A disorder resulting from damage to the brain during fetal development or in infancy. It is characterized by weakness, paralysis, rigidity, and lack of co-ordination of movement; the muscular spasms involved have led to the use of the term spastic for these children. A high proportion of children also suffer from epilepsy, and some are retarded mentally. Several types of brain injury are responsible, including maternal diseases during pregnancy, lack of oxygen during birth, and viral infections during infancy, but the cause is unknown in many cases.
| ICD-9 | 343 |
|---|---|
| DiseasesDB | 2232 |
| eMedicine | neuro/533 pmr/24 |
| MeSH | D002547 |
Cerebral palsy (CP) is an umbrella term encompassing a group of non-progressive neurological physical disabilities in the development of human movement and posture. CP arises from disturbances in the developing fetal or infant brain. The incidence in developed countries is approximately 2-2.5 per 1000 live births, and incidence has not declined over the last 60 years despite medical advances like electro-fetal monitoring. Cerebral palsy can occur during pregnancy (~75%), at birth (~5%) or after birth (~15%). There is no known cure for CP: medical intervention is limited to the treatment and prevention of complications possible from CP's consequences. Overall, cerebral palsy ranks among the most monetarily costly congenital conditions in the world to manage effectively.
Cerebral palsy is divided into four major classifications to describe the different movement impairments.
In 30% of all cases of cerebral palsy, the spastic form is found along with one of the other types. There are a number of other minor types of cerebral palsy, but these are the most common. Onset of arthritis and osteoporosis can occur much sooner in adults with CP. Further research is needed on adults with CP, as the current literature body is highly focused on the pediatric patient. CP's resultant motor disorder(s) are sometimes, though not always, accompanied by "disturbances of sensation, cognition, communication, perception, and/or behavior, and/or by a seizure disorder” (Rosenbaum et al, 2005).
General Classification
Ataxia (ICD-10 G80.4): Persons with ataxia have damage to their cerebellum which results in problems with balance, especially while walking. Spastic cerebral palsy is further classified by topography, dependent on the region of the body affected.Types of Spastic CP
Based on the group of muscles involved, the below are typically only used to further describe spastic CP.
Occasionally, terms such as monoplegia, paraplegia, triplegia and pentaplegia may be used.
Presentation (signs and symptoms)
All types of cerebral palsy are characterized by abnormal muscle tone, posture, reflexes, or motor development and coordination. The classical symptoms are spasticity, unsteady gait, and dysarthria, and soft tissue findings consist largely of decreased muscle mass, but taken on the whole, CP symptomatology is as diverse as the individuals who have it.
Secondary symptoms can include speech or communication disorders, seizures, hearing or vision impairment, cognitive disabilities, learning disabilities, and/or behavioral disorders.
Prevalence is best calculated around the school entry age of about six years. This amounts to approximately 5,000-10,000 babies born with cerebral palsy each year in the United States.
Each year, around 1,500 preschoolers are diagnosed with the disorder in the USA. it does not solely occur from brain damage, but from an individual(s)'s ability to 1) communicate with the child and 2) be able to have the child effectively communicate through speech or other means. For example, a child that had CP who suffers from blindness/deafness due to damage that occurred in the occipital and temporal lobes during birth could use tactile sign-language or tulonoma to communicate. Other disorders paired with CP include disorders of hearing, eyesight, epilepsy, perception of obstacles (such as judging how far away things are when driving a car), speech difficulties, and eating and drinking difficulties.
Overall, advances in care of pregnant mothers and their babies has not resulted in a noticeable decrease in cerebral palsy.
Most recently, Apgar scores have been indicated to not be a reliable method of determining whether or not an individual has CP;
Despite medical advances, the incidence and severity of cerebral palsy has actually increased over time.
History
Cerebral palsy, then known as "Cerebral Paralysis", was first identified by English surgeon William Little in 1860. Research conducted during the 1980s by the National Institute of Neurological Disorders and Stroke (NINDS) suggested that only a small number of cases of CP are caused by lack of oxygen during birth.
Motor difficulties are common in individuals with CP. The brain's plasticity at a young age is probably one of the main reasons for the steep differences between individuals with CP.
