Cerebral Palsy

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Cerebral-Palsy-child Cerebral Palsy

What Is Cerebral Palsy

Cerebral palsy is a term which encompasses a set of neurological conditions that cause physical disability in human development – they affect the brain and nervous system. The word cerebral refers to the area in the brain that is affected, while palsy means complete or partial muscle paralysis, frequently accompanied by loss of sensation and uncontrollable body movements or tremors. Cerebral means related to the brain or cerebrum. Cerebrum is a Latin word meaning “brain; top of the head, skull”. In the English language the cerebrum is the anterior (front) portion of the brain consisting of two hemispheres; it is the dominant part of the brain in humans.

What are the signs and symptoms of cerebral palsy?

A person with cerebral palsy will generally show symptoms during the first three years of life. A child/baby with cerebral palsy may have some of the signs and symptoms below:

Achieves developmental milestones, such as crawling, walking, or speaking, later than his/her peers.

Crawls in an unusual way.

Has abnormal muscle tone – the child will slouch while sitting. Muscle tone refers to a person’s automatic ability to tighten and relax muscle when required.

1. Has difficulty feeding and sucking.

2. Lies down in awkward positions.

3. Can be easily startled.

4. Favors one side of the body over the other.

5. Has overdeveloped or underdeveloped muscles (has floppy or stiff movements).

6.Has bad coordination and balance (ataxia).

7.Has involuntary, slow writing movements (athetosis).

8.Muscles are stiff and contract abnormally (spastic paralysis).

9.Has hearing problems.

10. Has problems with eyesight.

11.Has bladder control problems.

12. Has bowel movement control problems.

13. Has seizures.

14.Has problems swallowing.

15. Range of movements are limited.

There are several types of cerebral palsy

  • Spastic cerebral palsy
      • Spastic hemiplegeiaA child with spastic hemiplegeia will typically have spasticity (muscle stiffness) on one side of the body – usually just a hand and arm, but may also involve a leg. The side that is affected may not develop properly. The child may have speech problems. In the majority of cases intelligence is not affected. Some children will have seizures.
      • Spastic diplegiaThe lower limbs are affected, and there is no or little upper body spasticity. The child’s leg and hip muscles are tight. Legs cross at the knees, making walking more difficult. The crossing of the legs when the child is upright is often referred to as scissoring.
      • Spastic quadriplegiaThe child’s legs, arms, and body are affected. This is the severest from of spastic cerebral palsy. Children with this kind of cerebral palsy are more likely to have mental retardation. Walking and talking will be difficult. Some children have seizures.
  • Ataxic cerebral palsyThe child’s balance and depth perception are affected. Depth perception refers to a person’s ability to judge where objects are in relation to where he/she is. It is the least diagnosed type of cerebral palsy. The child will find it difficult to tie his/her shoelaces, button up shirts, cut with scissors, and other fine motor skills. Because of balance difficulties, the child may walk with the feet far apart. There may be intention tremors – a shaking that starts with a voluntary movement, such as reaching out for a toy, the closer he/she gets to the toy the worse the tremors become. Most children with ataxic cerebral palsy are of normal intelligence and have good communication skills. Some may have erratic speech.
  • Athetoid or dyskinetic (or athetoid dyskinetic) cerebral palsyThis is the second most common type of cerebral palsy. Intelligence will nearly always be normal, but the whole body will be affected by muscle problems. Muscle tone is weak or tight – causing random and uncontrolled body movements. The child will have problems walking, sitting, maintaining posture, and speaking clearly (tongue and vocal cords are hard to control). Some children drool if they have problems controlling facial muscles.
  • Hypotonic cerebral palsyMuscle problems will appear much earlier. The baby’s head is floppy, and he/she cannot control the head when sitting up. Some parents have described their child’s movements as similar to that of a rag doll. The baby gives only a moderate amount of resistance when an adult tries to move their limbs. The baby may rest with his/her elbows and knees loosely extended, compared to other infants whose elbows/knees will be flexed. Some babies may have breathing difficulties.Injury to the cerebellum can result in this type of cerebral palsy.

What causes cerebral palsy?

The control of muscles takes place in the cerebrum. Cerebral palsy may appear to be a muscle condition, but it is, in fact, caused by damage to the cerebrum. The cerebrum is also responsible for our memory, ability to learn, and communication skills – that is why some people with cerebral palsy have problems with communication and learning. Cerebrum damage can sometimes affect vision and hearing.

Some babies are deprived of oxygen during labor and delivery (birth). Because of this, doctors used to think that asphyxia (oxygen deprivation) during birth was the cause of the brain damage. However, scientists discovered during the 1980s that less than one tenth of cerebral palsy cases were caused by oxygen deprivation during birth. Most cases of damage to the brain among cerebral palsy children occurred before they were born – more specifically, during the first six months of pregnancy. Experts believe the brain damage happened because of three possible reasons:

Periventricular leukomalacia (PVL)

This refers to the damage of the brain’s white matter. Experts believe that lack of oxygen may have caused destruction of the unborn baby’s brain cells. PVL may have been caused by the pregnant mother catching an infection, such as rubella (German measles), having very low blood pressure, giving birth too early (premature birth), or consuming an illegal drug during the pregnancy.

Abnormal development of the brain

If the development of the brain is altered, the way it communicates with the body’s muscles can be affected, as can other functions. Experts say that any abnormality in brain development has the potential to cause cerebral palsy. During the first six months of pregnancy the embryo/fetus is particularly vulnerable to abnormal brain development. This can be caused by mutations in the genes responsible for brain development, some infections, such as toxoplasmosis (parasite infection), herpes and herpes-like viruses, and trauma to the unborn baby’s head.

Intracranial hemorrhage

This refers to bleeding inside the brain caused by the unborn baby having a stroke. Bleeding in the brain can stop the supply of blood to vital brain tissue, which consequently becomes damaged or dies. The escaped blood itself can clot and damage surrounding tissue. Several factors can cause a stroke in a baby during pregnancy and during the birth:

  • A blood clot in the placenta that blocked the flow of blood
  • The baby had a clotting disorder
  • There were interruptions in arterial blood flow to the baby’s brain
  • The mother had pre-eclampsia that was not treated
  • An emergency cesarean had to be performed
  • The second stage of labor was prolonged
  • A vacuum extraction was used during delivery
  • The baby had heart anomalies
  • There was inflammation of the placenta
  • There were umbilical cord abnormalities
  • The mother had a pelvic inflammatory infection
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