CEREBRAL PALSY

CEREBRAL PALSY

It is a non progressive neuromuscular disorder of cerebral origin. It includes a number of clinical disorders like purposeless muscle movements, tightness in the muscle tone and posture related problems.

Causes:

Abnormal brain development or the injury to the developing brain
> Birth Injuries
> Post natal infections like Encephalitis, meningitis
>Head injuries like car accidents, a falls , or child abuse
> Maternal infections like herpes simplex , German measles
> During delivery or labor lack of oxygen to the brain
> Gene mutations
> Severe jaundice in infants
> Forceps delivery
> Breech presentation of the baby during delivery
> Premature delivery
> Consanguineous marriages

TYPES OF CEREBRAL PALSY:

1. Spastic cerebral palsy
    Most common type of cerebral palsy. There is increase in muscle tone in the arms and legs which results in stiff muscles and difficulty in movements. There are 3 types:
> Spastic quadriplegia: Affects all four limbs that is both upper and lower limbs
> Spastic diplegia : Affects lower extremities of the body (legs)
> Spastic hemiplegia : Affects muscles of one sided body

2. Athetoid cerebral palsy: 
It is characterised by uncontrolled movements. There are Fluctuations in the muscle tone and the muscles may be too tight or loose than usual.

3. Ataxic cerebral palsy:
Characterised by ataxic movements like clumsiness, imprecision, instability. Lack of balance and coordination. The movements of the legs and arms are not in order

4. Hypotonic cerebral palsy:
 characterised by Less or low muscle tone. The muscles are floppy as the muscles are too relaxed.

5. Mixed cerebral palsy:
It is a combination of two or more types of cerebral palsy. Commonly caused from injuries to the brain. A blend of Spastic and athetoid cerebral palsy is commonly seen.

Signs &Symptoms and Complications:

>The symptoms may vary from person to person, according to the severity of the lesion, the site of the neurological deficit and associated defects.
> Delay in developmental milestones such as sitting up, standing and walking. The involvement is severe in about 30% of cases and the child is bedridden.
> scissoring hips
> Tightness in the limbs
> Flat foot
> Bending wrist and fingers
> Difficulty in Speech
> Drooling of saliva
> Difficulty in swallowing
> Lack of coordination
> Invountary movements
> Seizures
> contracture and deformities
> Irritation and mood swinging
> Depression
> Secondary Respiratory complications
> Pressure sores
The symptoms may usually appear when child reaches 3-4 years.

On examination:

> There may be weakness of muscles leads to deformities.
> The joints become stiff
> Lack of voluntary control when asked to hold an object.
> Mental deficiency maybe present
> Defective vision
> Impaired hearing
> Sensory deficits
> Lack of balance and coordination
> Assymetric posture and Gait

Treatment:

> Complete cure is impossible because the essential part of the brain is destroyed and cannot be repaired or replaced.
> Depending upon the severity of the underlying damage, a child can be made independent enough to earn his own living in due course.
> A child formerly depends on others for many daily living activities may often become independent.
> This needs only patience of the parents and attendants of the child.
> The treatment consists of multidisciplinary team comprising of Neurodevelopmental paediatrician
Orthopaedic surgeon
Physiotherapist
Speech therapist
Occupational therapist
ENT specialist
Ophthalmologist
Clinical psychologist
Teacher and social worker
>Orthopaedic treatment consists of prevention and correction of deformities by orthotics
Controlling spasticity or tightness in the joints by drugs , nerve blocks and through operative procedures like neurectomy, tendon lengthening. Advising assistive and adaptive devices like splints , casts and callipers.
> Speech therapy for developing communication skills  
> Clinical psychologist will give counselling to the parents and caretaker, based on the assessment and their plans of the treatment.
> Occupational therapy constitutes an important adjunct to the overall treatment to makes the child independent in daily living activities and make them independent.
> Special teacher :Mild cases can be looked at home but for severely handicapped children specialised schools are required.
> Physiotherapy treatment
Proper assessment should be taken initially and have to plan the treatment accordingly
For joint stiffness:
•Passive movements and stretching
• Ultrasound treatment to increase blood supply & to relax the muscles
• Massage also helps to relax the tight muscles
• Joint mobilisation techniques

For Contractures and deformities:
• Assisted Exercises
• Active assisted Exercises
• Stretching Exercises
• Applying splints

For Respiratory complications:
• Chest mobilisation Exercises
• Breathing Exercises
• Ballon blowing exercise

For Balance and coordination:
• Wobble board exercises
• Swiss ball exercises
• Frankels Exercises
• Hippotherapy performed on horse back
• Hydrotherapy treatment

For sensory stimulation :
Techniques of stimulation like
• Brushing
• Icing
• Stroking
• Heating
• Pressure
• Slow and quick muscle stretches

 For strengthening body :
• Active exercises
• Resisted Exercises
• Bicycling
• Treadmill training
• Ball squeezing Exercises for wrist and fingers
• Quadriceps table Exercises for knee joint

> Bobath’s Approach for neurological rehabilitation
> Proper posture and Gait training


Note: 
Please consult your doctor and plan the exercises program accordingly, don’t do yourself