PT Weekly: Cerebral Palsy

Cerebral palsy (CP) can be described as a group of disorders that affect muscle movement and coordination. It’s a permanent non progressive damage to an immature infant brain and it appears in early childhood. Depending on the area of the brain that is affected, it can manifest in vision, hearing, sensation, movement and posture disorder.
Cerebral means brain, palsy means weakness.

According to CDC, Center for disease control and prevention, CP is the most common cause of motor disabilities in children.

Signs and Symptoms of Cerebral Palsy
There are several symptoms of CP which vary from individual-to-individual and range from mild to severe. Symptoms depends on the affected area of the brain.
Listed are common signs;
1. Delayed developmental milestones, such as neck control, rolling over, sitting independently, or crawling.
2. Weak or poor sucking reflex
3. Variations in muscle tone, such as being flabby or too rigid
4.  Excessive drooling
5. Delays in speech development and difficulty speaking
6. Tremor and involuntary movements
7. Difficulty walking
8. Favoring one side of the body.
9. Neurological problems, such as seizures, and intellectual disabilities

Causes
Cerebral palsy is caused by an abnormality or disruption in growth of a developing infant brain. It occurs in pregnancy, during and after childbirth. In many cases, the cause is not always known, but there are several factors that can lead to problems with brain development, which include:

1. Bleeding in the brain while the baby is in the womb, during or after birth
2. Seizures at birth or in the first month of life
3. Traumatic brain injuries such as fall
4. Gene mutations that lead to abnormal development
5. Maternal infections that affect the developing fetus
6. Fetal stroke, an interrupted blood supply to the developing brain
7. Lack of oxygen to the brain related to difficulty in labour or delivery (birth-related asphyxia).
8. Being pregnant with multiples, such as twins or triplets
9. Bacterial meningitis Inflammation in the membranes surrounding the brain and spinal cord.
10. Viral encephalitis Inflammation in the membranes surrounding the brain and spinal cord.
11. Severe or untreated jaundice (Yellowing of the skin)
12. Breech presentation.
13. Low birth weight. (Less than 2.5 kilogram)
14. Babies born in less than 28 weeks are at higher risk of cerebral palsy.

Complications from cerebral palsy
Several complications either during childhood or in adulthood arise as a result of muscle weakness, abnormal muscle tone etc. Some of which are:

1. Contracture: Shortening due to severe muscle tightening (spasticity)
2. Premature aging: Some type of premature aging will affect most people with cerebral palsy in their 40s because of the strain the condition puts on their bodies.
3. Malnutrition: Swallowing or feeding problems can make it difficult for someone who has CP, particularly an infant, to get enough nutrition.
4. Mental health conditions: People with cerebral palsy might have mental health conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression.
5. Heart and lung disease.
6. Osteoarthritis: Pressure on joints or abnormal alignment of joints from muscle spasticity may lead to the early onset of this painful degenerative bone disease.
7. Osteopenia: Fractures due to low bone density can stem from several common factors such as lack of mobility, nutritional shortcomings and anti-epileptic drug use.

Types of Cerebral Palsy
1. Spastic Cerebral Palsy: Characterized by awkward reflexes, stiffness, contracture and abnormal gait.
2. Ataxic Cerebral Palsy: Causes problem with balance and coordination
3. Atethoid Cerebral Palsy: Characterized by mixture of hypo and hypertonia
4. Mixed Cerebral Palsy: Present with little signs of 2 or the 3 types of CP mentioned above.

Prevention
Most cases of cerebral palsy can’t be prevented, but the risk factors can be lessened. In pregnancy or while planning to become pregnant, ensuring the under listed steps help both the mother and the growing fetus keep healthy and minimize pregnancy complications:

1. Complete vaccination
2. Personal self-hygiene
3. Early and continuous prenatal care.
4. Practice good child safety. Prevent head injuries and infections
5. Avoid alcohol, tobacco and illegal drugs
6. Avoid self-medications
7. Pay close attention and check your baby for any changes. Eg Jaundice

Management
Cerebral palsy involves a multidisciplinary approach. The medical health professionals involved in the management of cerebral palsy are:

1. Neurologists
2. Physiotherapists
3. Ear, Nose and Throat Surgeon
4. Orthopedic Surgeons
5. Occupational therapists
6. Speech and language therapists
7. Psychologists
8. Special Educators
9. Rehabilitation Nurses

Physiotherapy Management
Primarily, the aims of management are to increase mobility and promote physical development such as sitting, crawling, and walking. Treatment should be started early and should aim to be continued on a regular a basis. So, the aims are:

1. Increase muscle strength and activation
2. Decrease muscle tightness and spasm
3. Encourage physical development through play therapy and everyday activities
4. Improve mobility with the use of different mobility aids.

All the above-mentioned aims can be achieved through series of exercises ranging from:
1.  Passive mobilization
2.  Passive stretching
3.  Rolling exercises
4.  4-2 point kneeling
5. Curl up exercises
6. Paraspinal stimulation
7.  Standing with standing box
8. Sitting
9. Night and day resting splints to maintain alignment and prevent contractures

Occupational Therapist Management
Occupational therapy can help with managing everyday activities and functions, like eating, getting dressed and using the bathroom. It does so by improving physical and cognitive ability and fine motor skills.

Benefits of Occupational Therapy
Occupational therapy is beneficial for children and adult with cerebral palsy in many ways. By optimizing upper body function and improving the coordination of small muscles, occupational therapy can help children with CP master the basic activities of daily living.

• Occupational therapy can help children by:
• Increasing their chance for independence
• Improving their ability to play and learn
• Boosting their self-esteem and confidence
• Helping them develop a workable routine
• Giving them a sense of accomplishment
• Improving their quality of life

Cerebral palsy is the most common movement disorder in children. Several potential treatments are being examined, including stem cell therapy. However, more research is required to determine if it is effective and safe.