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Celebral Palsy

 
     
 
We do not know the cause of most cases of cerebral palsy.
That is, we are unable to determine what caused cerebral palsy in most children who have congenital CP.
We do know that the child who is at highest risk for developing CP is the premature, very small baby who does not cry in the first five minutes after delivery, who needs to be on a ventilator for over four weeks, and who has bleeding in his brain.
Babies who have congenital malformations in systems such as the heart, kidneys, or spine are also more likely to develop CP, probably because they also have malformations in the brain.
Seizures in a newborn also increase the risk of CP. There is no combination of factors which always results in an abnormally functioning individual.
That is, even the small premature infant has a better than 90 percent chance of not having cerebral palsy.
There are a surprising number of babies who have very stormy courses in the newborn period and go on to do very well.
In contrast, some infants who have rather benign beginnings are eventually found to have severe mental retardation or learning disabilities.

CEREBRAL PALSY IN THE NEWBORN


Many children with cerebral palsy have a congenital malformation of the brain, meaning that the malformation existed at birth and was not caused by factors occurring during the birthing process.
Not all of these malformations can be seen by the physician, even with today's most sophisticated scans, but when CP is recognized in a newborn, a congenital malformation is suspected.
When a diagnosis of CP is made, the mother and father often feel guilty and wonder what they did to cause their child to have this disorder.
While it is certainly true that good prenatal care is an essential part of preventing congenital problems, it must be stated that congenital problems, or "birth defects," often occur even when the mother has strictly followed her physician's advice in caring for herself and the developing infant.
Though the causes of "birth defects" are usually unknown, we do know that the developing brain can be affected by several factors.
When the fetus is exposed to certain chemicals or infections through the expectant mother, for example. The developing brain can be injured if the expectant mother suffers severe physical trauma, the fetal brain can be injured, too, but this is rare.
Finally, prematurity and a low birth weight have been shown to be related to an increased incidence of specific disorders.
Many chemicals are known to adversely affect the developing brain, alcohol being the most commonly used.
The term Fetal Alcohol Syndrome describes the long-term, multi-system effect of alcohol on a child whose mother abused alcohol during the pregnancy.
When a fetus is exposed to large amounts of alcohol, several body systems, including the neurological system will almost certainly suffer damage.
Cigarette smoking by the mother has been shown to decrease birth weight, and low birth weight is associated with several disorders, including cerebral palsy.
Severe malnutrition in the mother can adversely affect brain growth in the fetus, and it, too, can result in a low birth weight.
The use of cocaine or crack by the expectant mother is associated with blood vessel complications, and these complications affect many organs as well as the central nervous system.
Cocaine use is increasing and thus becoming more prevalent as cause of brain damage in infants.
Most infants whose mothers used cocaine during pregnancy develop mental retardation rather than cerebral palsy, however.
Infections such as rubella (German measles), toxoplasmosis, and cytomegalovirus (CMV), ( if a woman has them during pregnancy), also may injure the brain of the fetus.
Rubella can be prevented by immunization, prior to becoming pregnant, and the chances of becoming infected with toxoplasmosis can be minimized by not handling the feces of cats and by avoiding raw or uncooked meat.
Congenital infection with human immunodeficiency virus (HIV, the virus that causes AIDS) also causes brain damage in children, though it usually causes mental retardation rather than CP.
It is likely that many other infections in the expectant mother injure the developing fetus, but they are not recognized as causative factors because the woman who has the infection either does not recognize the symptoms of infection or is symptom-free.
Premature infants are at a much higher risk for developing cerebral palsy than full-term babies, and the risk increases as the birth weight decreases.
Between 5 and 8 percent of infants weighing less than 1500 grams (3 pounds) at birth develop cerebral palsy, and infants weighing less than 1500 grams are 25 times more likely to develop cerebral palsy than infants who are born at full term weighing more than 2500 grams.
any premature infants suffer bleeding within the brain, called intraventricular hemorrhages, intracranial hemorrhages. Again, the highest frequency of hemorrhages is found in the babies with the lowest weight: the problem is rare in babies who weigh more than 2000 grams (4 pounds).
This bleeding may damage the part of the brain that controls motor function and thereby lead to cerebral palsy.
If the hemorrhage results in destruction of normal brain tissue (a condition called periventricular leukomalacia) and small cysts around the ventricles and in the motor region of the brain, then that infant is more likely to have CP than an infant with hemorrhages alone.
Does prematurity "cause" cerebral palsy, or do some infants who are born prematurely have abnormal brains from the beginning, leading to their premature births

