What is Cerebral palsy?
Cerebral Palsy (CP) is a neurological disorder that arises from abnormal brain development, generally before birth. It affects the motor system of the body, which controls muscle coordination, muscle tone, kinesthetic or motor skills, and fluid movement of the body. Being a non-progressive disorder, it doesn’t cause further damage to the brain and is a one-time impact on the brain, which causes significant developmental impairments in the child.
Signs, Symptoms, and Complications
Sensory organs
- Vision loss or blurred vision
- Partial deafness in one or both ears
Cognitive and Psychological Health
- Delays in speech development
- Difficulty in communication
- Language disorders
- Depression
Skeleto-muscular
- Spinal deformities such as spinal curvature (scoliosis), saddleback (lordosis), and hunch-back (kyphosis)
- Stiff muscles, exaggerated reflexes, lack of muscle coordination, tremors, and involuntary movements
- Variations in muscle tone
- Favouring one side of the body more
- Osteoarthritis, osteopenia, or osteoporosis
- Contractures, where-in muscles get locked in painful positions
Others
- Drooling or difficulty swallowing
- Dental problems
- Urinary and bowel incontinence, urinary infections
- Gastro-intestinal issues
- Hydrocephalus or a build-up of Cerebro Spinal Fluid (CSF) in the skull
- Heart and lung conditions
- Easily prone to pain and fatigue
- Seizures
Treatment Goals
- Help the child/adult manage some of the above medical conditions
- Help manage pain better
- Instill socially accepted behavior and help with social interactions
- Promote independence in day-to-day functions like eating, bathing, and dressing
- Optimise mobility and improve range of motion
- Help with learning and schooling
Treatment factors
The options or types of treatments for CP depend on:
- Co-occurring conditions or how many of the above symptoms are manifesting together
- Level of impairment – as defined by the 5 levels (L1/2/3/4/5)
- The exact location of movement problems
- The type of CP (spastic, ataxic, athetoid, hypotonic, or mixed)
Treatment Options
CP cannot be cured entirely. However, the signs and symptoms can be managed better so that the child/adult has a reasonable quality of life. Advances in medical technology, medications, and therapies in the last 3 decades have created multiple options for treatment.
Medications
- Injections to relax specific muscles or nerves, with Botox being the most preferred drug
- Muscle relaxants such as Baclofen, Diazepam, Tizanidine, and Dantrolene. These are either given orally or pumped into the spinal cord using a sub-cutaneous pump surgically implanted into the abdomen
- Medications to reduce drooling, with Botox being preferred again
- Medicines for seizures, gastro-intestinal issues, and dental problems
Therapies
- Physical Therapy & Rehabilitation – provided by a physiotherapist. This aims to improve balance, posture, muscle strength, flexibility, and mobility, thereby making the child/adult more physically independent.
- Occupational Therapy & Rehabilitation – provided by certain specialists, to improve the child/adult’s ability to independently comb their hair, brush teeth, fasten zippers, open jars, pick up small objects, use scissors, read and write, etc.
- Speech & Language therapy –handled by specialists called Speech Therapists. This makes use of technology devices such as a computer and voice synthesizer. The therapist can also address the difficulty in swallowing and help control drooling.
- Recreational therapy – this addresses both the child’s emotional state and improves motor skills. Certain sporting activities are encouraged with constant supervision.
Surgery
- Orthopedic procedures – When the contractures or deformities are severe, surgery on bones and joints can help align the limbs properly. They also help lengthen or reposition muscles and tendons.
- Selective Dorsal Rhizotomy: Here, the surgeons cut specific nerve fibers to relax certain muscles and reduce their stiffness or pain.
- Surgery for severe cases of seizure.
- Hydrocephalus is treated by implanting valves that drain the excess CSF from the skull.
- Orthodontic surgery can help correct dental issues.
Others
- Orthotic devices: Casts, splints, and braces are placed on affected body parts to help improve balance and movement. Powered scooters, rolling walkers, and wheelchairs can help improve posture and movement.
- Assisted devices: Here, computer-based communication devices working in tandem with Velcro-fastened shoes and crutches can make day-to-day life easy.
- Intellectual disabilities are overcome to a certain extent by medication, behavior therapy, and occupational therapy.
- Lasik surgery, glasses, hearing aids, and cochlear implants help reduce vision and hearing impairment
- Gastrointestinal issues are treated by medication and special eating techniques
- Urinary infections are treated by giving frequent baths, while urinary incontinence is treated using diapers
Outlook
Treatment for Cerebral Palsy has become a sophisticated science today, with numerous specialists being involved in this. If you or any of your dear ones have a child/adult with Cerebral Palsy, do not despair. Consult a reputed hospital to avail the benefits of the above treatments. This will make the patient’s and the caregivers’ life easy and reduce the emotional burden associated with Cerebral Palsy.
Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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