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Cerebral Palsy

What is cerebral palsy?

The word cerebral means something to do with the brain (cerebrum). Palsy means a weakness or problems in moving the body.

Cerebral palsy is a physical condition affecting movement and posture. It is a permanent, non progressive condition that can range in severity from mild to severe. The condition is not hereditary or contagious.

The muscles and limbs of a person with cerebral palsy are not damaged, however the passages relaying information from the brain to the muscles are. The damage to the brain either occurs prior to, during or soon after birth. This can result in muscle tightness, low muscle tone, in-coordination or a combination of these.

Cerebral palsy, except in its mildest forms, can be seen in the first 12-18 months of life. It presents when children fail to reach movement milestones. Babies most at risk of cerebral palsy are those born prematurely or with low birth weight.

In Australia it is estimated that a child is born with cerebral palsy every 15 hours. Worldwide, the incidence is the same – 1 in 400 births. There is no pre-birth test. For most, the cause is unknown.

www.thespasticcentre.org.au
www.mydr.com.au

What are the symptoms of cerebral palsy?
If a child has CP, the early signs are likely to appear before the age of about 3 years. Children with CP are often slow to achieve developmental milestones, such as learning to sit up, crawl, roll over, and walk.

The symptoms of CP vary from person to person, and can change over time. Some people with mild CP may walk a little awkwardly but otherwise can function well, whereas a person with severe CP may have contorted arms and legs and may need lifelong care. Many people with CP also have difficulty in controlling the muscles involved in speech, making it difficult for them to talk clearly.

People with cerebral palsy may have seizures and other impairments affecting their vision, hearing and/or intellect.

What part of the body is affected by CP?
This is different from one person to another. In cerebral palsy, certain words are used to describe the parts affected:

  • Hemiplegia – the leg and arm on one side of the body are affected.
  • Diplegia – both legs are affected significantly more than the arms. Children with diplegia usually have some clumsiness with their hand movements.
  • Quadriplegia – Both arms and legs are affected. The muscles of the trunk, face and mouth can also be affected.

www.mydr.com.au


Types of Cerebral Palsy

There are four main types of cerebral palsy and each involves the way a person moves. The four main types are:

Spastic CP
This is the most common type of cerebral palsy. Spasticity means stiffness or tightness of muscles. The muscles are stiff because the message to the muscles is sent incorrectly through the damaged part of the brain. Spastic CP may affect both arms and both legs, one arm and one leg on one side of the body or mainly the legs. The majority of children with CP have spasticity, making their movements stiff and awkward.

When people without cerebral palsy perform a movement, some groups of muscles become tighter and some groups of muscles relax. In people with spastic cerebral palsy, both groups of muscles may become tighter. This makes movement difficult or even impossible.

Athetoid or dyskinetic CP
Less than a quarter of children with CP will display athetosis, in which the person has slow, uncontrollable, writhing movements (and sometimes jerky, abrupt movements) of the arms, legs and body. The face and tongue can also be affected, making it very difficult to talk.

There are two forms:

  • Athetosis is characterised by uncontrolled, slow, ‘stormy’ movements;
  • Dystonia is characterised by sustained or intermittent muscle contractions causing twisting or repetitive movement.

Ataxic CP
About one in 10 children displays ataxic symptoms, in which a person has poor muscle co-ordination, with muscle weakness and trembling, and difficulty with balance and depth perception. A person with ataxic CP may be unsteady when they walk, and may walk with their legs widely spaced apart. People with ataxic CP may also find it difficult to make quick movements or movements that need a lot of muscle control, such as writing or doing up buttons. It affects a person’s balance and coordination.

Mixed CP
Many children with CP display a mix of the above symptoms, most often spastic and athetoid symptoms.


What is the outlook for someone with CP?

Each person is different, with the severity of CP playing a key role in the outlook of a person with CP. Some people with CP may need no extra support to enjoy everyday activities, while others may need ongoing assistance and equipment such as a wheelchair or walker to help them move around, or special equipment such as an electronic device to help them communicate.

The outward appearance of a person with CP may not reflect their intellectual capabilities or their abilities to gain qualifications, work and enjoy life in the community.
A child with cerebral palsy can achieve greater control over movement as they learn and practice motor skills.


Where to get assistance

Where to get assistance if you are concerned if your child has cerebral palsy issues.
Cerebral Palsy Education Centre Inc. (CPEC)

  • Phone: (03) 9560 0700
  • Fax: (03) 9560 0669
  • Email: info@cpec.com.au
  • Address: Beacon Street, Glen Waverley, Victoria 3150, Box 211, Glen Waverley, Victoria 3150

Children’s Neuroscience Centre
Royal Children’s Hospital
Flemington Road
Parkville
Victoria 3052 Australia
(03) 9345 5661 (Secretary, appointment & EEG enquiries)
(03) 9345 7926 (Epilepsy Nurse Specialist)

Orthopaedics
3rd Floor, Main Building
50 Flemington Road
Royal Children’s Hospital
Parkville
Victoria 3052 Australia
PH: 9345 5444

Department of Developmental Medicine
The Royal Children’s Hospital,
Ground floor
Flemington Road, Parkville, VIC, 3052
Ph: +61 03 9345 5898
E: dev.med@rch.org.au

Hugh Williamson Gait Analysis Laboratory,
3rd Floor, Main Building,
Royal Children’s Hospital,
Flemington Road, Parkville,
Victoria, 3052,
Australia
Phone: +61(03) 9345 5354
Fax: +61 (03) 9345 5447