CEREBRAL PALSY IN THE INFANT AND CHILD

During infancy and early childhood, the child is completely dependent on others for his or her safety and protection. Protecting the child from injury is one of the most important responsibilities of the child's caregivers.
One such injury is asphyxia, which can damage the brain in a variety of ways,
and is the number one cause of CP in this age group.
The three most common causes of asphyxia in the young child are: choking on foreign objects such as toys and pieces of food (including peanuts, popcorn, and hot dogs); poisoning; and near drowning.
The brain may also be damaged when it is physically traumatized as a result of a blow to the head. A child who falls or is involved in a motor vehicle accident or is the victim of physical abuse may suffer irreparable injury to the brain.
One form of child abuse is the shaken baby syndrome, in which the caretaker is trying to quiet the baby by shaking too vigorously, causing the brain to strike repeatedly against the skull under high pressure.
Severe infections, especially meningitis or encephalitis, can also lead to brain damage in this age group.
Meningitis is inflammation of the meninges ( the covering of the brain and the spinal cord), usually caused by a bacterial infection, and encephalitis is brain inflammation which may be caused by bacterial or viral infections. Either of these infections can cause disabilities ranging from hearing loss to CP to severe retardation.

HOW IS A DIAGNOSIS OF CEREBRAL PALSY MADE?

Many of the normal developmental milestones, such as reaching for toys (3-4 months), sitting (6-7 months), and walking (10-14 months), are based on motor function.
A physician may suspect cerebral palsy in a child whose development of these skills is delayed.
In making a diagnosis of cerebral palsy, the physician takes into account the delay in developmental milestones as well as physical findings that might include abnormal muscle tone, abnormal movements, abnormal reflexes and persistent infantile reflexes.
Making a definite diagnosis of cerebral palsy is not always easy, especially before the child's first birthday.
In fact, diagnosing cerebral palsy usually involves a period of waiting for the definite and permanent appearance of specific motor problems.
Most children with cerebral palsy can be diagnosed by the age of 18 months, but eighteen months is a long time for parents to wait for a diagnosis, and this is understandably a difficult period for them.
Making a diagnosis of cerebral palsy is also difficult when, for example, a two-year- old has suffered a head injury.
The child may immediately appear to be severely injured, and three months after the injury he may have symptoms that are typical of a child with cerebral palsy.
But one year after the injury such a child may be completely normal.
This child does not have cerebral palsy. Although he has a scar on his brain, the scar is not permanently impairing his motor activities. After injury, waiting and observing are necessary before the diagnosis can be made.

WHAT ARE THE DIFFERENT TYPES OF CEREBRAL PALSY?


Cerebral palsy may be classified by the type of movement problem (such as spastic or athetoid cerebral palsy) or by the body parts involved (hemiplegia, diplegia, and quadriplegia).
Spasticity refers to the inability of a muscle to relax, while athetosis refers to an inability to control the movement of a muscle. Infants who at first are hypotonic wherein they are very floppy may later develop spasticity.
Hemiplegia is cerebral palsy that involves one arm and one leg on the same side of the body, whereas with diplegia the primary involvement is both legs.
Quadriplegia refers to a pattern involving all four extremities as well as trunk and neck muscles. Another frequently used classification is ataxia, which refers to balance and coordination problems. The motor disability of a child with CP varies greatly from one child to another;
thus generalizations about children with cerebral palsy can only have meaning within the context of the subgroups described above.
For this reason, subgroups will be used in this book whenever treatment and outcome expectations are discussed.
Most professionals who care for children with cerebral palsy understand these diagnoses and use them to communicate about a child's condition.
As noted above, a useful method for making subdivisions is determined by which parts of the body are involved.
Although almost all children with cerebral palsy can be classified as having hemiplegia, diplegia, or quadriplegia, there are significant overlaps which have led to the use of additional terms, some of which are very confusing.
To avoid confusion, most of the discussion in his book will be limited to the use of these three terms. Occasionally such terms as paraplegia, double hemiplegia, triplegia, and pentaplegia may occasionally be encountered by the reader; these classifications are also based on the parts of the body involved.
The dominant type of movement or muscle coordination problem is the other method by which children are subdivided and classified to assist in communicating about the problems of cerebral palsy.
The component which seems to be causing the most problem is often used as the categorizing term. For example, the child with spastic diplegia has mostly spastic muscle problems, and most of the involvement is in the legs, but the child may also have a smaller component of athetosis and balance problems.
The child with athetoid quadriplegia, on the other hand, would have involvement of both arms and legs, primarily with athetoid muscle problems, but such a child often has some ataxia and spasticity as well.
Generally a child with quadriplegia is a child who is not walking independently. The reader may be familiar with other terms used to define specific problems of movement or muscle function terms such as: dystonia, tremor, ballismus, and rigidity.
The words severe, moderate, and mild are also often used in combination with both anatomic and motor function classification terms (severe spastic diplegia, for example), but these qualifying words do not have any specific meaning.
They are subjective words and their meaning varies depending on the person who is using them.