Cerebral palsy (CP) is a chronic disorder of posture and movement caused by the lesion of the central nervous system. CP consists of involuntary reflex movements and muscle contractions (spasms) that may affect a region, half of the body or the entire body. A number of diseases like mental retardation, seizures or visual and auditory dysfunctions are commonly associated with cerebral palsy.
Consulting a specialist
Recommended medical specialists
Treatment – Overview
Treatment if the condition gets worse
Cerebral palsy is the result of the injury or abnormal development of the nervous system (brain). In most cases the cause is unknown. The lesion or dysfunction can occur during pregnancy, when giving birth or in the first 2-3 years of life.
The causes of the CP which occurred during pregnancy or birth can be genetic or chromosomal abnormalities, infections or other diseases of the mother or fetus which occurred during pregnancy or peripartum complications (during labour). Any of these can affect the normal growth and development of the fetus or deprive the fetus or the newborn of his needs of blood, oxygen and nutrients. Diseases of the newborn such as untreated hypoglycemia can also cause brain damage that can cause CP.
CP due to premature birth is linked to the insufficient brain development. Children born prematurely are at increased risk of brain hemorrhage (intraventricular hemorrhage or IVH). Periventricular leukomalacia (PVL), a disease of the white matter of the brain, is more common in children born prematurely than in those infants born at term. Both IVH and PVL, increase the risk of CP.
The aspects that may cause CP in the first two or three years of life are related to brain damage as a result of a serious illness such as meningitis, of a brain injury resulting from an accident or head injury or after a temporary lack of oxygen to tissues as in the case of a drowning event.
Even if it is present at birth, cerebral palsy may become evident only between one and three years of life. This is due to the modalities of growth and development of children. Doctors or parents can recognize the irregular movements of the child only when the child grows and they become evident. These babies and young children can keep the newborn reflexes and delay the achievement of a normal development of their age. Parents and guardians are usually the first to notice the delays in the child’s development which may be early signs of CP. In the severe forms of CP there are signs even from birth or soon after it. However, some early signs of severe CP vary, depending on the specific type of disease.
The signs of severe CP that can be observed immediately after birth are:
- Difficulty in sucking and swallowing;
- Weak or sharp cry;
- Abnormal positions; the body is either very relaxed and soft or too stiff; when taken in the arms, babies can extend their back, arms and legs; these abnormal positions are different and much more severe than those occurring in children with colic .
Some problems related to CP may occur or become evident once the child grows. These include:
- Muscle atrophy in the affected limbs. The damage of the nervous system causes the limitation of movements of the affected limbs. The limitation of movements affects the normal development of muscles;
- Abnormal perceptions and sensations like pain at light touch. Even daily activities like brushing your teeth can cause pain. The abnormal sensations can make difficult the identification of common objects by touch, such as observing the difference between a soft bubble and a tough baseball;
- Skin irritation. Abundant salivation is common when facial muscles and those of the neck are affected. Abundant salivation irritates the skin, especially that around the mouth, chin and chest;
- Dental diseases. Because of the pain that may occur when washing the teeth, the risk of tooth decay and gingivitis (gum inflammation) increases. The adverse effects of drugs administered in order to treat seizures can also contribute to the development of gingivitis;
- Traumas. There is the risk of falls and other accidents, depending on the muscle control, joint rigidity (difficult mobility) and the overall muscle tone. Seizures associated with CP can also cause accidental bruises;
- Infections and chronic diseases. Severe CP causes difficulties related to alimentation. The inhalation of chewed food into the lungs increases the risk of pneumonia. Adults are at increased risk of heart and lung damage. Some children with CP has several behavioural disorders such as excessive sleepiness, irritability and loss of interest for the world around them.
All patients with cerebral palsy have movement and posture disorders. However, most children have no signs of CP at birth. Parents and guardians can observe the first signs of CP, such as the inability of a child to turn from one side to the other side, to sit, to crawl (to go on all four) or to walk at the usual age. The signs of CP may become increasingly evident along with age. Some developmental problems can occur only after the first year of life. Brain injury that causes CP does not worsen along with age; although they may appear, they are subject to change or may become more severe as the child grows.
