What is Cerebral Palsy in children?
What is Cerebral Palsy in Children
"Could a greater miracle take place than for us to look through each other's eyes for an instant?"
Henry David Thoreau
What is Cerebral Palsy
Life is nothing if not miraculous, parents holding their babies for the first time are often mesmerized by those ten chubby little fingers and toes, an outward reassurance that physically, all is well. What parents are praying for is the miracle of a healthy child.
Never-the-less; there are times when those first appearances can be misleading, and joy can turn to sadness when conditions like cerebral palsy are diagnosed.
According to Centers for Disease Control and Prevention, about one in every 33 babies are born with a birth defect.
Cerebral palsy (CP) is a general term used to describe some neurological conditions affecting a child's movement and coordination, it is the most common motor disability in childhood. Statistically; 1 in 400 children in the UK are affected by cerebral palsy, around 1800 babies are diagnosed with the condition each year.
The incidence of cerebral palsy has increased in infants born prematurely in the US, according to research from Loyola University Health System (LUHS).
The United Cerebral Palsy (UCP) Foundation estimates that nearly 800,000 children and adults in the US are living with CP, and around 10,000 babies are born with the condition each year. The encouraging news is that researchers from UK, Denmark and Sweden have found evidence that CP rate among very low birth weight infants has begun to fall. CP is 20 to 80 times more common among children that are born weighing less than 3.3 pounds, the term used by medical professionals to describe these babies are very low birth weight (VLBW).
Cerebral palsy is not a progressive condition; it will not worsen as the child grows older. But the high levels of strain and stress placed on the body can cause health problems in later life.
Cerebral Palsy Causes
This condition affects the brain and nervous system. Cerebral palsy refers to the part of the brain that is affected, the area of the brain known as the cerebrum (a Latin word for brain, top of the head or skull). The cerebrum is in the anterior or front section of the brain; it is the dominant part of the human brain. Palsy means complete or partial muscle paralysis often accompanied by loss of sensation, tremors and uncontrollable movement of the body. The damage to the brain can happen before, during, or after birth. Symptoms of cerebral palsy vary from child to child depending on which type of the condition a child has.
Before the 1980s, scientists believed that brain damage in babies who were deprived of oxygen during labour and delivery was due to oxygen deprivation or asphyxia. However; studies in the 80s revealed that asphyxia accounted for less than 5 to 10 percent of cerebral palsy cases and that most cases of brain damages occurred before birth. Experts believe that brain damage among cerebral palsy children is due to three possible causes:
(1) Periventricular leukomalacia (PVL) this is one of the most important causes of cerebral palsy, it refers to the damage to the brain's white matter. White matter is the part of the brain that is made up of large amounts of the nerve fibre and is protected by the white fatty protein known as myelin. The white matter in the brain function by directing communication between the grey matter or thought-processing section of the brain and other parts of the body. Damage to the brain due to a reduction of blood supply and oxygen can have serious consequences in later life since the white matter is responsible for the transmitting of signals to the muscles. PVL can occur as a result of:
- Infections like rubella (German measles) caught by the mother
- Mother having an abnormally low blood pressure
- Premature birth, particularly in children born at six months or earlier
- Mother consuming illegal drugs such as cocaine during pregnancy
(2) Abnormal Development of the brain, anything that alters or affects the normal development of the brain, can lead to problems with the way it transmits information to the muscles, and, therefore, can cause cerebral palsy. The brain is especially vulnerable during the first 20 weeks of a child's development and can be affected by:
- Mutation in the genes that helps in brain development.
- Trauma to the head of the unborn child
(3) Intracranial Haemorrhage, or bleeding in the brain, can be dangerous because the brain is deprived of blood supply which can cause the death of brain tissue through lack of oxygen. Bleeding into the brain, or intracranial haemorrhage can also cause direct damage to the tissue of the brain.
Intracranial bleeding commonly occurs in unborn babies, it is the breaking or rupturing of a blood vessel in the brain. The rupturing of the blood vessel can happen as a result of several factors such as a pre-existing abnormality in the child's blood vessels, in a mother who is suffering from high blood pressure, or from an infection during pregnancy, particularly pelvic inflammatory disease.
