Cerebral palsy is a neurological disorder of movement, muscle tone, and posture caused by damage to the brain, either before, during, or in the first few years after birth. (6) Cerebral refers to the brain, and palsy means a muscle problem or weakness. (1) Cerebral palsy does not progress; it is one-time an injury to the central nervous system before the age of two. (5) Because of the varied intensity in symptoms of cerebral palsy, some children with the disorder may live long and happy lives while others may succumb to their condition. (8)
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Most children who have cerebral palsy have Congenital Cerebral Palsy, which means that they were born with the disorder, but there are some cases in which the damage to the brain occurred after birth, and so the child would have Acquired Cerebral Palsy. There are numerous causes of cerebral palsy and in many cases the cause is unknown. (6) The damage to the brain can occur because of certain genetic conditions or mutations, shortage of oxygen at birth (hypoxia), infections in the mother or fetus, bleeding in the brain, acute jaundice, or any severe head injuries. (2)
There are certain medical situations that are risk factors for cerebral palsy. A baby born prematurely or underweight has a greater risk of developing the disorder. Another risk factor is infections or fever in the mother during pregnancy which can enter the womb and placenta and infringe on the fetus’s developing brain. Additionally, when a fetus has a different blood type than its mother, the mother’s body will send antibodies to the fetus which can harm the brain. (6) Other risk factors include: a low Apgar score, being a multiple, breech birth, and exposure to toxic substances. (2)
The brain has numerous parts which are each responsible for different aspects of functioning. The frontal lobe controls concentration, problem solving, speech, smell, and motor skills. The parietal lobe is in command of taste, body awareness, touch, and pressure. The occipital lobe is responsible for vision, and the temporal lobe is in charge of hearing, facial recognition, language, and hearing. Damage to the any of these parts of the brain is irreparable, and will cause disabilities in the area it controls (though with intervention there can be functional improvement). If the damage occurs in the prenatal, perinatal, or postnatal period it will result in cerebral palsy. (5)
In a typical child, there are four main elements of development: gross motor, fine motor, communication, and social. Gross motor skills include lifting the head, rolling over, sitting, crawling, walking, jumping, and balancing. Fine motor skills involve grasping, reaching, stacking blocks, feeding, dressing, and writing. Communication skills are required for being able to express oneself and to understand others. This encompasses cooing, laughing, babbling, following a command, and pronouncing basic words correctly. Social skills are important in order to have normal interactions with others. This consists of smiling, fearing strangers, playing games, helping with simple tasks, and taking turns. (3)
However, in a child with cerebral palsy the cerebral cortex of the brain is damaged, resulting in a loss of ability to properly control the muscles. (6) Due to this, a child who has cerebral palsy has significant delays in reaching developmental milestones. All four areas of development can be impaired at each stage in the child’s life. (3) Nevertheless, it usually becomes apparent that something is wrong when a baby fails to start rolling over, crawling, or walking. (9) Furthermore, uncoordinated movements, loose or tight muscles, and lingering infant reflexes are all problematic developmental signs prevalent among children with cerebral palsy. (4)
If a parent or doctor realizes that a child is showing signs of developmental delay, there are tests that can be used to diagnose cerebral palsy. Cranial ultrasounds take pictures of the brain, using high frequency sound waves, to identify which brain tissue is damaged. CT scans also show images of the brain, but in x-ray form. MRI scans can detect the location and type of the injury to the brain, using radio waves and a magnetic field. An electroencephalogram is used to monitor the brain’s activity by taping electrodes to the scalp of the child, and any abnormalities can be identified. (6)