The specific symptoms of CP depend on its type and severity, on the degree of mental debility and the development of other complications or the association of other diseases. The type of the existent CP and what part of the body is affected will determine the degree of the child’s mobility. Most patients with CP have a spastic form of CP which affects only one part of the body. For example, there may be symptoms only at the level of one limb or one half of the body. Most children find ways to accommodate with their disability. Some patients can do it by themselves, others live their life and work in situations that provide them a certain degree of assistance (aid). If both limbs are damaged, it is recommended to use a wooden scooter (a device used for support while sleeping), a modified wheelchair, a wheelchair or other special equipments. Cerebral palsy that affects the entire body causes the biggest problems. Severe spastic and athetotic CP (dyskinesia, involuntary jerky movements) are forms of total CP. Many of those affected can not care for themselves, either because of the severe functional impotence, or because of mental retardation. However, some patients can live with the help of family members or persons qualified to help them. Complications, as an epileptic access or other chronic physical impairments of CP can be difficult to diagnose before one up to three years. Sometimes such predictions are possible only at school age when learning skills, communication skills and other skills can be quantified. The degree of support and supervision depends on the number and the severity of problems. The degree of mental debility is an important predictor of daily functionality. About 75% of the patients with CP have a certain degree of cognitive impairment. Approximately 60% of them are mentally retarded (from moderate to severe forms), and the others are developed normally, but have a degree of learning difficulty.
Other conditions, such as visual or auditory dysfunctions, are commonly associated with CP. Some of them are diagnosed early, others as the child grows. Also, as people with normal physical development, patients with CP have several social and emotional concerns throughout their life. Because of the physical limitations, there can occur other concerns besides those mentioned above and this is why patients with CP need understanding and encouragement from other people. Of all children diagnosed with cerebral palsy, 90% of them reach adulthood.
A more accurate assessment of the quality of life depends on the existent type of CP, the severity and impact of other diseases that are associated with CP. Most adults with mild or moderate forms of CP and some with severe forms are independent (they do it all by themselves) and work. The opportunities to live independently and to get employed have improved for patients with CP. These are the result of a better support from the family members and from more advanced technologies, such as computers equipped with microphone, electric wheelchair and other devices.
Premature birth and low birth weight
40-50% of the children who develop CP are born prematurely. The risk of developing CP increases as the birth weight is lower. Premature infants usually have a lower weight than the normal one, lower by about 2.5 kg, but term infants may have low birth weight as well. There is a higher risk of premature birth and low birth weight in the case of twin pregnancies compared to single fetus pregnancies. There is also a higher degree of likelihood in the case of children born prematurely or with low birth weight to have, during the period of growth, development difficulties that can affect the brain. For example, a condition called periventricular leukomalacia or PVL, which consists of the damage of the white matter of the brain, is more common in children born prematurely than in term infants.
Risk factors before birth
The risk of a fetus to have brain abnormalities and consequently to develop CP is higher when the mother gets certain conditions during pregnancy, such as:
- Infections like rubella, cytomegalovirus and toxoplasmosis infections. The risk is very high if infections occur in early pregnancy- uterine or vaginal infection of the mother. These infections can cause the inflammation of the placenta (chorioamnionitis), which can disrupt the normal development of the brain;
- Exposure to certain medications such as thyroid or estrogen hormones;
- Alcohol and illegal drugs
- Other conditions such as bleeding in the uterus between the sixth and the ninth month of pregnancy, large amounts of proteins in the urine (proteinuria) or high levels of blood sugar (hyperglycemia).
Risk factors for CP at birth
Although rarely, some children develop CP as a result of some complications that appeared during pregnancy. The risk factors include:
- Premature birth. Babies born prematurely are at increased risk of developing cerebral hemorrhage (intraventricular hemorrhage or IVH) which are causes of CP;
- Prolonged or difficult labour. Lack of oxygen, brain infections or physical traumas (secondary to the use of forceps or other instruments) are all factors that may increase the risk of developing CP. In turn, CP can cause a difficult birth because of the disorders of movement and posture associated with this disease;
- Early detachment of a normally inserted placenta. Normally, the placenta separates from the uterus after a few minutes after the baby is born. If it separates before birth, the blood and oxygen supply from the mother decreases, which increases the risk of developing CP
- Uterine or vaginal infection of the mother, like the streptococcal infection, that can be transmitted to the fetus during birth. CP can occur if the infection affects the brain of the child.
