Human Nervous system - Cerebral-Palsy
Causes
- Before Birth: Due to premature birth, RH incompatibility, genetic incompatibility, mother's illness
- During Birth: Due to prolonged labour, forceps delivery, cord around the neck resulting in insufficient supply of oxygen and glucose to the growing brain of the baby.
- After Birth: An infant may suffer cerebral palsy as a result of: Meningitis, Encephalitis, Epilepsy, Jaundice or Accidents, and many other causes
Can CP be Prevented?
Littles Theory :
Here are two theories about the cause of cerebral palsy. A British orthopaedic surgeon of the nineteenth century, William Little, felt that damage to the brain occurred during childbirth. If the birth process is problematic, there is a chance that blood supply to the brain may not be adequate. This, said Little, was what caused CP. This theory had gained wide acceptance until recently. In this case, if good obstetric care is given during pregnancy, peri-natal and neo-natal periods, the incidence of CP can be brought down dramatically.
Freuds Theory:
When Little put forward his theory to Sigmund Freud, the father of psychoanalysis, the latter rejected it. He felt that since CP was accompanied often by other disabilities and seizures, the problem must have started in the womb. Though many children born out of difficult labour do get CP, in many cases of CP there is no apparent cause. Also, research today leads us to believe that children are not as sensitive to the short supply of oxygen as was believed. Because of these reasons, the Freud theory is gaining currency. Problems like German Measles affect the foetus. But there must be others that we do not know much about. This makes preventing CP difficult. However, good gynaecological care and sound health of the mother gives the child a better chance of escaping CP.
Types of Cerebral Palsy Spastic:
This is the most common type of CP. Here the childs muscles are tense and contracted. The child makes weak movements or has difficulty moving at all. Athetoid: The child exhibits constant, uncontrolled motion of limbs, head, and eyes. Rigid: In this condition tight muscles resist efforts to make them move. Ataxic: The child has a poor sense of balance, often causing the child to fall and stumble. Tremor: The child exhibits uncontrollable shaking, which interferes with co-ordination. There may also be a combination of vision, speech, hearing and learning problems. Detecting Cerebral Palsy A child is born with cerebral palsy or can become afflicted in infancy. There are some indicators of CP that can be noticed early. The doctor may advice tests to confirm the diagnosis. Medication and surgery are advised in some cases to avoid complications.
- Early Indicators
- Developmental Milestones of a Normal Baby.
- Tests a Doctor may Advice
- Medication and Therapy
Early indicators
- Most often a problem is suspected when the childs milestones are delayed.
- A mother may find that the child is about eight months old and the head is still not steady.
- The child may be close to his second birthday and still may not be trying to walk.
Developmental Milestones of a Normal Baby.
- The muscle tone of the body may be different. The muscles are stiff or flaccid.
- The child may show preference for one side of the body.
- The child may exhibit unusual posture.
- Progress of a Normal Baby
All normal children do not cross the developmental milestones at the same pace. However the following chart gives us an idea regarding the stage when we can reasonably expect a baby to achieve certain milestones as part of its physical and mental growth.
| Age (in Months) | Normal activities (when prone) | Normal activities (when supine) |
| 3 | Lying on stomach, Holds head up | |
| 4-6 | On back-looks, listens reaches out and makes sounds | In supine, No head lag.Cries when uncomfortable, smiles when happy |
| 5-6 | Puts things in the mouth | Sits up with support |
| 6 | Rolls over and head becomes steady.Transfers objects from one hand to another | Reaches out and grasps objects |
| 7-8 | Repeats simple words.Is afraid of strangers | Sits alone |
| 10 | Likes to play with sand and water | Crawls |
| 10-12 | Stands alone | Stands alone |
| 11-12 | Learns more words | Walks holding onto things |
| 13 | Walks alone | |
| 15-18 | Eats without help | Places objects on top of each other.Likes to listen to stories and asks questions |
Tests a Doctor may Advice :
The doctor needs to look at the medical history of the child, including details of the pregnancy and the birth of the child. It would be helpful if you maintain a record of vaccination and noted the illnesses and the child has suffered. The doctor first checks the reflexes of the baby. A reflex action is an automatic response by the body to some external stimulus. When a baby is held on its back with its head in a level below its feet, it stretches out its arm as if to hug something. This is called the Moro reflex. This reflex action is not present in normal babies after six months. In children with cerebral palsy it is exhibited for much longer. The doctor can also check for hand preference. Hand preference is not marked in babies until the first year or so. But a hemiplegic child will use her good hand even if you hold a toy close to the other hand. To rule out the possibility of other illnesses, and to see if the damaged part can be located, other tests may be advised by the doctor. A CAT scan which can show, with the help of X rays and a computer, brain tissues and structures and MRI, which uses magnetic and radio waves to do the same, may be required. An Electro Encephalogram (EEG) is recommended to detect if the child gets fits. With these tests the doctor can determine if the child is spasticor not. But sadly the CP childs visit to the hospital does not stop with this. A complete health check up is required to determine if there are other disabilities.
Medication and Therapy
- When is medication useful?
- What are contractures?
- When is surgery necessary?
When is medication useful?
The brain damage a child has suffered cannot be repaired. But some of its effects can be modified. If the child has fits or seizures these can be brought under control through medicines. Medication can also reduce the stiffness of the muscles and help them relax. These are administered orally or injected into the muscle in question.
What are contractures?
Though CP is not a progressive condition, complications might develop. In a normal person when the bones grow the muscles attached to the bone grow at the same pace. This is because the muscles are in constant use and are stretched regularly. But in a spastic child, as the muscles are stiff and not much movement is made, the muscles do not stretch and sometimes stop growing. They become fixed in an abnormal position. This condition is called a contracture.
When is surgery necessary?
When bones are growing and muscles dont this might result in deformity. For instance, if the big muscle at the back of the ankle (Tendo Achilles) does not grow in pace with the bone the child will not be able to rest the heel and will be forced to walk on her toes. Then it becomes necessary to operate and lengthen the muscle. However if the problem is noticed early enough physiotherapy and a suitable orthotic device (like braces) can stretch and exercise the muscle and enable it to grow. Physiotherapy becomes an integral part of the spastic childs routine. This prevents the weakening of muscles due to disuse. It also prevents contractures and thereby helps avoid surgery.
