What is Cerebral Palsy?

Cerebral Palsy (CP) is a condition of the central nervous system (brain, cerebellum, spinal cord) and is caused by damage to one of its parts that does not progress over time. It was first described in 1860 by the English surgeon William Little. The disease is characterized mainly by movement disorders, speech and hearing problems, sometimes with intellectual disability and epilepsy. It is classified into the following categories according to the clinical picture of the patient and the topographical distribution of the motor disabilities: Hemiplegia, diplegia, tetraplegia, athetoid cerebral palsy and ataxic cerebral palsy.

Symptoms

Infants with cerebral palsy have muscle weakness, lack of muscle tone and, later, muscle spasticity and lack of coordination.

In a child with cerebral palsy, other symptoms may include salivation, speech impairment, difficulty controlling the bladder and/or bowel, seizures, hand tremors, and inability to locate objects by touch. Children with this disorder may experience visual impairment more often than other children. Usually children with cerebral palsy may have average or above average intelligence. However, there may be mild or severe impairment of cognitive function in some patients.

Cerebral palsy can be classified into 4 different types:

• Spastic: characterized by stiff movements and caused by damage to the motor cortex
• Dyskinetic: characterized by uncontrollable movements and caused by damage to the basal ganglia
• Ataxic: characterized by poor balance and coordination and caused by damage to the cerebellum
• Mixed: a combination of 2 or more types of CP

Causes

Cerebral palsy is caused by abnormal brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. In many cases, the cause isn't known. Many factors can lead to problems with brain development. Some include:

• Gene mutations that result in genetic disorders or differences in brain development
• Maternal infections that affect the developing fetus
• Fetal stroke, a disruption of blood supply to the developing brain
• Bleeding into the brain in the womb or as a newborn
• Infant infections that cause inflammation in or around the brain
• Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical abuse
• Lack of oxygen to the brain related to difficult labor or delivery, although birth-related asphyxia is much less commonly a cause than historically thought

Epidemiological data

Cerebral palsy is a relatively rare disorder that affects men and women in equal numbers. The United Cerebral Palsy Association estimates that between 1 in 1000 and 3 in 1000 infants develop cerebral palsy each year in the United States.

Treatment

There is no cure for cerebral palsy. Several medical specialties are involved in its diagnosis and treatment (paediatricians, neonatologists, paediatric neurologists, neurologists, geneticists, neurophysiologists, neurosurgeons, orthopaedists, etc.) and many paramedical professions (physiotherapists, speech and language therapists, occupational therapists, psychologists, etc.). The clinical picture and abilities of a child with cerebral palsy can be greatly improved with interventions such as:

An important part of rehabilitation for people with cerebral palsy is Physiotherapy, which focuses on developing and retraining movements as close to the normal patterns as possible. Sometimes the use of aids such as splints, braces, stools, wheelchairs, etc. is indicated. There are many neurodevelopmental techniques such as Bobath, PNF, Vojta, hippotherapy, specific hydrotherapy techniques, etc. In addition, it is necessary to stretch the spastic muscle groups and strengthen their competing muscle groups in order to reduce the contractures and permanent deformities.

The aim of Occupational Therapy is to help the person through targeted activities and therapeutic methods to carry out his/her daily activities, reaching the maximum degree of autonomy. Occupational therapy intervention has as its main concern the support of children in order to integrate smoothly and fully into the school environment and to develop their social activities.

In particular, it helps to improve posture and balance control (e.g. sitting position), develop the functionality of the upper extremities (gross - fine movement) and achieve autonomy in activities of daily living (feeding, dressing - undressing, toileting, etc.).

The proper use of adapted equipment and adaptations in the environment (home, school) is an important part of occupational therapy intervention, which tries to create a functional environment for the child with cerebral palsy.

Speech Therapy is an important part of the rehabilitation team for children with a brain dysfunction. Approximately 65 - 70% of these children have some speech difficulties. Difficulties range from slight abnormalities of articulation, such as a slight dysarthria, to a complete lack of verbal communication. The aim is to give the child as much control over the speech organs as possible so that he or she can speak freely and express their needs.

There is no medication that "cures" cerebral palsy, as brain damage is irreversible. However, groups of drugs such as antiepileptic/muscle relaxants are important aids in limiting seizures and/or anticholinergic drugs, which can help control urinary incontinence.

In some cases, surgery may be performed to lengthen and transfer tendons in patients who have severe muscle contractions associated with cerebral palsy. This procedure can be done in several areas of the body, including the elbows, shoulders, and back of the heel.

Neuroplasticity

Cerebral palsy is a life-long condition, meaning that the brain damage that causes it will not go away over time. However, it is important to remember, that the brain has neuroplasticity, which is the ability to rewire itself and reassign affected functions to undamaged areas of the brain.

Through intensive training that focuses on high repetitions, individuals with cerebral palsy improve mainly their motor skills.

Additionally, early intervention is key to improving several functions, because children’s brains have greater levels of plasticity than adult brains.

From the Synopsis Team

Angelina Chatzaki, Occupational Therapist