Risk factors for CP, emerged after birth
The risk factors for the development of CP immediately after birth or within the first two or three years are related to brain damage and include:
- A serious disease like severe jaundice, meningitis, or lead poisoning (very rare). The early signs related to these include difficulty in breathing, low levels of thyroid hormones (thyroxine) and low blood sugar (hypoglycemia). Babies born prematurely or with low birth weight are susceptible to develop these diseases;
- Severe head injury after an accident or falling. These include the child’s injuries like shaking, pushing or other forces (abused child syndrome, which is also called intentional head injury-IHI);
- The decrease of the amount of oxygen supplied to the brain may be the result of a brain tumor or a drowning event;
Other risk factors
Babies born from very young mothers or over 35 years have an increased risk of developing CP. A genetic or chromosomal defect as thrombophilia, a blood disorder increases the risk of CP.
Consulting a specialist
It is recommended to consult a specialist if the child with CP has:
- Respiratory problems
- Choking during feeding and he fails to remove food
It is recommended to the following persons to consult a specialist:
- Pregnant women who are suspected to have rubella or other infection, who was exposed to some toxic substances like strong chemicals or radiation, who consumes alcohol or prohibited drugs;
- A child who has a seizure for the first time.
If a child is diagnosed with CP, it is recommended to consult a specialist if he has:
- A seizure (first crisis of his life);
- Constipation which is not controlled with home treatment;
- Exudative, bloody or painful skin irritations that worsen;
- Difficulties in eating that can not be controlled at home, such as:
- Bouts of coughing and choking during sucking, if food is aspirated into the lungs, the risk of developing pneumonia increases
- Difficult chewing accompanied by weight loss and hunger
- Frequent accidents that threaten the safety of child
- Other complications like urination disorders, bleeding gums, increased joint stiffness.
It is recommended to observe the child’s degree of development reached at that age, to regularly perform checks to his doctor and tell him the observations or whenever new events related to the child’s development occur. Watchful wait is not recommended when the child was diagnosed with CP and if he develops complications.
Recommended medical specialists
The doctors who can diagnose and treat cerebral palsy are:
- Pediatrician (some pediatricians who are specialized in developmental disorders)
- Doctor of internal medicine
- Neurological surgeon
- Psychiatrist and other appropriate persons in the application of long-term treatments
- Orthopaedic surgeon
- Psychiatrist, psychologist, social workers and nurses working in the psychiatric ward.
Other professionals who may be involved in caring for patients with CP are:
- The specialists in occupational therapy
- Dentist or specialist in orthodontics
- Speech-Language Pathology professionals
Some clinics are specialized in treating children with CP.
The diagnosis of cerebral palsy:
- the signs of cerebral palsy may not be present at birth. It is recommended for the doctor to closely monitor the signs of CP of a newborn or child if he has the risk factors. These factors may be problems that occur during pregnancy or birth, there can be premature births or illnesses which occur during the first two or three years of life.
Doctors are cautious in diagnosing CP too early because some children with motor dysfunction early after birth may not develop CP later. Sometimes symptoms may occur at the same time with the maturation of the nervous system, following the development of the brain, nerves and muscles. It may take several years until a child with impaired movement and posture is diagnosed with CP.
The diagnosis of cerebral palsy is made on the basis of the notice of the delay in the infant’s physical development based on the history of the disease (anamnesis), physical examination, screening tests and other tests like MRI (which is done in order to exclude other organic causes).
