Cerebral Palsy

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Cerebral PalsyCP is a non-progressive neurological disorder that affects a child’s movement, motor skills and muscle tone. In many cases vision, hearing and sensations are also affected. CP is the most common cause of motor disabilities in childhood. Abnormal brain development or injury to the developing brain can cause CP, which usually occurs before birth, but can happen during birth or first years of life. Some of the other possible causes include- Asphyxia neonatarum, gene mutations, severe jaundice in infants, maternal infections, brain infections, ICH, head injuries as a result of a car accident, a fall or child abuse.

Who is at risk for CP

  • Premature birth
  • LBW
  • Being a twin or triplet
  • A low Apgar score
  • Breach birth
  • Rh incompatibility
  • Maternal exposure to toxic substances.

Symptoms of CP vary from person to person and range from mild to severe. It can become more severe or less severe over time. Some of the more common signs include-

  • Delay in developmental milestones.
  • Variations in muscle tone, such as being too floppy or too stiff.
  • Delay in Developmental milestones
  • Variations in muscles tone, such as being too floppy or too stiff
  • Delay in speech development and difficulty in speaking
  • Spasticity or stiff muscle & exaggerated Reflex
  • Ataxia or lack of muscle coordination
  • Tremors or involuntary movements
  • Excessive drooling & problems with swallowing
  • Difficulty in walking
  • Neurological problems such as seizure, intellectual disabilities and blindness

There are different types of CP that affect various parts of brain. Each type causes specific movement disorder.

  1. Spastic CP: Most common type (80%). It causes stiff muscles and exaggerated reflexes, making it difficult to walk, (scissor like movements). Muscle weakness and paralysis may also be present.
  2. Dyskinetic CP/Dystonia/Athetoid: It causes involuntary repetitive twisting movements in the arms, legs, and hands. May also affect face and tongue.
  3. Hypotonic CP: It causes diminishing muscle tone and overly relaxed muscles. The arms and legs move very easily and appear floppy like a rag roll. Such child will have little control over their head. As they grow older, they may struggle to set up straight as a result of weakened muscles.
  4. Ataxic CP: Least common type and is characterized by voluntary muscle movements that often appear disorganized clumsy or jerky. Usually will have problems with balance and coordination. They may have difficulty in walking, performing fine motor functions such as grasping objects and writing.
  5. Mixed CP: Combination of symptoms focus the different type of CP.

CP Classification based on body parts affected

  • Monoplegia/Monoparesis – Only one limb is affected
  • Diplegia/Diparesis – Legs are affected more than the arms
  • Hemiplega/Hemiparesis – Arm & leg on one side of the body are affected
  • Paraplegia/Paraparesis – Lover half of the body (B/L legs) affected
  • Triplegia/ Triparsis – Three limbs are affected
  • Double hemiplegia – All four limbs are involved, but one side of body is more affected
  • Tetraplegia/Tetraparesis – All four limbs are involved, but three limbs are more affected than the fourth
  • Quadriplegia/Quadriparesis– All four limbs are involved.
  • Pentaplegia/ pentaparesis – All four limbs are affected with head and neck paralysis often accompanied by eating and breathing problems.

In many instances, CP isn’t diagnosed until the child reaches the age of walking and talking. When diagnosing CP, physician looks for poor coordination skills, spastic movements, and uncontrolled muscle movements. They will also perform developmental screenings.

MANAGEMENT FOR CP

  • MEDICAL MANAGEMENT: Currently there’s no cure for CP. Generally medications are used to help control spastic movements, seizures and to control pain which include medications like Baclofen, Diazepam, Anticonvulsants, Anticholinergic, Stool softeners/ Laxatives, Dantrolene.
  • SURGICAL MANAGEMENT: It is usually done to help children to have better orthopedic functions commonly include repairing hip dislocations as well as scoliosis surgery, nerve root repair, tight/stiff muscle repair and surgery to reduce spasticity.
  • PHYSIOTHERAPY MANAGEMENT: PT is the front line intervention for CP. Also offers preventive benefits, reducing the likelihood of complications and disability. Its goals and activities are customized for each child, promoting greater flexibility, mobility and stability. By preserving and improving overall health and functioning, physical therapy enables children’s to fully engage in activities of daily living.

GOALS OF PT

  • Increase strength and conditioning.
  • Enhance endurance
  • Increase ROM
  • Manage pain
  • Promote coordination
  • Prevent contracture
  • Reduce swelling and inflammation
  • Increase participation in self-care
  • Facilitate greater mobility with or without mobility aids
  • Ease muscle spasms
  • Educate parents and family members.

INTERVENTIONS

  • Strengthening exercises
  • Stretching and flexibility activities
  • Teaching and practicing mobility skills
  • Help using assistive technology
  • Environmental and home activity recommendations
  • Balance and coordination exercises
  • ROM exercise
  • Adaptive play
  • Gait training
  • Posture correction.

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