Cerebral Palsy In Children

Lots of children born to this world are not so lucky so as to be born with perfect health. Some are born with several health problems. Others, even though born healthy, will develop serious illness during their initial stage of life. Both ways, if a child not attaining developmental milestones, it will be overwhelming for the parents and near and dear ones.

One of the common causes of childhood developmental disability is ‘cerebral palsy’.

What Is Cerebral Palsy (CP)?

Firstly, we need to mention here that cerebral palsy is not considered as a disease. It is a group of disorder affecting the child’s central nervous system. It happens when the parts of the brain controlling the ability to use the muscle get injured due to various reasons. Cerebral palsy is the most common disorder of childhood, which can weaken the motor skills of a child and affect his body movements and postures.

How Does Cerebral Palsy Affect The Child?

Cerebral palsy can affect the ability of the child to move and limit the capability of the child’s posture, balance, communication and thus affect his eating, sleep and learning. The affect varies from one child to other depending on the severity and the parts of the body which get effected by cerebral palsy.

• When the muscle in the mouth is affected, eating food becomes a difficult task. The sucking of food or fluid into the lungs (food aspiration) occurs
• Some children’s vision and hearing ability may get affected
• Most of the children with CP shows behavioral problems
• Tooth decay and osteoporosis are found among most children with CP
• Drooling is another significant effect of CP
• Intellectual disabilities are more common in children with CP

Does The Damage OF The Brain Gets Worse As The Child Grows?

Cerebral palsy doesn’t worsens over time. The brain damage that leads to cerebral palsy is generally non progressive. That is, there will be no ongoing degeneration of the brain. The initial damage occurred to the child’s brain will be the stretch of damage for the rest of the child’s life.

What Are The Causes Of Cerebral Palsy?

There are several causes that can lead to cerebral palsy. It can be a brain injury that might have occurred during the baby’s development in the womb or during the birthing processes of the baby. Some of the causes are:

1. Infections: Bacterial meningitis that affect the brain cause cerebral palsy
2. Premature babies: Babies who born preterm especially with body weight below 1 ½ kg are more prone to cerebral palsy
3. Jaundice: Untreated jaundice can damage the brain cells of the baby that may lead to cerebral palsy
4. Rh incompatibility: When the mother and fetus have different Rh factors, the mother’s body produce antibodies that can destroy the fetus’s blood cells. This can lead to jaundice in new born and can destroy the brain cells causing cerebral palsy
5. Oxygen deprivation: Poor blood flow to the brain due to some complication that can occur during the labor and delivery or due to some accidents, can result in cerebral palsy
6. Prenatal exposure: When the mother is exposed to mercury poisoning (from fish), drugs or alcohol during the pregnancy, the child’s chances of having cerebral palsy increases
7. Birth injuries: Injuries that cause to the brain of the child during the delivery can lead to cerebral palsy
8. Hemorrhage: Hemorrhages caused inside or just outside the brain due to some sort of accidents can end in cerebral palsy

What Are The Types Of Cerebral Palsy?

Depending on the level of severity the cerebral palsy can be broadly generalized as:

1. Mild: If the child is having mild cerebral palsy, he can move about without assistance. The child’s daily activities are not hindered. All the developmental milestones will be reached without much noticeable delay. Some symptoms like being clumsy, walking on tip toe, constant crying, and some abnormalities in muscle tone and lesser concentrating power when compared to other children of the same age can make one doubt about the possibilities of cerebral palsy.
2. Moderate: If the child is having moderate cerebral palsy, he will walk with a limp. Special leg braces or canes are needed to support for carrying out daily activities.
3. Severe: Child with severe cerebral palsy has to use a wheel chair or another special equipment to support the daily activities as all parts of child’s physical abilities is being challenged.
4. No cerebral palsy: If the damage of the brain occurred after the completion of brain development due to some traumatic brain injury or infections the child, so far normal, shows the signs of cerebral palsy.