These steps include:
- Finding information about the child’s medical history andthe evolution of the mother’s pregnancy. The delays in development are usually observed by parents or doctors during routine checkups. These checkups are a good opportunity for your doctor to find details about the motor or sensory abilities, especially about those which should appear in the first or second year of life;
- A physical examination in order to find the signs of CP. During the physical examination, the doctor can say if the child retains newborn reflexes longer than it is normal, which is a sign of CP. The basic muscle functions of those of posture, visual and auditory disorders will also be evaluated;
- Screening tests. Your doctor will recommend the performance of some questionnaires related to development and other tests in order to determine the extension of development delays and establish whether you need a more extensive examination;
- The brain magnetic resonance imaging to identify brain abnormalities and other medical conditions. Taken together, the results of these investigations can guide the doctor towards the diagnosis of CP. If the diagnosis is unclear, additional tests may be performed in order to analyse the brain tissue or to exclude other diseases. Sometimes the results of these tests can be helpful in assessing the severity of CP.
The tests may include:
- Additional questionnaires to assess developmental disorders
- Computed tomography of human brain
- Ultrasound of the brain.
The evaluation and monitoring of CP
Once CP is diagnosed, a child will be examined in order to find other medical conditions that may occur along with cerebral palsy, such as:
- Other developmental disorders beyond those already identified; the development skills will be evaluated periodically in order to determine if other symptoms such as speech and language delays appear along with the development of the nervous system;
- Intelligence tests to identify the intelligence under the normal one (mental retardation);
- Seizures – electroencephalogram (EEG) is useful for detecting the abnormal activity in the brain if the child has a history of seizures;
- Difficulty in eating and sucking;
- Auditory and visual dysfunctions;
- Psychological assessment for behaviour disorders.
In most cases your doctor can identify the long-term effects of physical damage even from the age of one to three years. In some cases these predictions are not possible until school age, a period during which the ability to learn, communication skills and other skills can be quantified. The degree of support and supervision necessary for a child depends on the number and the severity of disorders.
Some children need to regularly perform the following tests:
- Radiography in order to detect a contortion or the displacement of the coxofemoral joint (hip); children with CP are irradiated several times between 2 and 5 years. It is recommended to perform an X-ray if there is hip pain or other signs of hip dislocation such as abnormal movement of the hip or knee. The spine radiography is recommended for the detection of spine deformities (scoliosis)
- Targeted analyses, necessary to identify the disorders and make therapeutic decisions.
Additional tests may be needed depending on the child’s symptoms and other associated medical conditions.
Cerebral palsy can not be cured, however, many treatments can help patients maximize their skills and muscle tone, prevent complications and improve the quality of their lives. Brain injury that causes CP does not progress over time. However, new symptoms may occur or deteriorate in time because of the child’s growth and development. The specific treatment varies from one patient to another and may change to the same patient if there are other new disorders. In general, the treatment focuses on measures that improve the quality of life and health in general.
Treatment – Overview
- Physical therapy is an important part of the treatment that starts immediately after the diagnosis is made and may continue throughout the patient’s life. This treatment can begin before a sure diagnosis is made, depending on the patient’s symptoms;
- Medications can control some of the symptoms of CP and prevent its complications. They may consist of injectable antispasmodics for the improvement of muscle relaxation and they can improve the rate of movement as well. Other drugs may be used for the common disorders associated with CP, such as anticonvulsants to prevent seizures;
- In rare cases, orthopedic surgery (for muscles, tendons and joints) or selective dorsal rhizotomy (the sectioning of the spinal nerve roots or of that of the brain) for contracture or other mobility disorders is immediately performed after diagnosing a newborn or young child with severe abnormalities.
Usually the biggest problem of parents is the fear of how severe the disease can develop. It is good to learn about CP in order to better understand the disease and meet some of its obstacles and the joy of the patients with this disease when they overcome them. Information determines the safety about they way in which they can help their child.
The maintenance treatment of CP is based on the continuation and adjustment of the existing treatments and adding new ones if it is necessary. Although the cerebral lesions that cause CP do not progress over time, some of their effects may appear for the first time, others may change or become more severe with the child’s growth. Regular checks are important for monitoring the evolution of the disease. These checks may consist of questionnaires to assess whether the new steps of development are purchased at the right time or blood tests done regularly in order to detect the adverse effects of the medications the child takes. It is also recommended the periodic examination of eyesight, hearing and language. Other tests may be done in order to determine whether diseases typically associated with CP developed. These problems can be treated from the moment of their occurrence.