Symptoms of cerebral palsy can be seen starting in infancy and through the years of early childhood. These symptoms include, but are not limited to, increased or decreased muscle tone, spasticity (tightening of muscles), rigidity, tremors, ataxia (lack of muscle coordination), seizures, difficulty walking, sucking, and eating, and delays or non-achievement of developmental milestones. Other symptoms associated with cerebral palsy are vision and hearing difficulties, seizures, incontinence, oral diseases, and intellectual impairment. (7) The symptoms also differ greatly from one child to another. As a result of the manner in which the brain of each child sustained the damage, one child can be paralyzed with a range of associated symptoms, and another can just have minor tremors or weakness. (8) In addition, cerebral palsy can be unilateral, which means that it affects only one side of the body, or it can be bilateral, in which it affects both sides of the body. (5)
Several complications can arise in a child with cerebral palsy as a result of the muscle problems and difficulties. Firstly, spasticity can cause contracture, which is when the muscles shorten and harden, leading to inhibited bone growth, bent or deformed bones and joints, and dislocation. Spasticity can also cause an early onset of osteoarthritis due to misaligned joints and muscles and pressure on joints. Secondly, difficulty eating and swallowing can make it hard for children with cerebral palsy to obtain adequate nutrition. In some cases a feeding tube is used to supply sufficient nutrition. (7)
Unfortunately, there is no cure for cerebral palsy. However, there are certain therapies and medical procedures that can help a child live with the disorder. (4) Physical therapy uses certain exercises to improve gross motor skills, balance, and muscle strength. Additionally, braces are used to stretch muscles, prevent contractures, and increase mobility. Occupational therapy helps improve functions of daily living, such as eating, dressing, hygiene, writing, and playing. Speech and language therapy is necessary to help a child with cerebral palsy communicate, either through speech, sign language, or a communication device.(6)
Medications for a child with cerebral palsy are most often used to reduce stiffness or contraction in muscles. These oral medications can include diazepam, tizanidine, baclofen, and dantrolene sodium. Injections, or implantable pumps are also used to administer medications to children who have limited or no muscle control. Surgeries are often performed to reduce spasticity and stiffness in the feet and legs when it becomes difficult to walk. Another type of surgery, called selective dorsal rhizotomy, is performed when all other treatments have failed. In this operation, the surgeon cuts nerves at the bottom of the spinal column to decrease the pain caused by extreme spasticity. (6)
Currently, research is being done to gain a clearer understanding of the specificities that cause cerebral palsy such as brain development and genetic defects. Furthermore, scientists are using neurobehavioral tests and imaging techniques to predict if a baby will have cerebral palsy. (6) Although cerebral palsy cannot be prevented, there are certain measures a person can take to reduce the risks. Taking care of one’s health and regularly seeing a doctor before and during her pregnancy are very important to ensure a healthy baby. Vaccinations are also imperative in order to prevent diseases and infections that could harm the fetus. Putting the proper child safety precautions into place by using car seats, bed rails, and bike helmets can prevent acquired brain damage. (7) Individuals with cerebral palsy must be treated with respect and care. Proper treatment and early and continuous therapies can increase comfort, function, and overall quality of life for a person with cerebral palsy.
References
Benaroch, R., MD. (2017, March 28). What Is Cerebral Palsy? What Causes It?
Retrieved November 15, 2018, from https://www.webmd.com/children/guide/ understanding-cerebral-palsy-basic-information#2
Gill, K., MD. (2018, August 17). Cerebral Palsy: Symptoms, Causes, Types, and
Treatments. Retrieved November 15, 2018, from https://www.healthline.com/health/cerebral-palsy
Miller, F., & Bachrach, S. J. (2017). Cerebral palsy: A complete guide for caregiving. Baltimore, MD: Johns Hopkins University Press.
Shrader, M. W. (Ed.). (2018, September). Cerebral Palsy. Retrieved November 15, 2018, from https://kidshealth.org/en/parents/cerebral-palsy.html
Cerebral Palsy Introduction. (2018, January 9). Retrieved November 15, 2018, from https://www.physio-pedia.com/Cerebral_Palsy_Introduction
Cerebral Palsy: Hope Through Research. (2013, July). Retrieved November 15, 2018, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Cerebral-Palsy-Hope-Through-Research
Cerebral palsy. (2016, August 25). Retrieved November 15, 2018, from https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999
Definition of Cerebral Palsy. (2018). Retrieved November 15, 2018, from https://www.cerebralpalsy.org/about-cerebral-palsy/definition
Cerebral Palsy: Symptoms, Treatments, and Causes of Cerebral Palsy. (2016). Retrieved November 15, 2018, from https://cerebralpalsygroup.com/cerebral-palsy/
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