Cerebral Palsy

In the middle of the nineteenth century, Dr. Little, an orthopedic surgeon, described a condition that later was called cerebral palsy (CP). Cerebral palsy is a disorder of movement and posture that is not progressive in nature; it is often associated with a seizure disorder as well as problems in the areas of speech, vision and intellect. Cerebral palsy results from an injury, defect or lesion to the developing brain of a fetus, newborn or infant.

Who is likely to develop cerebral palsy?

The prevalence of cerebral palsy is approximately four out of every one thousand live births. According to a paper published in 2002, it is more common in twin births. In most cases, the cause of cerebral palsy in a patient cannot be determined. Some children have congenital anomalies that may lead to CP; others may have suffered from low oxygen during the period around birth, some may have been exposed to infections or harmful drugs and others may have a genetic or chromosomal defect. There is an increased prevalence of CP among low birth weight infants.

It is easiest to understand the symptoms of CP by describing the motor handicap.

• Spastic hemiplegia: individuals with this type of CP have decreased spontaneous movements on the affected side and show a hand preference at an early age. This is more common in low birth weight infants than spastic diplegia. About one third of the patients have a seizure disorder and twenty-five percent have cognitive disorders.
•  Spastic diplegia is spasticity that affects both legs. Walking is delayed, but the prognosis for normal intellectual development is excellent.
• Spastic quadriplegia is the most severe form of CP. There is marked motor impairment of all extremities plus a high association with impaired intellect and seizures. There are associated problems with speech and vision, as well as difficulties in swallowing that could lead to poor growth.
• Athetoid CP is rare. The symptoms include poor muscle tone, head control and difficulty in feeding. Unusual motor movements may begin to occur around the age of one year. Athetoid CP may be due to perinatal birth injury due to a high level of a substance called bilirubin. High bilirubin may occur in the period shortly after birth due to breakdown of blood cells. Current technology usually is able to prevent complications of high bilirubin including athetoid CP.

A complete history and physical examination is performed. Since the symptoms and signs of CP will occur years before adolescence, most teens will have had the diagnosis established in early childhood. A complete neurological examination including a baseline electroencephalogram and imaging of the brain may also be performed. Testing for blood chemistries, congenital infection, chromosomes, hearing, visual function and developmental testing may also be performed.

A multidisciplinary team is usually necessary to give optimal care to individuals with CP. This team consists of physicians as well as a physical therapist, occupational therapist, speech pathologist, educator, social worker, and developmental psychologist. Since the symptoms of CP will vary among individuals, a number of different medical specialties may be called to assist in the care of the patient. These specialties include orthopedics, neurology, gastroenterology, otolaryngology, ophthalmology and physiatry.

The types of treatment available for children and teens with CP are myriad and depend on the child’s disabilities. For example, children with spastic diplegia are usually treated first with adaptive equipment in order to help them learn to walk. With the assistance of walkers and standing frames, they are often able to achieve independent ambulation. If a patient has spasticity of the legs or hip dislocation, then a surgical procedure may be performed to relieve the symptoms. Or an injection of botulinum toxin may relieve spasticity. For patients with spasticity affecting all of the extremities, then motorized wheelchairs, modified typewriters and computers and special feeding devices may be used.

For those children and teens with communication disorders from CP, technology has allowed adaptive hardware and software to enhance their communication skills. For example there are specially adapted computers that utilize artificial intelligence to augment language function.

Sir Ludwig Guttman recognized the therapeutic benefit of organized sports in the lives of teens who had physical challenges. As a result, the paralympic movement was founded in 1948. The growth of these games has led to an increased awareness of the abilities of people with physical challenges such as CP and afforded increasing opportunities for physically challenged teens to participate in sports. Participation in sports by teens with CP as well as those teens without medical problems has a positive impact on physical and psychological health, self-image, self-esteem and motor development.

 One example of an adapted sport that older teens with CP may participate in is the wheelchair competition of the Boston Marathon. Wheelchair design has changed over the past several years to accommodate needs of the athlete with a disability. This includes a narrower turning radius, elimination of spokes and sharp edges and a more aerodynamic design. The teen who competes from a wheelchair may be subject to overuse injuries to the rotator cuff, wrists and hands as well as trauma due to falls from the wheelchair.

Teens with CP may also require educational interventions during high school. Schools have multidisciplinary teams to customize educational opportunities for students with CP. Adolescents with CP win admission to the most competitive colleges and universities. For students at the college level, there is a staff coordinator at the university who can help students with disabilities fashion an academic program that will allow them to successfully complete a college program regardless of their disability.

As teens with CP transition adolescence, they need to learn to take charge of their health care since much of their previous care was family centered and directed by parents. This means the adolescent should become more involved in decision-making regarding his or her health, and clinicians should help the adolescent do this. So over time, as the teen learns to become independent, he or she will be able to manage his health care.

For most teens who have CP, there is no specific cause that can be identified. Comprehensive prenatal care for the mother to be may help to prevent CP, and comprehensive pediatric care after birth is important for early identification of those infants with CP.

Related topics:

Academics, body image, brain disorders, chronic illness, disabilities, exercise, eye problems, growth and development, hearing loss, hip displacement, learning disorders, pregnancy, seizures, self-esteem, speech disorders