The maintenance treatment for CP may include:
- Physical therapy. This is an important part of the maintenance treatment and may help your child acquire normal mobility. It can also prevent the need for surgery. If surgery is required, intense physical therapy for at least six months or more is necessary.
- Monitoring of any medication taken in order to control symptoms and prevent complications. Medications may include oral or injectable antispasmodics to relax muscles and reduce spasms, anticonvulsants to treat seizures or anticholinergics to control the involuntary body movements (dystonic cerebral palsy) or heavy salivation
- Orthopedic surgery (for muscles, tendons and joints) or selective dorsal rhizotomy (the sectioning of the spinal nerve roots) to prevent the affection of bones and muscles, associated tendons and ligaments. Special equipment and devices will be used, such as the orthopedic device (corset, device used to fix), plaster devices and others.The specific type which is used depends on the child’s needs. For example, a child can use a plaster device after surgery or in order to reduce movement on a particular side so as to strengthen the muscles and tendons from the opposite side of the body.
The maintenance treatment for CP can also include:
- Breathing exercises. These may be associated with physical therapy or may be made separately. While doing them, patients are taught techniques to control the affected muscles, being useful to reduce muscle tension. They are not effective for every patient.
- Massage therapy and hatha yoga. These therapies are recommended for the relaxation of tense muscles, to strengthen muscles and keep joints flexible. Hatha yoga with breathing exercises is sometimes recommended to prevent lung infections. Additional studies are recommended in order to prove the benefits of these therapies in patients with CP.
- Therapies for the stimulation of learning and sensory development. Infants and toddlers can benefit from these stimulation and neurodevelopmental therapies. Some of these therapies are useful also for older patients. These therapies can not correct the damaged parts of the brain, but they can stimulate the unaffected parts of it.
- There are many controversial treatments, some of them can be harmful. It is recommended to consult a specialist for each treatment that is applied to the child. Each patient with CP presents disorders and a variety of responses to different treatment options.
Most patients with CP need help for:
- Feeding. CP can affect jaw control and interfere the ability to chew, suck and swallow. The use of special tools such as dishes that stick on the bottom, the proper positioning of the child at the table and eating soft or semi-solid food like porridge may be useful.
- Using the toilet. Some patients with CP have ankyloses of the coxofemoral joint (hip) or similar impairments that can make difficult the use of the toilet. Others present urination disorders. The help from a specialist in occupational therapy and the use of special clothing for their control is recommended.
- Bowel movement. Most patients with CP suffer from chronic constipation with bowel movement disorders. Laxatives and stimulants to control the bowel movements are commonly used.
- Washing and nursing. Patients with CP do not have control over their hands and arms and therefore they can not care for themselves. Some of them can be taught some self-care techniques through daily exercises.
- Dressing. The use of clothes and shoes that can be easily dressed and undressed like those with zippers or Velcro is recommended.
- Teeth care. Cerebral palsy can affect jaw muscles, teeth can grow in an abnormal position and may be prone to decay (fall) and sensitivity on the tongue and mouth may occur. Also many patients can not use a toothbrush. The use of special devices like electric toothbrush or an electrical device for cleaning teeth and the use of toothpaste for sensitive gums and cleaning teeth regularly, is recommended.
- Skin care. Abundant salivation is common in patients with CP, which can cause irritation around the chin, mouth and chest. The absorption, rather than wiping the secretions by using absorbent clothing that covers the rib cage of the child and the application of lotions or porum starch on areas prone to irritation, is recommended.
- Speech. Some patients with CP have the jaw muscles and the mouth affected and a reduced hearing. These problems, alone or combined, can cause difficulty in the pronunciation of words. In order to improve communication specialists will pronounce the words slowly, looking directly into the child’s face during the conversation and using drawings or objects during the conversation. Reading is also important, using books with clear drawings can be helpful.
- Safety. Patients with CP are prone to falls and other accidents especially if they have seizures. It is recommended to take safety precautions at home in order to prevent accidents, such as a solid furniture or unpolished floors. Also, avoid sharp objects and supervise children with CP when they are in the bathroom.
