Children Cerebral Palsy

Children Cerebral Palsy

  Autor NN Team Data: 01.10.2009

Children Cerebral Palsy
The cerebral palsy term is a general one, which refers to many conditions that affect the child ability to control the body movement. This disease is caused by brain damages which occur during the brain development, before or after birth. Unfortunately, the cerebral palsy cannot be treated, but a proper treatment and care may improve the child's condition and the level of independence. The cerebral palsy may be spastic, ataxic or athetoid. 

The spastic cerebral palsy is the most common one, occurring in 70% of the cases. The muscles are "stuck", permanently tense. This affects the moves in an unforeseeable way. Usually, the moves are difficult but not impossible. Depending on the affected part of the body, the spastic cerebral palsy can be: 
Diplegia - both hands or legs are affected.
Hemiplegia - the left or right side are affected, thus the right arm andleg or the left arm and leg.
Quadriplegia - all limbs are affected, both arms and legs.
Monoplegia - only one limb is affected.
Triplegia - three limbs are affected.

The cerebral palsy affects only 5-10% of the patients. The child cannot control the moves, has no balance, the walk is difficult and abnormal, and the fine and precise moves are difficult. In addition, there is a limbs trembling caused by a voluntary movement, which gets worse as the child is closer to the objective. 
The athetoid cerebral palsy affects 10-20% of the patients. The main symptom is the slow, uncontrolled movement of the arms, legs, hands. In rare cases, the face and tongue muscles are affected, leading to excessive drooling and involuntary grimaces. The symptoms get worse when the patient is stressed, scared, tired and might disappear completely during sleeping. If the face muscles are affected, the talking is difficult. As the cerebral palsy is of many types and may affect a child less or more, the symptoms differ very much from one child to another. 

Generally, the symptoms include:
  • Lack of muscles control during the voluntary moves 
  • Tense, "Stuck" muscles, exaggerated reflexes 
  • scissor walking 
  • muscles tone variations, from too relaxed to too tense 
  • excessive drooling, difficult food swallowing, sucking and talking 
  • lack of fine motor skills (writing, laces binding) 
The disease doesn't get worse in time thus the symptoms remain the same during the whole life in the worst case, or they get better visibly, due to the treatment in the best case. 
Most cerebral palsy are caused by problems that occurred before the birth. But there were cases when the diseases occurrence was related to an infection or lesion appeared at birth or during the first months of life, or even during the first years of life. 

Here are the main causes of cerebral palsy: 
  • Infections during intrauterine development: Rubella, chickenpox, Cytomegalovirus, toxoplasmosis, Syphilis. Some of these diseases can be prevented with a vaccine, others with a proper lifestyle and sexual behavior. 
  • Infections during the first months of life: meningitis, viral encephalitis. 
  • Congenital abnormality: the causes are not always known. Usually the gene mutations or the exposure to radiations, to toxins, represent the causes. 
  • Strokes: it's true that they occur at elderly people most often, but they might occur at any age, including during intrauterine development. A stroke may occur because of blood clots in placenta, which stop the blood flow to the baby, thus the supplying of the brain with oxygen. 
  • Lack of oxygen at birth. This is a rare cause, but it's possible. If during the birth, the baby's brain is not supplied with the necessary oxygen, there might be lesions which could lead to cerebral palsy. 
  • Severe jaundice: Jaundice is very frequent at newborns, but only the severe cases may lead to cerebral lesions. 
The risk of cerebral palsy is higher at premature infants, at babies with little weight and at twins. Also, the danger is higher if the mother was exposed to toxic substances during the pregnancy and if she suffers from certain diseases (convulsion, mental retardation, thyroid problems). Controlling the chronicle diseases and avoiding the risk factors might help preventing the baby's cerebral palsy. 

Children with congenital cerebral palsy may have symptoms since their birth. But when the disease is not very severe, the exact diagnosis cannot be established until they are 4-5 years old. Most cases are diagnosed around 1-2 years old. In order to obtain a diagnosis, there are more types of tests. The blood tests are used to exclude other possible diseases, and the brain activity is tested with CT, EEG and NMR. 

The treatment cannot cure the cerebral palsy, but may reduce the symptoms and improve the life quality a lot. The proper treatment will be established by a medical team (pediatrician, physiotherapist, speech therapist, etc) after assessing the child's health very well. The approach is different according to the palsy type, to the severity, to other diseases and complications. Generally, the following treatments are used: 
  • Medication. They might be used to relieve the muscles if they are too contracted. They could be orally substances or botulinum toxin (Botox) which is given into the muscles in order to paralyze them. 
  • Physiotherapy. The exercises are done under the supervision of a therapist, and are meant to improve the balance, the coordination, the mobility and the motor development. If it's the case, you can resort to occupational therapy. 
  • Speech therapist may help improving the speech or finding other means of communication, for example the sign language. 
  • Surgery is done for the most severe cases. The surgery can be done on tendons, joints but also on the nerve who maintain the muscles contracted. 
Although the medical treatments are necessary and very important for the improvement of life quality, nothing can replace the care and attention of parents. The parent is the most important person from the medical team of the baby. If he cannot say what he wants or needs, his mother or father must speak for him, ask questions, decide what's best in his interest. 

More important for children with cerebral palsy is to find their independence, as much as possible. No matter what the parent does, he must have this only purpose: to help the child be independent. Every step, no matter how small, made for this purpose is very important. That's why, the child must be allowed to do certain things by himself, although he is slower or he does them worse than the healthy adult, and at the same time he must be praised and rewarded for any success, no matter how small. It's possible for the parents not to be present in their child's life in some cases, and apparently insignificant skills- such as descending the stairs, binding the laces, heating the food - could make the difference between a normal life and the isolation in a hospital. 

Read the English version of this article: Children Cerebral Palsy