Cause
Since cerebral palsy refers to a group of disorders, there is no exact known cause. Some major causes are asphyxia, hypoxia of the brain, birth trauma or premature birth, genetic susceptibility, certain infections in the mother during and before birth, central nervous system infections, trauma, and consecutive hematomas. After birth, the condition may be caused by toxins, physical brain injury, incidents involving hypoxia to the brain (such as drowning), and encephalitis or meningitis. However the cause of most individual cases of cerebral palsy is unknown.
Recent research has demonstrated that intrapartum asphyxia is not the most important cause, probably accounting for no more than 10 percent of all cases; rather, infections in the mother, even infections that are not easily detected, may triple the risk of the child developing the disorder, mainly as the result of the toxicity to the fetal brain of cytokines that are produced as part of the inflammatory response.
Premature babies have a higher risk because their organs are not yet fully developed. This increases the risk of asphyxia and other injury to the brain, which in turn increases the incidence of cerebral palsy. Periventricular leukomalacia is an important cause of cerebral palsy.
Also, some structural brain anomalies such as lissencephaly cause symptoms of CP, although whether that could be considered CP is a matter of opinion (some people say CP must be due to brain damage, whereas these people never had a normal brain).
Bones
In order for bones to attain their normal shape and size, they require the stresses from normal musculature. Osseous findings will therefore mirror the specific muscular deficits in a given person with CP. Depending on the degree of spasticity, a person with CP may exhibit a variety of angular joint deformities.
Prognosis
Cerebral palsy is not a progressive disorder.
The ability to live independently with cerebral palsy varies widely depending on severity of the disability. Some individuals with CP will require personal assistant services for all activities of daily living. However, in most cases, persons with CP can expect to have a normal life expectancy; As the condition does not directly affect reproductive function, many persons with CP can have children and parent successfully.
Treatment
There is no cure for cerebral palsy, but various forms of therapy can help a person with the disorder to function more effectively. For instance the use of a standing frame can help reduce spasticity and improve range of motion for people with CP who use wheelchairs. Non-speaking people with cerebral palsy are often successful availing themselves of Augmentative and Alternative Communication systems such as Blissymbols.
Cultural Dimensions
See also: United Cerebral PalsyPublic perception
Those with Cerebral Palsy are sometimes stigmatized and shunned. This has lessened since the 1950s thanks to public education and United Cerebral Palsy and its affiliates.
Thomas Galton believed that there was a correlation between physical disability and aptitude, and this attitude remained prevalent as concerned CP until the 1970s. At this time, cerebral palsy was an overdiagnosed disorder, and a common misunderstanding then and now is that CP causes mental retardation. In fact, only CP individuals with brain damage in the hippocampus or the frontal cerebral cortex develop mental retardation. While learning difficulties and CP may co-occur, it is common for individuals with CP to lead normal lives.
Use of the term "spastic"
The term "spastic" describes the attribute of spasticity in types of spastic CP. The term "spastic" was used by the charity as a term for people with cerebral palsy. In the United States the word spastic has the same usage as an insult, but is not generally associated with CP.
Cerebral Palsy Claimed as a Learning Disorder
One scholarly point of view makes the claim that the motor disorders of CP can be accurately seen as inherently leading to learning problems (Hari and Tillemans, 1984) wherein the condition, even though it is physical, leads to secondary learning difficulties stemming from the initial trauma. Not all scholars or educated members of the public agree with this analysis, but some of its conclusions do correlate to a lot of the everyday difficulties experienced by adults with certain types of CP.
In this view, while the original brain damage is non-progressive, its effect upon all areas of development may be constantly changing and can result in, a generalized dysfunction. A motor disordered child, after brain injury, is still actively attempting to solve problems arising from tasks in the environment.
Experimentation in support of this idea includes Taub’s study (1980) on the deafferentation of a limb in monkeys which started to use the deafferented limb again for functional activities once his intact limb was restrained.
The above can account for the exhibition of various non-functional and stereotyped motor patterns in a child with a motor disorder. Dysfunction is not static or localized and it affects the whole personality of the child with cerebral palsy.
The dysfunction of the child is not the maladaptive movement pattern itself, but the result of an interrupted learning process. While the origin of Cerebral Palsy is medical, the consequences interrupt the general learning ability of the individual. It can be concluded that instead of thinking in therapy and adaptation, by applying an appropriate educational approach such as Conductive education the individual may learn to overcome the consequences of the motor disorder.
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