The behavioural therapy during which the child is taught different ways of communication, and in the case of children of a school age ways to communicate with others, especially peers. An important part of the maintenance therapy is the cooperation with people specialized in caring for children with CP and the understanding of the needs and rights of the child, self care and the care of other family members.
These strategies include:
- Identifying and understanding your child’s educational rights;
- Emotional support. The child’s needs change with growth. He becomes more aware of his physical limitations, he needs to talk about his feelings and about the therapeutic possibilities. It’s easier to talk about all these things with a stranger (someone who is not part of the family). The doctor is the one who can recommend any emotional counseling from which the child can benefit. Also, a more active involvement of the child in making decisions about his own health, is recommended.
We recommend rest, healthy food, exercises and learning new ways to overcome the obstacles that arise when caring for a child with CP. Parents provided with physical energy and spiritual power, succeed more easily in helping their children with CP.
- Cooperation in the family. The whole family is affected when one of the members has CP. It is important to help the family members cope with the situation, especially the siblings. It is recommended to prevent the development of fear and unrealistic worryo of the other siblings that may feel ignored or overwhelmed.
Of all children with CP, 90% of them reached adulthood (around the age of 20 years). Most adults with CP have a job, despite the physical dysfunctions from moderate to severe. As this stage of life is achieved, the integration of patients with CP in an occupational therapy program in order to prepare for an independent living, is recommended. Helping a child with CP to live independently requires patience and ingenuity of the parents who will have to deal with the frustrations and obstacles that appear. The child may need encouragement and additional support in order to overcome the responsibilities and expectations that arise.
Treatment if the condition gets worse
Although the brain lesion that generates CP does not worsen over age, some of its effects can occur for the first time, others may change or become more severe with the growth and development of the nervous system. The main diseases related to CP may develop, may become more severe or may cause complications. The treatment varies from case to case and depending on each type of CP, but it generally includes medication, surgery, a series of specific therapies and the use of orthopedic equipment. Drug treatment may be indicated in case of symptoms of CP such as muscle spasms or seizures. In the case of severe muscle spasms it is recommended to take antispasmodics (muscle relaxants). These include Diazepam (Valium), Dantrolene (Dantrium) and Baclofen (Lioresal). Very rarely, intrathecal Baclofen (ITB) is used. For this, a small pump is placed in the abdominal subcutaneous tissue. This pump releases Baclofen in the blood along the spinal cord. This treatment may be more effective than the medication treatment in order to relieve muscle spasms. But it is more complicated than the oral treatment and has some risks (infection of the place where the probe is implanted). Injectable antispasmodics like botulinum toxin (Botox) are administered with a needle directly into the affected muscle. If seizures occur, anticonvulsants such as Carbamazepine (Tegretol) are used. Anticholinergic drugs like Glicopyrolat (Robin) are useful for patients with CP who have involuntary body movements (dystonic cerebral palsy) or for those who drool profusely.
Types of surgical treatments
- Orthopedic surgery for the loss of strength of muscles, tendons and joints, especially in the case of hip, knee and ankle joints;
- Selective dorsal rhizotomy which consists of the cutting of the nerve roots of the limbs, which are the most affected by spasms and involuntary movements, in order to increase the flexibility and control of muscles. If a surgery is recommended, the physician must take into consideration the symptoms, the age and the condition of the patient. A thorough clinical examination is needed in order to determine what type of muscles and nerves are affected and what type of surgery is recommended for each case. An examination of walking can be recommended in order to establish the degree of its impairment;
- Physical therapy is frequently a part of the maintenance therapy, but it can change the other way after surgery or if other conditions or the worsening of old ones occurs. Following the surgery, physical therapy is recommended for at least 6 months. Biofeedback may be useful alone or as part of the physical therapy. Although biofeedback is not effective in all patients with CP, some patients who use this technique learn to control their affected muscles and to reduce muscle tension;
- Special equipment and devices. In order to maintain or improve joint mobility, to increase muscle strength and relax overactive muscles (spastic), many patients with CP use various devices and practise different exercises daily. Such devices and equipments may include braces, splints, supports and special chairs, strollers, wheelchairs, special shoes and other personalized materials in order to solve specific problems. Individualized treatments may be necessary depending on the specific needs that may occur.
