Cerebral Palsy
Meaning
Cerebral Palsy or C.P. does not refer to the specific disease but the collective word of permanent brain disability syndrome in children. The disability will be stable and will not extend. It will result in the faulty of muscular coordinating working which subsequently causes the unusual movement and poses, for example, the hardening of the legs, arms, body, face, tongue, stability, posing when sitting, standing, walking, or even cannot walk.
Beside the unusual movement and posing there may be other brain abnormalities such as perception and learning impairment, mental retardation, and epilepsy, etc.
Causes
It might be caused from many factors however about 25% cannot be figured out its cause. Most of the cases occur during the brain development, i.e. in the womb to ages of 7-8 years old. There are 3 causal stages:
1. Prenatal period: from 0 6 months pregnant:
1.1 Mother infection during pregnancy such as German measles, syphilis, herpes, malaria, aids, etc.
1.2 Fetal distress, for example, mother having bleeding during pregnancy similar to abortion or premature placenta separation, lack of nutrition in mother or severely pale.
1.3 Lack of significant nutrients in mother such as iron, iodine, vitamins, etc.
1.4 Mother has congenital disease such as diabetes causing the unusually big baby and may be dangerous during birth giving or toxemia of pregnancy. High blood pressure may cause brain bleeding in the baby.
1.5 Some medicines and toxicants such as lead, mercury, cigarette, alcoholic drinks overdosed by mother.
1.6 Brain abnormality at birth such as hydrocephalus, cretinism, stunted brain.
1.7 Chromosome aberration
1.8 Incomplete placenta and unbilical cord.
2. Perinatal period: from 3 months pregnant to the last stage until the first week after giving birth:
2.1 Premature birth: its weight is less than 2,500 grams; high risk of cerebral palsy.
2.2 Perinatal asphyxia: from abnormality or difficulty of birth such as bottom birth or umbilical cord around the neck, amniotic fluid aspiration (thick meconium) or birth with birth aids such as wrench or head sucker.
2.3 Anti blood group between mother and child.
2.4 Birth using pain killer such as morphine, or epidural anesthesia is risky to birth asphyxia.
3. Postnatal period:
3.1 Asphyxia such as side effects from operation, anesthesia, drowning, or epilepsy.
3.2 Infections such as meningitis, encephalitis, measles, etc.3
3.3 Accidents which causes pain to the childs brain such as skull fracture, brain bleeding.
Symptoms
Cerebral palsy symptoms are dependent on movement and poses of the body and can be classified into 3 categories:
1. Spastic: the most found, muscle will be tensed than regular causing the abnormalities as follow:
1.1 Horizontal half: contraction happening to the same leg and arm (spastic hemiplegia). The arm will be more serious than leg. The prominent abnormalities of the arm are bent elbow, bent wrist, and bent finger. The contraction of the leg makes it to peck down. It looks like a hemiplegia in an adult.
1.2 Vertical half: contraction of both arms and legs (spastic diplegia) the legs will be more severe than arms.
1.3 Full body: serious contraction of both legs and arms. The seriousness of contraction between legs and arms are the similar. Sometime the arm contraction is found more severe than legs (spastic quadriplegic).
2. Self movements (athetoid, ataxia)
2.1 Athetoid: the muscular tension will be moving and uncertain and resulting in movement uncontrollable. Some may also have tilted neck and distorted mouth.
2.2 Ataxia: the muscular tension will be less to normal. It causes the stability problem, non-synchronized muscles. There might be body shaking during moving.
3. Mixed type: mostly found especially those of contraction and self movement.
Problem and abnormalities happening with cerebral palsy children
1. Mental retardation: the cerebral palsy children belong to every level of intellect. It was found that 20% are having lower-than-normal intellect or mild while 30%-40% found having moderate to severe retardation.
Psychological test generally does not tell genuine intellect because the children are also having other problems such as seeing impairment, hearing impairment, speaking and perception including mood disorder, lack of stimulator, inspiration, and experience. Therefore, when tested the lower-than-normal result will be received.
2. Perception, learning, and thinking: the cerebral palsy children have limited movement. This makes them unable to explore and learn the environment extensively. They cannot understand position, direction, coarseness, fineness, shape, temperature sensation and they cannot learn the body image and organs including their relation.