A few cases of cerebral palsy are caused by damage after birth; this may be due to infection of the brain such as meningitis or traumatic head injury.
There are many types of cerebral palsy, the most common is spastic cerebral palsy occurring in about 7 in 10 cases.
Spastic Cerebral Palsy
- Hemiplegic cerebral palsy, hemiplegia means that the leg and arm of one side of the body are affected. Spastic means that the affected muscle are stiffer than normal. The degree of stiffness can vary hugely from case to case. Movement of an affected arm or leg are stiff and jerky; some muscles can become permanently shorten. When this occurs, it is referred to as contracted. A child with this type of CP typically have muscle stiffness or spasticity on one side of the body, often only a hand and arm are involved, but a leg may also be affected. The affected side may be underdeveloped. The child may have speech difficulties, some children will suffer from seizures, however; in the majority of cases, intelligence is not affected.
Quadriplegic Cerebral Palsy, this is the most severe form of spastic cerebral palsy, the legs, arms and body of the child are affected. Children with this type of cerebral palsy are much more likely to have mental retardation; some may have seizures. Walking and talking will be difficult to do.
Diplegia Cerebral Palsy there is little or no upper body spasticity, but the lower limbs are affected. The leg and hip muscles are tight, the child's knees cross over, this is often referred to as scissoring and makes walking tough for the affected child
Ataxic cerebral palsy affects the child's balance and the ability to judge where objects are situated in relation to his/her position. This is known as “depth perception.” Ataxic cerebral palsy is the least diagnosed type of CP. Children with this type of cerebral palsy will find it difficult to do simple action requiring the use of fine motor skills.
Activities like tying shoelaces, doing up buttons, using scissors are difficult to achieve. Due to the problem with balance, children may walk with their feet far apart. There may be what is referred to as intention tremors, shaking that begins with a voluntary movement, such as reaching for an object, the closer the child gets to the object the more pronounced the tremors. The majority of children with ataxic cerebral palsy have good communication skills and are of average intelligence.
Athetoid (dyskinetic) cerebral palsy, this is the second most common type of CP. While the whole body will be affected by muscle problems, intelligence is almost always normal. The muscle tone is weak or tight, giving rise to random and uncontrolled body movements. Children with this type of CP will find walking, sitting, maintaining posture difficult. Some children may drool if they have the problem of controlling facial muscles; they find speaking clearly difficult because the tongue and vocal cords are hard to control.
Hypotonic Cerebral Palsy, hypotonia is diminished muscle tone. This type of CP may be the result of severe brain injury or malformation. Some parents described the movement of their child with hypotonic cerebral palsy as that of a rag doll. Muscle problems appear earlier, the baby's head is floppy. These children only give a moderate amount of resistance when an attempt is made to move the limbs. The child with hypotonic cerebral palsy, rest with elbows and knees loosely extended, in comparison, a healthy baby's elbows and knees will be flexed. Some of these infants may also have breathing difficulties.
The Public Perception of Children With Cerebral Palsy
Cerebral Palsy affects over 17 million people worldwide; it accounts for the highest number of childhood physical disabilities. But although large numbers of individuals have this disorder, it is still misunderstood by a vast proportion of the general public.
The New Jersey School of Osteopathic Medicine performed a randomly sampled survey of 100 adults using a 20-item questionnaire on participant's perception of the term Cerebral palsy and its associated disability and prognosis. The study found that a percentage of the general population holds several misconceptions about cerebral palsy:
40% that the condition was a genetic disorder
20% that the children affected cannot speak
57% that affected children dies earlier than unaffected children
20% that adult people with cerebral palsy cannot hold a job
4% that cerebral palsy is infectious
3% that parents should restrict their children's association with affected children
Although most of the people who took part in this study were educated from a middle to upper-middle class section of the population, the study concluded that the term cerebral palsy was ambiguous to many and may have negative connotations.