- Occupational therapy helps adult patients cope with limitations (restrictions) and live as independently as possible;
- Speech exercises are necessary for learning to control mouth muscles. This therapy may be useful for children with speech and feeding difficulties. It is advisable to start the therapy before they start school and continue it during school;
- Nutrition advice may be necessary when a need for regimen is encountered because of some difficulties caused by the consumption of certain foods;
- Both massage therapy and hatha yoga are necessary to relax tense muscles, to strengthen muscles and keep joints flexible. Haghia yoga breathing exercises are sometimes used to prevent lung infections. Further studies are needed in order to detemine the benefits of these therapies for patients with CP
- Infants and young children may benefit from therapies for the stimulation of learning and sensory development. These therapies can not correct the damaged parts of the brain, but they can stimulate the healthy brain regions
- Behavioural therapies are necessary for school-age children with CP in order to learn better ways of communicating with others.
We recommend to consult a specialist for any therapy you want to apply.
In some cases the etiology of CP is unknown. However, a number of links between CP and certain circumstances during pregnancy, labour and immediately after birth have been identified. Some of them are preventable, some are not.
CP can be prevented before and during pregnancy by adopting and maintaining healthy lifestyle habits:
- Healthy Eating
- Avoid smoking
- Avoid exposure to harmful substances
- Regular medical examination.
CP can also be prevented in children by avoiding situations that can cause brain damage:
- Taking measures to prevent accidents
- Know the signs of mechanical jaundice
- Avoid contact with patients with severe contagious diseases such as meningitis
- Vaccination of children at the right time.
Through the collaboration between the members of the family and the physician, home treatment can be used in order to ensure the best care of children with CP.
Educating and supporting parents and family members:
- Documenting about the disease. Usually, the biggest problem for parents is the fear of the unknown. By learning more about the disease, we can more easily help children with problems. There are national or local organizations of people with CP, specialized in treating emotional and social problems;
- Knowledge of the education rights of children with CP. Children with CP in the United States have the right to education provided by law. These laws include free treatment programs, equal rights of access to public education and the protection of the rights of parents to decide or not to agree on the decisions about children’s education;
- Colaborating with teachers and other school officials. Colaborating with teachers, school administrators, consultants in learning difficulties and the teachers’ council is necessary in order to establish an effective educational program for the child with CP. A collaborative team will help the child achieve his potential;
- Providing emotional support. The needs of a child with CP change with growth. He becomes more aware of his physical limitations, he needs to talk about his feelings and about the therapeutic possibilities. It is easier for him to talk about all these things with astranger (someone who is not part of the family). The doctor is the one who can recommend any emotional counseling from which the child can benefit. Also, a more active involvement of the children in making decisions about his own health, is recommended.
Preparation for an independent living
Parents and other persons who take care of children with CP can help them to develop the highest potential. One of the most important things is to help children be as much independent as possible. A recent study concluded that most adults with CP (84%) were of the opinion that parents have unjustifiably protected them during childhood.
The child’s needs change as they reach adolescence and young adult age. Adolescents and adults with CP require emotional support and comprehension. Family members and other supportive friends can help them overcome the challenges (difficulties) which occur in patients with CP. It is recommended to gradually prepare children with CP in order to lead an independent life. Usually, teenagers learn to develop their skills and strength of mind. However, they may need support and encouragement in order to overcome the responsibilities and additional tasks. Teenagers and young adults with CP may require more support (mentoring) than other people of the same age concerning the development of an intimate relationship. Parents will have to change their habits as children with CP grow and develop. For example, parents will not be able anymore to pick their children with severe CP up due to the increase in length and weight. Parents must prepare for the situation when they will not be able anymore to properly care for their children as they grow up.
