Cerebral Palsy

Cerebral Palsy is a disorder in which muscular control and coordination are impaired due to brain damage. In many patients, speech and hearing are also affected, and the patient may also be mentally retarded. Cerebral palsy is usually first noted in infancy or early childhood.

It is estimated that there are probably more than half a million cases of cerebral palsy in the United States. Each year there are six new cases for every 100,000 people. Of these six, roughly two are feebleminded and four have normal intelligence. Of these four, one is mildly affected, two are moderately affected, and one is severely affected. People who are mildly affected require very little attention and should perform more or less normally in school or at work. A moderately involved patient may require some assistance in his daily activities and may also need physical, occupational, or speech therapy, though he is usually able to attend either public school or a special school for the handicapped. The moderately involved patient may also require more intensive care at regular intervals to prevent him from becoming severely involved. The severely involved patient is either predominantly or totally dependent on outside help and may be either homebound or institutionalized, depending on his mental state and other factors.

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Types of Cerebral Palsy

The various forms of cerebral palsy are sometimes classified into four major groups according to the type of disability. Some patients have a combination of two or more of these types, depending on the area and degree of brain involvement.

Well over half of all patients exhibit at least a partial spastic weakness of one or more extremities. In this type, known as spastic cerebral palsy, the muscles are under a continuous state of tension, with increased reflex activity. About 40% of all patients have the athetoid type, with disorganized spontaneous muscular movements. In these patients the extremities move involuntarily in many different directions.

The atoxic form, which occurs in relatively few patients, is manifested as a disturbance in balance while walking or standing. These patients may fall often and frequently cannot move about without assistance. In patients with the tremor type, there is a spontaneous vibration, or trembling, of one or more of the extremities.

The various forms of cerebral palsy are also often further divided into four groups on the basis of the particular extremities involved. In monoplegia, only one limb is affected. In hemi-plegia, there is involvement of an arm and a leg on the same side of the body. Diplegia, or paraplegia, indicates involvement of either both arms or both legs. In quadriplegia, all four limbs are affected.

Cause of Cerebral Palsy

The brain damage that produces cerebral palsy may result from a variety of causes. Sometimes it occurs before birth as the result of a disease or injury that affects the fetus in the mother's uterus. Difficulties during childbirth may also produce brain damage. In later life, it may result from various infections, vascular diseases, or head injuries.

Each type of cerebral palsy is caused by damage, to a different area of the brain. Damage to the motor regions of the cerebral cortex results in the spastic type, while damage to the basal ganglia (special masses of gray matter at the base of the brain produces the athetoid type. The ataxic and tremor types are caused by damage to the cerebellum. Associated difficulties in speech, hearing, or vision are usually due to damage of the brain centers governing these functions. Similarly, mental retardation results when areas of the cerebral cortex concerned with intelligence and other higher functions are affected.

Treatment of Cerebral Palsy

Many drugs have been used to help relieve spasticity, but these usually have met with only short-term success. The primary goal in treating cerebral palsy is to maintain or improve the functioning of the patient by the use of such services as phyiscal therapy, occupational therapy, speech therapy, and social and psychological counseling. In addition, the application of braces or other appliances may be helpful, and in some cases surgery is used.

Physical therapy for the cerebral palsy patient includes exercise programs aimed at preventing permanent muscle and joint tightness and attempting to improve muscular strength, control, and coordination. Although such programs may be started while the patient is in a hospital or other institution, a home program of therapy should be continued with help from the patient's family.

Occupational therapy may be of significant value to the mildly affected patient and may help a moderately involved patient to care for himself more effectively. Appropriate social and psychological counseling throughout the patient's life can be important in helping him adjust to his condition. Generally, optimum physical benefits cannot be achieved until the patient has adjusted to his social and psychological problems.

Speech therapy can be of particular value in assisting the patient's family in communicating with him. It is most helpful for patients with either aphasia or dysarthria. Aphasia, caused by damage to the speech center of the brain, is a difficulty in comprehension, expression, or both. Dysarthria is a difficulty in articulation and is caused by abnormal functioning of the muscles of the face and mouth.

Various kinds of appliances, such as braces, splints, and standing tables, may be helpful in preventing deformities, controlling involuntary movements, supporting the patient's weight, and enabling him to walk. A number of surgical procedures can also be of value in helping a patient achieve maximum functioning. Such operations include lengthening the heel cords when there is severe tightness of the calf muscles, releasing thigh muscles that are contracted, and fusing certain joints, such as the ankle or wrist. Also, it might be hepful to cut certain nerves supplying severely spastic and tightened muscles, and muscle transplants may occasionally be helpful. Patients with athetoid cerebral palsy may be helped by cryosurgery, in which the damaged tissue is destroyed by chilling it to a very low temperature.

Prognosis of Cerebral Palsy

Although there is no cure for cerebral palsy, the patient should be given maximum opportunity in both his home and educational environment to achieve as high a functional level as possible. Many patients can live relatively normal, productive lives if optimal use of their abilities can be realistically combined with appropriate therapy and satisfactory adjustments to their disabilities.

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