Cerebral Palsy

Cerebral palsy or CP is a group of disorders associated with developmental brain injuries that occur during fetal development, birth , or shortly after birth. It is characterized by a disruptionof motor skills , with symptoms such as spasticity , paralysis , or seizures . Cerebral palsy is also known as static encephalopathy and Little's disease (which is strictly speaking only the "spasticdiplegia" form of CP). It is no longer considered a disease, but rather it is a chronic nonprogressive neurological disorder. Theincidence is about 1.5 to 4 per 1000 live births. There is no cure, but therapy may be helpful. It has one of the highestlifetime costs of any birth defect.

The disorder is marked by several important signs. All persons with cerebral palsy developed it while the brain was under development. This limits the age at which the disorder can develop to at most 5years old, however 80% of all cases occur before the baby reaches 1 month old. Secondly, it is a nonprogressive disorder, thatis, once the damage to the brain is done no additional damage occurs. Cerebral palsy never worsens, though its symptoms maychange with time. The disorder also never improves. It is a permanent disability which stays with a person their entire life. Anytemporary problems would suggest a disorder other than cerebral palsy, which is why a reliable diagnosis of it can't occur untilthe child is four or five years old. Additionally, the disorder is characterized by disruption of the motor skills of the person.The severity in the loss of motor skills varies greatly from case to case. Lastly, even though there is a loss of motor skills,the muscles themselves are not defective. The problem lies solely in the brain'sability to control those otherwise healthy muscles.

History

Cerebral palsy, then known as "Cerebral Paralysis", was first identified by a British surgeon named William Little in 1860 . Little raised the possibility of asphyxia during birth as a chief cause of the disorder. It was not until 1897 that Sigmund Freud suggested that adifficult birth was not the cause but rather only a symptom of other effects on fetal development. Modern research has shown thatasphyxia is not found during birth in at least 75% of cases. Such research also shows that Freud's view was correct, even thoughduring the late 19th century and most of the 20th century Little's view was the traditional explanation. ("Conditions", 9)

Cause

Since cerebral palsy refers to a group of disorders, there is no exact known cause. Some major causes are asphyxia or hypoxia of brain, birth trauma or premature birth , genetic susceptibility, certain drugs or infections in the motherduring and before birth, central nervous system infections, trauma ,and consecutive hematomas . After birth, the condition may be caused by toxins,physical brain injury, incidents involving hypoxia to the brain (such as drowning ),and encephalitis or meningitis . Despite all of these causes, the cause of many individual cases of cerebral palsy is unknown.

Recent research has demonstrated that asphyxia is not the most important cause as it was once considered to be, though itstill plays a role, probably accounting for about 10% of all cases. The research has shown that infections in the mother, eveninfections that are not easily detected, may triple the risk of the child developing the disorder.

Premature babies have a higher risk because their organs are not yet fully developed. This increases the risk of asphyxia andother injury to the brain, which in turn increases the incidence of cerebral palsy.

Incidence and prevalence

The incidence is about 1.5 to 4 per 1000 live births. This amounts toapproximately 5,000-10,000 babies born with cerebral palsy each year in the United States . Each year, around 1,500 preschoolers are diagnosed with the disorder. In around 70% of allcases, cerebral palsy is found with some other disorder, the most common being mental retardation .

Overall, advances in care of pregnant mothers and their babies has not resulted in a noticeable decrease in cerebral palsy.Only the introduction of quality medical care to locations with less than adequate medical care has shown any decreases. Theincidence increases with premature or very low-weight babies regardless of the quality of care. Twins are also four times more likely to develop cerebral palsy than single births, and triplets are more likelystill to develop it.

Despite medical advances, in some cases the incidence of cerebral palsy has actually increased over time. This may beattributed to medical advances in areas related to premature babies or the increased usage of artificial fertilizationtechniques.

Types

Based on the group of muscles involved (typically only used to further describe spastic CP):

1. Tetraplegia or Quadriplegia : Involvement of the four limbs, the trunk and the head.The great majority of these individuals will not be able to stand up or walk.
2. Diplegia: The four limbs are affected, but lower limbs are more involved than upper limbs. Some of thepersons with dyplegia will be able to walk alone or with orthosis.
3. Hemiplegia: Only the right side or the left side of the body is involved. It represents the mildest form ofCP. An individual with hemiplegic CP will have only few limitations in daily activities.

Based on the 'quality' of movement:

1. Ataxia: Persons with ataxia have damage to their cerebellum which results in problems with balance, especially while walking. It is the most rare type, occurringin at most 10% of all cases.
2. Athetoid or dyskinetic: Persons with this type generally have involuntary body movements.The damage occurs to the extrapyramidal motor system and/or pyramidal tract and to the basal ganglia . It occursin ~20% of all cases.
3. Spastic: Persons with this type have damage to the corticospinal tract , motor cortex , or pyramidal tract. It occurs in ~70% of all cases.

These three types may be found together. In 30% of all cases of cerebral palsy, the spastic form is found with the one of theother types. There are a number of other minor types of cerebral palsy, but these are the most common.

Presentation (signs and symptoms)

All types of cerebral palsy are characterized by abnormal muscle tone, posture, reflexes, or motor development andcoordination. The classical symptoms are spasticity, paralysis, seizures, unsteady gait, and dysarthria. While mental retardation and cerebral palsy do not cause each other, the twodisorders are found together in approximately 40%-70% of all persons with cerebral palsy.

Prognosis

Cerebral Palsy is not a progressive disorder. A person with the disorder may improve somewhat during childhood, if theyreceive extensive care from specialists. Some individuals with the disorder will need to stay under the immediate care of anotherperson for their entire lives, while others may be healthy enough to pursue mostly independent lives.

Treatment

There is no cure for cerebral palsy, but various forms of therapy can help a person with the disorder to function moreeffectively. Nevertheless, there is only some benefit from life-long care. The treatment is usually symptomatic and focuses onhelping the person to develop as many motor skills as possible or to learn how to compensate for the lack of them. The disorderdoes not affect the expected length of life so treatment focuses on quality of life issues. Non-speaking people with cerebralpalsy are often successful availing of Augmentative and Alternative Communication systems such as Blissymbols .

Usage of the term "spastic"

The term "spastic" describes the attribute of spasticity in one type ofcerebral palsy. In 1952 a UK charity called The Spastics Society was formed. The term "spastic" was usedby the charity as a term for people with cerebral palsy. This rapidly became used as a general insult to disabled people, and thecharity changed its name to SCOPE in 1994 althougha new slang word of abuse, scopey, started to appear not long afterwards.

References

• "Conditions in Occupational Therapy: effect on occupational performance." ed. Ruth A. Hansen and Ben Atchison(Baltimore: Lippincott Williams & Williams, 2000), 8-21. ISBN 0-683-30417-8
• "Cerebral Palsy." (National Center on Birth Defects and Developmental Disabilities, October 3, 2002), http://www.cdc.gov/ncbddd/dd/ddcp.htm
• "William and Spackman's Occupational Therapy 9th Edition." ed. Maureen E. Neistadt and Elizabeth Blesedell Crepeau(Lippincott-Raven Publishers, 1998), 233, 589-598. ISBN 0-397-55192-4
• Faults-and-all book marks Scope's 50thanniversary