3. Temper and social attitude will be quickly changed. They will often depressed because they cannot move intentionally; sometimes they can move but sometimes they cannot. They cannot play with other children, cannot help themselves and this makes them feel depressed.
4. Epilepsy: it was found that 20%-50% of cerebral palsy children also have epilepsy. The forecast of the disease found severe. This needs to be clarified from the convulsion after birth which will not be happen again or the convulsion form the high fever that its forecast shall be better. The parents shall bring the child to see the doctor regularly because he/she will need special care including to adjust the dose to be suitable to the current symptoms.
5. Eye: the cerebral palsy children often also have seeing impairment. It was found that 20%-60% have squint eye toward the inner end. If abandoned, only one eye will catch the picture which will make the dimension distorted. Other impairments that may found in the children with cerebral palsy are, as for example, they cannot move two eyes upward simultaneously or nystagmus. For the long-sighted eye, it was found by 25-75%. The children, therefore, shall have the optometrist to examine at the first time and again before entering school.
6. Ear: Children with cerebral palsy will also have hearing impairment because the defect of the central ear especially high frequency differentiation. The children will hear less noise i.e. soft speaking will not be able to convey to then. The parent may have to speak repeatedly. If shouted, it will frighten the child which will affect the childs mood.
7. Meaning conveyance and interpretation: the cerebral palsy children will have the dialogue faulty. That they cannot control their head they cannot locate the source of sound and cannot imitate it or cannot communicate with others. Examples of speaking faulty include non-speaking, slower-than-normal speaking, or speaking with difficulty, abnormalities of speaking muscles, or abnormalities of the brain controlling the language and communication skills, including IQ.
8. Bones: dislocation and subluxation of the joints such as hip joint, shoulder joint can be found in cerebral palsy children. Scoliosis, contraction, and equinus may also be found.
9. Teeth: decayed tooth is often found in the children with cerebral palsy because mouth and teeth sanitary cannot be well cared. The children cannot open their mouth or gargle themselves. The parents shall regularly bring the children to the dentist.
Caring/ Cure
That there are various types of cerebral palsy and each type composes of integrated problems such as movement, hand use, absorption, communication, intellect, social and temper, including environment and family,
Caring the children with cerebral palsy shall cover in every aspects recognizing the cooperation by children, family and curing staff.
With proper curing and love they have received since they were very young, the children shall have better development than when curing has been received when they are growth. This, however, depends on the type and severity of the disease.
Curing according to the problem includes:
Physical therapy, i.e. movement and posing assessment, movement and posing development practice, stability practice, joint distortion prevention, exercise by hydrotherapy, muscle and bone curing by tools and approaches of physical therapy.
Occupation therapy, i.e. intellectual and small muscle development assessment, absorption practice, routine activity skill practice, dressing, self dining, hands and arms movement practice to prevent joint stiffness and distortion. Sensation encouragement, perception and response order.
Vocal correction, i.e. speaking and language capability assessment, speech correction, etc.
Medicine treatment:
- Oral medicine: capable of decreasing muscular hardening however its side effect is drowsiness. The medicine decreases all muscle thus cannot correct the joint distortion.
- Regional analgesia: currently popular, it is produced from bacteria and makes the nervous end blocked when injected into the contracted muscle. It also decrease the joint distortion. The medicine will be temporary active and it will end its effect within 3-4 months and the muscle will contract again. The cerebral palsy children have a lot of distorted muscles; if all of them are to be cured, the large quantity of expensive drug must be used. The patient with strong joint the drug will not help.
Operation:
- Operation decreases the stiffness of muscles. The operation will be conducted at the musclewith stiffness; this includes tendon movement to balance the joint.
- Bone operation: in the case the bone is pull to the distortion under the consideration of the doctor if the operation is appropriate.
Other treatments include operation for squint eye, drooling, hearing aids, convulsion control, and psychiatry problems.
Tools and accessories with treatment: the contraction cerebral palsy child needs extra tools or accessories such as ankle foot orthoses-AFO to prevent tension of the achillis tendon. In the case of pecking of the ankle the walker may be needed.
Study of cerebral palsy in children: most of them have normal IQ but with movement disability prevents them to go the treatment.