Lincoln's Story: A word of warning; This will touch your heart
Cerebral Palsy; Male children are at greater risk
Cerebral Palsy Risk Factors
Asphyxia (Deprived of oxygen)
The brain receive little or no oxygen. Events that can lead to asphyxia include, unbilical cord problems, i.e., prolapsed cord. excessive bleeding during pregnancy or during birth, abnormal presentation, i.e., breech births. Prolonged or traumatic delivery, delivery involving shoulder dystocia and maternal shock
Infectious diseases known to increase the risk of CP are, rubella, herpes, chorioamnionitis, and toxoplasmosis. Maternal pelvic inflammatory infection, inflammation of the placenta and STDs
Complications of birth
Breech presentation are more likely in babies with cerebral palsy. Babies with vascular or respiratory problems during labor and delivery, may have already suffered brain damage or abnormalities
Jaundice or blood type compatibility
More than 50% of newborns develop jaundice after birth, severe, untreated jaundice can give rise to neurological disorders such as Kernicterus, this can kill brain cells, cause deafness and CP.
Babies that are born smaller than the gestational age are at risk for cerebral palsy due to the same factors that prevented normal growth in the womb. The apgar score is a numbered rating that reflects a new born's condition.
Parent's health and habits
Include, parental age, maternal height and weight, reproductive fitness, maternal health, exposure to toxins prior to conception, socio-economic factors
Traumatic Brain Damage
This can occur during the use of devices such as forceps and vacuum extractors
This can result in excessive bleeding and pain, in a lack of blood, oxygen and nutrients to the fetus. These factors can increase the risk of a child developing CP. Complications can include, placental abruption and placenta previa.
Multiple births and Infertility drugs
Multiple births such as twins or triplets are linked to an increased risk of CP. The death of a baby twin or triplet increases the risk further. The risk of CP is higher in infants who weigh less than 5.5 pounds at birth, or those that are born less than 37 weeks into the pregnancy.
Intrauterine growth restriction (IUGR)
IUGR, is defined as a fetus with a weight that falls below the 10th percentile and abdominal circumference below 2.5th percentile when compared to others of the same gestational period, this can be due to chromosomal abnormalities, drug and alcohol abuse, heart disease and high blood pressure in the mother, poor nutrition, pre-eclampsia or eclampsia, placenta problems or parents smoking.
Drugs and Alcohol
Consumption of illegal drugs and excessive alcohol by the pregnant mother can contribute to a higher risk of CP
Cerebral Palsy Life expectancy and more facts
- The life expectancy of a child who is mildly affected by cerebral palsy is much the same as a child without the condition.
- A two-year-old child who is unable to walk has three chances in four to live into adulthood.
- From 100 children aged five who can neither walk, feed or dress themselves, 63 will live to reach the age of 20, and 50 will reach the age of 30.
- A child of two, unable to walk, feed or dress themselves, who also has severe learning difficulties is as likely as not to reach the age of 25.
- There are more boys born with cerebral palsy than girls.
- For every 100 girls with cerebral palsy, there are 135 boys with the condition.
- Over 50% of children with cerebral palsy are affected by bilateral spastic cerebral palsy.
- Most cases of damage to the brain in children with cerebral palsy occurred before birth, during the first six months of pregnancy.
- Less than 1 in 10 of cerebral palsy cases are caused by asphyxia ( 0xygen deprivation) during birth.
- Hemiplegic spastic cerebral palsy occurs in one-third of children with cerebral palsy.
- Around 1 in 20 children with cerebral palsy has dyskinetic and ataxic cerebral palsy.
- 1 in 3 children with cerebral palsy cannot walk.
- 1 in 4 children with cerebral palsy is unable to feed or dress themselves.
- 1 in 10 children with cerebral palsy has severe vision problems.
- Around 1 in 50 children with cerebral palsy are deaf.
- About 1 in 11 children with cerebral palsy is blind.
- Around 1 in 4 children with cerebral palsy are reported to experience epileptic seizures.
Physiotherapy and Occupational Therapy Important in the Treatment of Cerebral Palsy
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