CEREBRAL PALSY
|
Written by Kyle James, Consultant Paediatric Orthopaedic Surgeon, 2014
What is Cerebral Palsy (CP)?
Cerebral palsy is the name given to a variety of conditions where there is a disorder of movement or posture caused by damage to areas of the brain that control the muscles. This may be caused by a developmental abnormality or an injury to the brain it its early stages of development. It is a permanent condition and is the most common cause of disability in children. Causes of Cerebral Palsy In many cases the cause cannot be identified. It is known that the developing brain may be damaged by exposure to infections during pregnancy or infancy. Other causes include prematurity, bleeding in the brain, lack of oxygen, low blood sugar levels, severe jaundice or a brain injury shortly after birth. There are also some rare inherited conditions. Types of Cerebral Palsy Cerebral Palsy can be classified by the type of movement disorder it causes. Listed below are some common types: Hemiplegia Mostly affects one side of the body. Usually children walk with a limp and have one affected arm. Diplegia Affects both sides of the body. Mostly affects the legs and usually occurs after premature birth. Children may walk on their toes with or without bent knees. The legs can turn in and cross at the knees (called scissoring). Children are often able to walk small distances, but more severely affected children require a wheelchair. They can also have difficulty with fine motor activities such as handling objects with their hands or writing. Quadriplegia The most severe form of CP. Both arms and legs are affected. Children are less likely to walk or sit without help. They may have problems with speech and feeding, learning, vision and hearing. They may also have epilepsy (prone to fits). Dyskinetic Cerebral Palsy Children with dyskinesia have difficulties with movement control – twisting (dystonia) or jerking (chorea) or writhing (athetosis) movements. Dyskinesia often occurs in conjunction with muscle stiffness (spasticity). Ataxic Cerebral Palsy The least common form of CP. Child shows a lack of balance and co-ordination. Staggers when walking and falls over a lot. May have difficulty with talking. Children with CP may also have mixed patterns of the types mentioned above. |
Orthopaedic Problems seen in Cerebral Palsy
Children with cerebral palsy often have increased tone (spasticity) in certain muscles while other muscles may be weakened. Children may have poor control or coordination of their muscles. Imbalance between muscles that stretch and bend around the joint can lead to the shortening of muscles (contractures) which are exacerbated as children grow. As a consequence muscle and joint problems can progressively change with growth. Problems include: Spine: Can develop a curvature called scoliosis. Hip: In some children, the imbalance in the hip joint can lead to pulling of the head of the thigh bone out of its position in the hip joint leading to hip dislocation. In other children it can cause the leg to turn in and cross at the knees (called scissoring) due to twisting of the hip and thigh bone. Knee: Flexion contracture – inability to straighten knee Ankle and Foot: Equinus contracture – tip toe walking. Arm and Hand: Inability to straighten the elbow, hand or fingers and coordinate movements limits children’s ability to handle objects and perform tasks. Children with Cerebral Palsy may also have other associated problems which need to be considered when providing care such as: Vision and hearing problems Speech and language problems Feeding problems – reflux or constipation Incontinence – problems with bowel and bladder control Epilepsy – fits Cognitive impairments. Intellectual disability, learning problems and perceptual difficulties are common. There is a wide range of intellectual ability and children with severe physical disabilities may have normal intelligence. Hip and spine surveillance in cerebral palsy Children with severe (non-ambulant) cerebral palsy (CP) are at high risk for hip dislocations and scoliosis. These conditions affect the care and quality of life of children and can cause pain. There are many strategies for the prevention or management of progressive hip displacement and scoliosis. The goals of these treatments are to prevent or reduce pain; to facilitate care-giving such as dressing, toileting/perineal hygiene, seating, positioning, transfers and other activities of daily living and recreation; and to preserve or optimize the quality of life of these children and their parents/caregivers. However, it is very important that preventive measures are taken at an early stage in order to achieve the best possible effect. As a result children who are at the greatest risk of hip dislocation and scoliosis are followed-up regularly with medical examination and radiological (x-ray) assessments. |
Treatments for CP
There is no cure for CP. Active management from an early age will help your child reach their full potential. The combined efforts of parents/ care givers, doctors and therapists both in the community and at the hospital can help a child achieve their goals. As a parent or care giver you should be fully involved in your child’s care, and the decisions made about your child’s treatment.