Paediatric Developmental Disability Clinic
Monash Medical Centre
Phone 13 KIDS (13 5437) for all Monash Children’s enquiries
246 Clayton Road
Clayton VIC 3168

Department of Developmental Medicine
The Royal Children’s Hospital,
Ground floor
Flemington Road, Parkville, VIC, 3052
Ph: +61 03 9345 5898
E: dev.med@rch.org.au

Hugh Williamson Gait Analysis Laboratory,
3rd Floor, Main Building,
Royal Children’s Hospital,
Flemington Road, Parkville,
Victoria, 3052,
Australia
Phone: +61(03) 9345 5354
Fax: +61 (03) 9345 5447

Paediatric Developmental Disability Clinic
Monash Medical Centre
Phone 13 KIDS (13 5437) for all Monash Children’s enquiries
246 Clayton Road
Clayton
VIC 3168


Treatments for Cerebral Palsy

How is cerebral palsy treated?
Unfortunately, there is no cure for CP; however, there are many resources available to help make life easier for people with CP and their carers. Healthcare professionals work together to provide a treatment programme suited to the individual to help them manage their CP and learn to become as independent as possible.

Your doctor or paediatrician may be able to prescribe medicines that can control seizures and muscle spasms. Medicines are also used to control spasticity.

Special braces or splints may be recommended to aid balance and movement, or surgery may be recommended to aid mobility.

A speech therapist can help with eating and communication difficulties, and can help with communication aids, sign language, or symbol language to replace speech or assist with speech.

Occupational therapy is used for fine motor skills and daily living activities. Another mainstay therapy for cerebral palsy treatment, occupational therapy is used much in the same way as physical therapy, primarily focusing on the hands and arms. Hyperbaric oxygen therapy (breathing pure oxygen while in a sealed, pressurised container) has been promoted by some for people with CP. However, research has not so far shown that hyperbaric oxygen benefits CP.

Physical therapy
Physical therapy is considered one of the mainstay therapies for cerebral palsy treatment. It is used to decrease spasticity, strengthen underlying muscles, and teach proper or functional motor patterns. A good physical therapist will also teach the family and caregivers how to help the patient to help themselves.

A physiotherapist can provide exercises to be conducted at home that will help with mobility. They can also advise parents on how to position their child properly and lift them safely.

Botox
www.cerebralpalsysource.com
When most people hear the term botox, they automatically assume that the impending use will be for some celebrities wrinkled, aging face and their last stab at beauty. However, few are aware of a more important use for botox, and the connection between botox and cerebral palsy.

Botulinum toxin type A, or botox, is a therapeutic muscle-relaxing agent that reduces the rigidity of muscles or unwanted spasms in a specific muscle. Botox is produced from the bacteria that causes food poisoning and provides relief for muscle stiffness at the site of injection.

When prepared for therapeutic use, botox is injected in small amounts into the spastic or stiff muscles. It begins to take effect by blocking transmission between the nerves and the affected muscles. The injection stops the signal between the nerve and the muscle, relaxing the muscle and reducing stiffness. Botox only affects the muscles that are injected and once the muscles are relaxed, therapists are able to stretch the muscles and stimulate normal growth.

There are several benefits associated with botox and cerebral palsy. Botox injections can offer many benefits including ease in stretching, improvement in child’s range of motion, tolerance to wearing braces and developmental improvements in crawling, standing, or gait changes.

Researchers have found that with botox and cerebral palsy, children under the age of six respond best to this type of cerebral palsy treatment, especially effective in children who have not developed fixed joint contractures. It is most effective when used in the early stages of spasticity while the child’s bones are still developing and before problems with bone development and deformity set in.

Dorsal rhizotomy
Publication from St. Louis Children’s Hospital
Center for Cerebral Palsy Spasticity
Department of Neurosurgery
St. Louis, Missouri, USA 63110

Currently, it is not possible to operate on nerves in the brain and correct the brain damage, but it is possible to operate on the sensory nerve fibers that come from the muscle.
Selective dorsal rhizotomy, a neurosurgical procedure, is an additional treatment option. The rhizotomy can reduce spasticity permanently and improve motor activities. When performed at an early age, the rhizotomy can reduce the number of orthopedic operations patients might otherwise require. Over the past 20 years, we have proven the selective dorsal rhizotomy to be a very safe and effective surgery.

During rhizotomy each nerve root is divided into 3 to 5 nerve rootlets. By cutting some – but not all of these rootlets, it is possible to reduce the message from the muscle to better balance the messages of flexibility (from the brain) with messages of stiffness (from the muscle). Once the muscle tone becomes more normal, it is easier for the child to move and gain motor skills like sitting, crawling, standing and walking.

Remember that increased muscle tone or spasticity is only one problem of movement in children with cerebral palsy. Reducing spasticity will make it easier for the child to move but does not eliminate weakness, abnormal movements or balance problems.

  • Dorsal rhizotomy reduces spasticity. The child will no longer feel so stiff; muscle tone will be more normal and movement will be easier. How much the child’s mobility improves after surgery depends on several factors:
  • The developmental level of the child before surgery.
  • The amount of therapy that can be provided after surgery.
  • The extent of your child’s movement problems due to causes other than spasticity.
  • The child’s motivation, cooperation and intelligence.

All LLT articles are the sole property of LLT and all contents are copyrighted – Life’s Little Treasures Foundation 2010

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