90% of all children with CP reached adulthood (around the age of 20 years). The preparation of children for adulthood must be a careful one. Helping a child with CP to live independently requires patience and ingenuity of parents who will have to cope with the frustrations and obstacles that occur. The child may need encouragement and additional support in order to overcome the responsibilities and expectations that arise. CP complications may develop and affect the quality of life; moreover, some forms of CP are much more severe and require additional help. So, preparing for a healthy adult life is important. The occupational therapy and similar programs can be useful. Most adults with CP have a job, despite their physical dysfunctions from moderate to severe.
Medication can control some symptoms of CP, prevent or reduce complications and treat other conditions associated with CP as well.
Antispasmodics are the most common drugs used by patients with CP. Antispasmodics may cause the relaxation of tense muscles and reduce muscle spasms. Most antispasmodics are taken orally and include:
- Diazepam (Valium)
- Dantrolene (Dantrium)
- Baclofen (Lioresal).
Injectable antispasmodics which are administered by a needle directly into the affected muscle, are occasionally used to relax muscles. They remain effective for 3 to 8 months depending on the type of antispasmodic which was used.
Injectable antispasmodics for the treatment of CP include:
- Douche with phenol or alcohol
- Botulinum toxin (Botox).
The anticonvulsants are used as treatment for patients with CP who have seizures. CThe most common are:
- Topiramate (Topamax)
- Lamotrigine (Lamictal)
- Oxcarbazepine (Trileptal)
- Zonisamide (Zonegran)
- Gabapentin (Neurontin).
If seizures occur, anticonvulsants such as Carbamazepine (Tegretol) are used. Anticholinergics are useful in patients with CP who have involuntary body movements (dystonic cerebral palsy) or drool profusely. These include:
- Trihexifenidil hydrochloride (Artane)
- Benztropin mesylate (Cogentin)
- Carbidopa-levodopa (Sinemet)
- Prociclidine hydrochloride (Kemadrin)
- Glicopirrolate (Robin).
Laxatives and intestinal stimulants are used to treat constipation, a common problem among patients with CP.
Keep in mind!
The drug treatment for CP addresses the needs of the patient. Unfortunately, drug therapy is insufficient in treating CP, especially in the case of forms of CP that include involuntary movements (the athetotic form of diskinetic cerebral palsy). Some drugs used to treat CP have severe adverse effects. For example, dantrolene sodium (Dantrium) may cause liver damage; it is necessary to perform regular checks of the haematological tests during the treatment with this medicine. Some medical specialists believe that the most used drugs to treat CP (diazepam [Valium], baclofen [Lioresal] and dantrolene [Dantrium]) should not be administered to children who are in their growth period. There is the opinion that the adverse effects of these drugs can cause side effects more severe than muscle spasms and muscle rigidity encountered in CP. For example, one of their side effects is drowsiness. Drowsiness may interfere with the child’s ability to concentrate and learn. Some specialists believe that the benefits of these drugs outweigh the risks of adverse effects.
Ask your doctor about the following:
How effective are the drugs used?
What are the adverse effects on a short and long term? Discuss options in case they appear.
How can drugs affect the child’s growth and development?
The physical therapy is one of the most important parts in the treatment of cerebral palsy. It is usually started after the diagnosis is made and it is continued throughout life. The physical therapy can be started before the diagnosis is made, depending on the symptoms present at that moment. Some patients with CP need special equipment and devices in order to treat specific impairments. For example:
- A child with an inequality of the legs needs to wear at the level of the short limb some special shoes with a sole and heel higher than the other;
- Some patients who can not move may require a cane, a crutch or a wheelchair.
The physical therapy and the special equipment can be used simultaneously, for example to perform some forced movements at the level of the affected muscles, technique called modeling. This approach stimulates the child to increase the rate of movements in the affected limbs during some funny activities or with some interesting devices and encouraging and rewarding them when they succeed in using the less functional muscle. The occupational therapy helps adult patients cope with the limitations (restrictions) and live as much independently as possible.
Individualized treatments may be needed depending on specific needs that may arise:
- Infants and young children may benefit from therapies which stimulate learning and sensory development.
- Behavioural therapies are necessary for school-age children with CP in order to learn better ways to communicate with others.
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