It is important to determine how much assistance is
required on a daily basis for optimal functioning. Orthoses,
adaptive equipment, and assistive technology devices are used to improve a child's
functional abilities and facilitate activities of daily living. Assistive technology device refers to any item,
piece of equipment, or product system
whether acquired commercially off the shelf, modified, or customized, that is used
to increase, maintain, or improve functional capabilities of a child with a disability.
October 6th marks the celebration of World Cerebral Palsy day. Take this day as an opportunity to celebrate the strength of those with
cerebral palsy and the beauty of diversity
In our world. We can get involved in supporting people
suffering from CP by further educating ourselves and
donating to organizations such as the Ontario Federation for cerebral palsy,
also known as the OFCP. The OFCP supports
independence, inclusion, and full integration of all people with CP.
OFCP also provides many resources and programs for the families of people with CP as well!
Thanks for watching and I hope this video helped you gain a more clear
understanding of what cerebral palsy actually is!