Cerebral Palsy
A group of disorders caused by an injury to the brain before, during, or shortly after birth. In many
cases, it is not known for sure what caused the brain injury.  Cerebral Palsy (CP) is used to describe a
medical condition that affects control of the muscles. Cerebral means anything in the head and palsy
refers to the inability of control to muscles or joints in the body.

Cerebral Palsy covers a spectrum of symptoms which vary in severity. A child with cerebral palsy may
have difficulty with fine motor skills, such as writing, gross motor skills (sustaining balance and walking),
or be affected by involuntary movements, such as uncontrollable hand gestures. The symptoms differ
from one child to the next, and may even change over time. Some cerebral palsy sufferers are also
affected by a few medical disorders, including seizures or mental impairment.

There are four types of CP:  Spastic, Athetoid, Ataxic, and Mixed.

Spastic Cerebral Palsy

Children with spastic (CP) have stiff and tense movements caused by muscles which are too tight (high
muscles tone). This causes difficulties when moving from one bodily position to another or letting loose
an object held in their hand. Spastic Cerebral Palsy is the most common type. This form of cerebral
palsy affects 50% or more of children who suffer from (CP) and commonly seen in low weight or
premature babies.

Ataxic Cerebral Palsy:

Distinctive by poor coordination and loose muscle tone (low muscle tone), children with this particular
form of the condition look very unsteady and shaky. They experience extreme shakiness the majority of
the time but this can become more apparent when trying to perform fine movements such as turning
the page of a book. Poor balance is also a problem for these children and they may be unsteady when
they walk. The ataxic form affects an estimated 5 to 10 percent of children who have (CP).

Athetoid or Dyskinetic Cerebral Palsy:

This means a mixture of muscle tone which is too tight or loose. Here the child has trouble holding
themselves in an upright, steady position for sitting or walking, and often show lots of movements of
their face, arms and upper body which is involuntary. Other uncontrollable features are turning,
twisting, facial grimacing, and drooling. This is due to an ever changing level of muscle tone.  Athetoid
cerebral palsy affects about 30 percent of children with (CP).

Mixed Cerebral Palsy

Occurs when two or more types of cerebral palsy are present in the one child. Statistics will say that
mixed cerebral palsy accounts for 10% of all cases of cerebral palsy, but the actual percentage may be
more.  The incidence of mixed cerebral palsy has been rising due to better diagnostic techniques.

Cerebral palsy is generally recognized in the early years, as developmental delays becomes apparent.
Though various kinds of medical scans can help doctors identify some brain abnormalities, the disorder
is most often seen in its symptoms.

Early Signs of Cerebral Palsy

1. Favoring one side of the body over the other

2. Poor muscle control and lack of coordination

3. Muscle spasms or seizures

4. Oral problems such as sucking, chewing, and swallowing

5. Unusual tightness and irritability in infancy

6. Inability to control bladder and bowels (incontinence)

7. Difficulty in speaking

8. Difficulty in concentrating, which has adverse effects on learning

9. Trouble in interpreting sense perceptions, such as inability to identify objects by touch

10. Other problems with the senses, especially hearing and vision

Some of children may show serious symptoms at birth; some may not show any signs for a long time.
Most children with cerebral palsy are diagnosed by age 5. It is important to diagnose the disorder early
so that therapy can minimize handicaps, learning is not hindered, and the child (and parents) can
adapt more readily.

Causes of Cerebral Palsy

Causes of why cerebral palsy occur varies. Approximately 58% of the cases of cerebral palsy occurred
in children who were born at full term and full weight, and in whom doctors see no cause of brain
damage, at the present time and technology. However, studies have shown that several conditions are
risk factors for cerebral palsy, not necessarily leading to, but increasing the risk that the unborn child
will have it.

Risks Factors

•        Infections in the mother during pregnancy, including rubella (German measles); sexually
transmitted diseases such as gonorrhea, chlamydia, and syphilis; and other bacterial and viral
infections, some of which attack the baby's nervous system.

•        Premature birth.

•        Low birth weight, though some infants who weighed under 2 pounds at birth and spent months in
neonatal intensive care have been unimpaired.

•        Difficult or abnormal delivery, especially awkward fetal position, lengthy or too abrupt
labor, or obstruction of the umbilical cord.

•        Hypoxia, or insufficient oxygen, in the brain, for a variety of reasons, such as premature
separation of the placenta during delivery or swelling of the brain due to illness.

•        Incompatibility between parents' and fetus's blood types, especially Rh incompatibility.

•        Jaundice of the newborn or hyperbilirubinemia ( liver problems), sometimes associated with Rh

•        Medications and drug abuse taken by the mother

•        Lead poisoning

•        Smoking by the mother

•        Alcohol abuse by the mother

No cure exists for cerebral palsy, but various kinds of therapies are used to help each child do as much
as he or she is capable of achieving. Among these are:

Physical therapy -  the use of therapeutic exercises and activities to extend the child's range of
controlled movement, generally focusing on gross motor skills.  Bobath techniques are used, where
exercises  focus on countering primitive reflexes and then on extending the range of voluntary
movement.  With the help of behavior modification, offering positive reinforcement to help children act
against the body's awkward inclinations. Physical therapists also help children learn how to use
orthopedic devices, such as wheelchairs and walkers.

Biofeedback - in which children are given information about the functioning of a particular part of the
body, often by electrical machines that produce visual or auditory signals, and are taught to
concentrate on changing the visual picture or sound. Through such techniques, children with cerebral
palsy can gain increased control over movements and are sometimes able to do things like drink from a
cup or control their bladder, skills that previously were beyond their reach.

Occupational therapy - the use of therapeutic exercises and activities to extend the child's range of
controlled movement, generally focusing on fine motor skills, many of them self-help skills. For children
that may mean learning how to dress themselves, comb their hair, brush their teeth, drink from a cup,
or hold a pen or pencil. For young adults that includes preparation for living as self-sufficiently and
independently as possible (vocational rehabilitation services).

Speech and language therapy - can help children overcome some speech and hearing impairments,
and also learn to use the great variety of mechanical and electronic devices that have been developed
to help them, such as voice synthesizers or specially adapted computers .

Medication -  including muscle relaxants for spastic muscles and anti-seizure drugs, if epilepsy is
involved. Drugs are best used sparingly, however, since the long-term side effects on the already-
damaged and still-developing nervous system are unknown.

Orthopedic devices - such as wheelchairs, walkers, page-turners, specially equipped automobiles, and
the like.

Many physical therapists stress that a
varied and stimulating environment is in itself a powerful
"treatment" for the child
. Also important to both child and family are counseling, which can offer
emotional support and relief of stress, advice on handling practical problems, and training to prepare
for the future, as the child grows into an adult. Many public and private organizations also provide
financial assistance, diagnostic and treatment centers, vocational training and guidance, respite care
for families of children with cerebral palsy, special recreational facilities, adapted work settings, and
adapted living arrangements.

Early identification of cerebral palsy can lessen developmental problems and lead to appropriate
intervention which makes a huge impact in the child’s life. Early intervention programs are family-
centered professionals and families work together with the child in specific activities. Educators,
physical and occupational therapists, social workers, speech- language pathologists, psychologists and
physicians can assist families by providing information and education.
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