Cerebral Palsy-

What is Cerebral Palsy?Cerebral palsy is a developmental disability that results from damage to or dysfunction of the developing brain. The impairments associated with cerebral palsy are nonprogressive but permanent. Varying degrees of disability related to functional mobility (movement and posture), daily living skills, and communication / socialisation skills results from these impairments.

Cerebral refers to the brain.
Palsy can mean weakness or paralysis or lack of muscle control.

Although Cerebral Palsy is a permanent condition, as a person learns and grows and practices skills, more control over movement may be achieved. No two individuals are affected in the same way … some people may suffer minor motor skill problems, while others may be totally physically dependent.

With effort it is possible to maximise function and minimise the disadvantage a person experiences as a consequence of disability or society and create new opportunities for greater participation and enhanced quality of life for people with cerebral palsy.

Types of Cerebral PalsyThere are four main types of Cerebral Palsy, each caused by whichever area of the brain is affected and extent of the damage. The types are generally classified according to how the muscles function, but no two people have exactly the same disability.

Spastic Cerebral PalsyThe most common type of CP. Spasticity means stiffness or tightness of muscles. This is most obvious when the child or adult tries to move.

Athetoid Cerebral PalsyAthetoid or athetosis is the term used for uncontrolled movements. This lack of control often leads to erratic movements when the child or adult starts to move.

Ataxic Cerebral PalsyThe least common type of cerebral palsy. Ataxic (or ataxia) is a term used to describe a lack of balance and coordination. It often presents as unsteady, shaky movements called TREMORS. Difficulties with controlling the hand and arm during reaching (overshooting or past-pointing) and problems with the timing of motor movements are also seen.

Mixed Type Cerebral PalsyThis term is used when more than one type of motor pattern is present and no one pattern is predominate.

How does Cerebral Palsy affect the body?Usually, there is a tension or ‘tone’ in the muscles, enabling us to stand or move our bodies freely. This ‘tone’ is controlled by messages from the brain. Cerebral palsy distorts messages from the brain to cause either increased muscle tension (called hypertonus) or reduced muscle tension (called hypotonus). Sometimes this tension or ‘tone’ will fluctuate, becoming more or less obvious.

Similarly, messages sent from the brain can be out of time, sent to the wrong muscle, or not at all.

Cerebral palsy can be categorised according to the parts of the body it affects:

Quadriplegia: all four limbs are affected. The muscles of the face and mouth may also be affected.Diplegia: all four limbs are affected, but the legs more so than the arms.

Hemiplegia: one side of the body is affected.Paraplegia: both legs, but neither arm is affected.

Causes of Cerebral PalsyDisorders of movement associated with Cerebral Palsy are usually the result of changes in, or injury to the developing brain, either before or during birth, or sometimes in early childhood. The precise nature of the injury is often not known, but is usually the result of a diminished blood supply and subsequent lack of oxygen to areas of the brain. This causes damage to cells in the brain. Some common causes of this type of brain damage include maternal infections during pregnancy, or accidental damage to the brain during a difficult birth; illnesses in a young child, such as meningitis, are other causes.

Recent research indicates that extremely premature babies may also be at risk. Similarly, the incidence of Cerebral Palsy appears higher in multiple births.

Signs in Early ChildhoodSigns in early childhood include :

Early feeding difficulties

Delayed development

Poor muscle control

Muscle spasms

Lack of coordination

Although the damage to the brain will not become worse, the effect on the body can become more obvious with age, and physical deformities can develop. Early detection and management can reduce the severity of the effects of the disability.

Associated DifficultiesCertain difficulties and medical conditions commonly occur in a child or adult with cerebral palsy. Some of these are:

EyesightThe most common eye problem is a squint. This may be corrected with glasses or in severe cases an operation. More serious eye problems are much less common.

HearingAll children with cerebral palsy should be seen by a specialist to check for hearing problems.

SpeechSpeech depends on the ability to control muscles in the mouth, tongue, palate and voice box. As these muscles may be affected, some people with cerebral palsy may find talking difficult. This situation will range from having no speech to those whose speech may only be slightly affected. Speech difficulties and difficulties associated with chewing and swallowing often occur together.

Spatial perceptionSome children with cerebral palsy cannot perceive space and relate it to their own bodies (for example, distances) or think spatially (for example, visualise a three dimensional building.

This is due to a problem in a part of the brain, and is not related to intelligence.

EpilepsyEpilepsy may develop in approximately one in three of all children with cerebral palsy. Others with cerebral palsy may develop epilepsy in adult life. There are various types of epilepsy and the seizures may range from occasional to more persistent. The condition is usually controlled with medication.

Intellectual or learning disabilityThere is a wide range of intellectual ability in people with cerebral palsy. Often it is difficult to assess learning ability in the early years. Severe physical disability does not indicate intellectual disability. In cases where it is known that there is intellectual disability this will range from mild to severe.

Some people have difficulty in learning to do certain tasks, such as reading, drawing or arithmetic, because a particular part of their brain has been affected.

Useful referencesCerebral palsy : a practical guide/ Marion Stanton. – Random House, 2002

/ Royal Children’s Hospital. Child Development and Rehabilitation . – Melbourne : Royal Children’s Hospital, Education Resources Centre ,http://www.rch.org.au/emplibrary/cdr/CPBooklet.pdf 2006 3rd ed.

Children with cerebral palsy: a parent’s guide/ edited by Elaine Geralis. – Woodbine House, 1998

Children with disabilities / Batshaw, Mark (ed) . 4th ed.- Sydney : Maclennan & Petty, c1997

http://www.acd.org.au/information/help.htm / Association for Children with a Disability Inc. . – Armadale, 1999

Handling the young cerebral palsied child at home/ Nancy Finnie. – Butterworth-Heinemann, 1997