Cerebral Palsy Children

Cerebral Palsy Children

Cerebral palsy is one of the commonest causes of severe physical disability in children. In the world, nearly 15 million and in India 3 million children are affected by this problem. Nearly 1.5 to 3 of every 1000 live births can be affected with cerebral palsy.

Cerebral palsy is a disorder of movement & posture and often accompanied by problems in sensation, perception, cognition, communication, behavior, speech & seizure. Suspicion of cerebral palsy can be made at a very early age of life. This suspicion can be made with the history of high-risk birth, low birth weight & premature delivery, abnormal social & motor response.

Cerebral palsy children are usually delayed in achieving milestones. They can also have lots of other associated medical problems. Cerebral palsy children have a problem in crawling, standing & walking. These children need intensive therapy at a very early age and when they get sufficient progress then they need maintenance therapy for a long duration.  

These children sometimes also denied their right to get admission in mainstream school, intermingle with normal children & participation in all social activities, sports. These cerebral palsy children can do much better in the study because they are confined to indoor with less outdoor activity.

What Is Cerebral Palsy In Children?

Cerebral palsy is a group of neuro-motor disorder it affects newborn as well up to 2.5 years of age but persists for whole life. It occurs because of brain insult in an early phase of life. It contains the problem in sitting, crawling, walking, poor coordination, sensation, speech, vision, hearing, movement disorder, epilepsy, growth disturbance, etc.

Brain insult remains static but disability can increase decrease static depending upon many factors. These children can have a good quality of life if they are given an early intervention by good rehab measures. Cerebral palsy can present in a variety of manner according to the site of lesion in the brain. It can present as spastic, dystonic, athetotic, mixed, ataxic, hypotonic, etc. Hypotonic cerebral palsy converts in dyskitec or spastic variety.

What Causes Cerebral Palsy In Children?

Cerebral palsy occurs because of some brain insult in-utero, after delivery, and up to 2.5 years of age. Most of the time causes are not known. Genetic factors play a major role. Other important causes are hypothyroidism of the mother, eclampsia, intrauterine infection before delivery.

Asphyxia, aspiration pneumonia, kernicterus, infection, birth trauma are few causes in newborns. Very low birth weight, premature baby, the second baby of twins, and triplets are prone to brain insult.

How Is Cerebral Palsy Diagnosed In Children?

Most of the time diagnosis of cerebral palsy is self-evident with clinical evaluation of the child. Now with careful history and examination, we can make a diagnosis of cerebral palsy as early as 6 months of life by taking history event at birth, history of brain insult, delayed milestone, abnormal reflexes, the abnormal tone in the body, abnormal response to stimuli history of epilepsy, etc.

MRI brain is needed to see features of brain insult and other problems. A careful history and detailed evaluation are important for correct diagnosis. Physiological Delayed milestones, syndromes, genetic, metabolic problems, muscular dystrophy are a few differential diagnoses.

What Problem Does CP Cause In Children?

Cerebral palsy cause many neuro-motor disorders in the child including delayed milestone, abnormal movement disorder, abnormal tone of the body, speech problem, epilepsy, vision problem, hearing issue, dribbling of saliva, growth abnormality, feeding problem.

These children can have difficulty in crawling, standing, and independent walking. The severity of the disability is based on the extent of brain insult. These children can have a range of severity from trivial problems to very severe disabilities.

Cerebral palsy can affect one limb to the whole body. According to extent of involvement it can be classified as hemiplegic, diplegic, triplegic, quadriplegic, etc. This child can also have behavioral problems and mental retardation. But mental retardation is found in 30-40% of children only.

These children also have a lack of immunity so recurrent infection is common. Adults affected with cerebral palsy can also have premature aging that leads to the early onset of aging problems that occurs in old age.

How Is CP Treated In Children?

Cerebral palsy can’t be cured. But by the various modality of rehab, we can decrease their disability and can increase ability so that they can be integrated into mainstream society. Physical and occupational therapy is the mainstay in the treatment plan of these children. Many advanced rehab measures have developed in the last two decades it includes NDT, SI, CIMT, Strength training, gait training, mirror therapy, yoga, etc.

Traditional therapy doesn’t help but do much harm to these children. Other accessory instruments are required for support which include Braces in the form of AFOs & gaiter along with walking devices including stick, elbow crutches, and walker.

Botulinum toxin is required to manage spasticity in an early age child. Surgery is required only in spastic cerebral palsy where fix bony deformity, muscle contracture, joint deformity, and bony torsion are interfering in ambulation. But usually, we defer surgery till the age of 7 years.

What Extra You Should Know About CP?

Besides all the direct symptoms of cerebral palsy other factors are also very important. Severely affected children can also have a lack of immunity, writing & learning problem, feeding problem, constipation, epilepsy. Most of the time cerebral palsy children are physically disabled but with proper training, they can do all the activities required for living a good quality of life. They can join a mainstream school. These children can have good singing. They can do lots of activities which are important for daily living but little assistance and training is required. They are slow workers but good at work once they learn and given sufficient time.

How Our Expert Team Can Help CP Children?

A multidisciplinary team of specialists is required to manage these children. It includes an orthopedic surgeon, neurologist, pediatrician, physical therapist, occupational therapist, speech therapist, special educator, social worker & orthotic specialist, etc.

A team of specialists works along with parents to plan a treatment strategy. The involvement of parents and their understanding is very important for a good outcome. Paediatrician deals with the routine medical problem of the child, neurologist deals with a neurological problem in a child, orthopedic surgeon deal with orthopedic issues.

Physical and occupational therapists provide therapy along with guidance and training of parents in home-based therapy and activities of daily life. Speech therapists provide speech and language therapy, special educator prepare the child for mainstream school. Treatment of children with cerebral palsy is a joint effort of a team of specialists and parents. Psychologists assess the psychological status of parents and children along with the IQ of a child so that they can guide them for a better future.