Depending on the inefficiency to control body in the desired manner, cerebral palsy is classified into:

1. Spastic (pyramidal) Cerebral Palsy: Spastic cerebral palsy is characterized by increased muscle tone (hypertonic) resulting in very stiff limbs. Around 50% – 75% of cerebral palsy cases comes under this group. The pyramidal tract comprises of two sets of nerve strands liable for voluntary movements. Pyramidal Cerebral Palsy refers to the damaged pyramidal tract which implies increased muscle tone. The muscles contract continuously making the limbs stiff and rigid.
   Spastic or pyramidal cerebral palsy is further divided according to the number of limbs affected as follows: (for understanding the terms better, just keep in your mind that ‘plegia’ refers to paralysis).
   • Monoplegia: Paralysis is restricted to only one limb of the child
   • Diplegia: Here, the paralysis occurs to two limbs. More often both legs are impaired than the arms affecting the lower body
   • Hemiplegia: This condition indicates the arm and leg of one side of the body are affected
   • Triplegia: All the three limbs, could be both legs and an arm or both arms and a leg, are affected. More often both legs and one arm are affected. Sometimes it can be referred to one upper and one lower extremity and the face
   • Quadriplegia: Here, all the four limbs are affected. Normally, the middle part of the body and muscles that control the mouth, tongue, and windpipe of the child are affected too making the eating and talking troublesome
   • Double hemiplegia: Here though all four limbs are involved, one side of the body is more affected than the other
   • Pentaplegia: This is the most difficult condition in which neck and head paralysis are accompanied along with all four impaired limbs
2. Non-spastic (extra pyramidal) Cerebral Palsy: Non-spastic cerebral palsy is characterized by decreased muscle tone (hypotonic) resulting in loose floppy limbs. When the injury of the brain occurs outside the pyramidal track it will lead to non-spastic cerebral palsy. A typical characteristic of non-spastic cerebral palsy is uncontrolled movements that occur involuntarily. The movement could be fast or slow, or, repetitive or rhythmic.
   Non-spastic or extra pyramidal cerebral palsy is further divided into:
   1. Dyskinetic cerebral palsy: In Dyskinetic cerebral palsy, the muscle tone alters between loose and tight causing involuntary muscle movements. This usually affects face and neck, limbs and sometime the middle part of the body of the child making it hard for the child to sit straight or walk properly. It is further divided into:
      • Anthetoid CP: Here, the involuntary movements are concentrated in the arms, legs and hands
      • Dystonic CP: Here, the involuntary movements are more concentrated on trunk muscle resulting in fixed twisted posture
   2. Ataxic cerebral palsy: In ataxic cerebral palsy, which is the rarest type of CP, the entire body is involved and affects the coordinated movements. Problems arises involves:
      • Poor balance and walk with feet unusually apart
      • Interpretation of depth is impaired
      • Coordinating the eyes and hand becomes very difficult
      • Poor hand control

Apart from all these, mixed cerebral palsy is reported in some children with combinations of the various forms of cerebral palsy. For example, the limbs can be affected with spastic CP and other parts with non spastic or vice versa, blending stiffness and involuntary movements.

What Are The Symptoms Of Cerebral Palsy?

Not all the signs are visible at birth. The signs vary with the severity and the area of the brain affected. The most commonly found early childhood symptoms are:

• Delayed development
• Lack of coordination
• Difficulty with speech and speech disorders
• Early feeding difficulties
• Delayed motor skill development
• Poor muscle control
• Salivating uncontrollably
• Seizures
• Involuntary shaky movements
• Stiff muscles
• Irritability
• Respiratory problems

How Is Cerebral Palsy Diagnosed?

When a baby is born prematurely, or with some health conditions, the doctor will watch the baby closely for too tight or too loose muscle tone, or any developmental delays particularly in key areas of motor function such as: visual alertness, grasping the objects, holding the head up, rolling over, sitting, standing up, walking etc.
But when the baby is born without any risk factors, CP can’t be diagnosed during the first year of the baby’s life. However, anyway CP can be diagnosed before the second birth day of the baby as by then lots of signs and symptoms would surface. Your child’s doctor can confirm the doubt by running an MRI scan, CT scan or EEG.

How Is Cerebral Palsy Treated?

Early treatment is essential as the developing stage of the brain and the body will be more adaptable to the treatment. The treatment is not focused on curing but making the child capable of living as independently as possible. For this, there will be a team of specialists to treat the child. The team includes:

• Speech therapist to evaluate the child’s ability to understand speech and ability to speak
• Occupational therapist to review and encourage the child’s ability to do the everyday tasks like feeding
• Physical therapist to provide therapy for the too tight and too loose muscles and to evaluate the strength of the muscle
• Psychologists to treat the emotional distress
• Developmental pediatricians to evaluate and provide treatment for wide range of developmental and behavioral problems occur due to CP

Be a strong mother and make your child independent and face the world bravely. In spite of all the treatment, there is some magic that only a mother can do. Diagnosed with CP doesn’t mean that your child can’t chase his dreams. The world is full of people who have made it big in spite of physical limitations. Read about some of them here