Encouraging Movement
It is important to help your child to move, stand and, if they can, to walk as well as possible. The muscles and joints in the limbs can become stiff and lead to bone deformities. Children’s muscles need to be used and stretched in order to grow properly. These shortened muscles and tendons are called contractures and are one of the most common problems with CP.
Physiotherapy and occupational therapy
Involves the use of stretching, strengthening, casting, splints and bracing, positioning and aiding movement. This is an essential part of the treatment plan of a child with Cerebral Palsy. Appropriate equipment and, where necessary, changes to the home may be advised to assist your child’s needs.
Medications
Reduction of muscle spasticity and spasms in the early stages of CP can assist in reducing permanent muscle shortening. This is often advised by doctors involved in your child’s care. Examples of medications are Baclofen, Diazepam and Botulinum Toxin Injections).
Botulinum Toxin Injections
Botulinum toxin type A (Dysport® or Botox®) is a medication used to treat children with spastic or dystonic Cerebral Palsy. Botulinum toxin injections work by decreasing the muscle stiffness (spasticity or dystonia), thus allowing easier movements. The results from botulinum toxin treatments are different for each child. Results are related to the severity of the muscle stiffness, extent of contractures, the age of the child and subsequent therapy. Improvements are usually seen 2-4 weeks after treatment and can be maintained up to 4-6 months. Repeated injections are usually required.
Surgery
Surgery is sometimes needed when muscle contractures are severe enough to cause permanent restrictions of movement or bone deformities. There are several types of surgery used to lengthen muscles, realign bones and treat contractures. The aim of surgery is to improve movement and function, to allow easier care of the child and in some cases to prevent painful complications such as dislocated hips.
There is no cure for CP. Active management from an early age will help your child reach their full potential. The combined efforts of parents/ care givers, doctors and therapists both in the community and at the hospital can help a child achieve their goals. As a parent or care giver you should be fully involved in your child’s care, and the decisions made about your child’s treatment.
Encouraging Movement
It is important to help your child to move, stand and, if they can, to walk as well as possible. The muscles and joints in the limbs can become stiff and lead to bone deformities. Children’s muscles need to be used and stretched in order to grow properly. These shortened muscles and tendons are called contractures and are one of the most common problems with CP.
Physiotherapy and occupational therapy
Involves the use of stretching, strengthening, casting, splints and bracing, positioning and aiding movement. This is an essential part of the treatment plan of a child with Cerebral Palsy. Appropriate equipment and, where necessary, changes to the home may be advised to assist your child’s needs.
Medications
Reduction of muscle spasticity and spasms in the early stages of CP can assist in reducing permanent muscle shortening. This is often advised by doctors involved in your child’s care. Examples of medications are Baclofen, Diazepam and Botulinum Toxin Injections).
Botulinum Toxin Injections
Botulinum toxin type A (Dysport® or Botox®) is a medication used to treat children with spastic or dystonic Cerebral Palsy. Botulinum toxin injections work by decreasing the muscle stiffness (spasticity or dystonia), thus allowing easier movements. The results from botulinum toxin treatments are different for each child. Results are related to the severity of the muscle stiffness, extent of contractures, the age of the child and subsequent therapy. Improvements are usually seen 2-4 weeks after treatment and can be maintained up to 4-6 months. Repeated injections are usually required.
Surgery
Surgery is sometimes needed when muscle contractures are severe enough to cause permanent restrictions of movement or bone deformities. There are several types of surgery used to lengthen muscles, realign bones and treat contractures. The aim of surgery is to improve movement and function, to allow easier care of the child and in some cases to prevent painful complications such as dislocated hips.
Cerebral Palsy is the most common cause of disability in children.
Cerebral Palsy is not a single disorder but a group of disorders with diverse implications for children and their families.
Treatment of CP consists of active management from an early age.
Physiotherapy and occupational therapy is an important part of managing CP.
Some children benefit from speech therapy, medications and surgery.
Cerebral Palsy is not a single disorder but a group of disorders with diverse implications for children and their families.
Treatment of CP consists of active management from an early age.
Physiotherapy and occupational therapy is an important part of managing CP.
Some children benefit from speech therapy, medications and surgery.
