It is a non progressive neuromuscular disorder causing mild to severe disabilities throughout life.This condition is manifested as a group of persisting qualitative motor disorders which appear in young children due to damage to the brain during delivery or due to some pathological conditions in the intrauterine life.The neuroligical problems are multiple but non progressive in nature.Approximately 2 per 100 live birth is having this problem.This disease is having no hereditary tendency.
Causes of cerebral palsy:
1) Injury to the brain during delivery.
2) As a complication of forceps delivery.
3) Lack of oxygen supply to the baby during delivery.
4) Infections during delivery.
Signs and symptoms of cerebral palsy:--
The signs and symptoms may not be similar in all babies affected.Depending upon the damage to the brain there may be mild to severe lesions.
Mild cases:- 20% children will have mild disability.
Moderate cases:-50% cases are having moderate disability.The affected children require self help for assisting their impaired ambulation capacity.
Severe cases:-About 30% of the affected children are totally incapacited and bedridden and they allways need care from others.
Abnormal findings in cerebral palsy:-
1,Abnormal neonatal reflexes.
2,Stiffness of all muscles with awkward motion.
3,Extention of extremities on vertical suspension of the infant.
4,Scissoring of the lower limbs due to spasm of the adductor muscles of the thigh.
5,In severe cases the back bend backwards like and arch.
6,May have total or partial paralysis.
7,Arrest of neurological and behavioral developement.
8,Swallowing may be difficult in some cases.
9,Drooling of saliva.
10,Mild to severe mental retardations.
11,Abnormal movements are seen in some cases.
12,Tremors with typical movements.
13,If cerebellum is affected there will be loss of muscle tone with difficulty in walking.
14,Complete or partial loss of hearing.
15,Speech may be affected.
16,Squint and other visual problems may be associated.
17,Convulsions may be seen in some children.
Cerebral palsy is diagnosed by detailed clinical examination and by eliminating other similar diseases like brain tumour, progressive atrophy ect.All investigations like CT scan,MRI and routine investigations are needed to ruleout other diseases.
Management of carebral palsy:--
General management:
This includes proper nutrition and personal care. Symptomatic medicines are needed to reduce convulsions and muscle stiffness. Diazepam can reduce spasticity and athetosis.
Dantrolene sodium helps to relax skeletal muscles.
Physiotherapy:
Here massage,exercise, hydrotherapy and ect are needed.Special training is given to train walking,swallowing and talking.The affected children are also trained to hold articles for routine activities.
Rehabilitation:
Moral and social support should be given to these children.They should be send to special schools where special training can be given by trained staff.Mentally retarded children need special training.Depending up on the disabitity special instruments and machines are given for locomotion and to assist their daytoday activities.
Occupational therapy:
This is given by occupational therapists.They train the disabled people to do some suitable works so that these people can have their own income.
Pathophysiology Of Cerebral Palsy
Cerebral Palsy is an umbrella term that encompasses a group of non-progressive, non-contagious conditions that cause physical disability in human development. The cerebral part refers to the affected part of the brain, generally the cerebrum. Palsy is the disorder of movement. The affected centers have not been perfectly localized and the disease most likely involves connections between the cortex and other portions of the brain.
Cerebral palsy can occur during pregnancy (75% or so of cases), after birth and up to age 3(roughly 15% of cases), and during birth (around 5% of cases). Of all the cases of cerebral palsy, between 40 and 50% of them are cases involving babies that are born prematurely.
Cerebral palsy is a non-progressive disorder which means that brain damage does not get worse as time goes on. Despite this, there are secondary orthopedic difficulties that often occur. There is no known cure for the condition. Medical intervention is limited to the treatment and the prevention of complications possible from this condition. These include osteoporosis and arthritis occurring at a younger age in adults born with cerebral palsy.
There has been a slight increase in the occurrence of cerebral palsy. The majority of people feel that this is attributable to low birth weight babies surviving due to improved neo-natal care. While this is good, babies with a low birth weight, who are commonly premature as well, are more susceptible to Cerebral Palsy.
Cerebral Palsy has four major classifications. These four classifications are spastic, athetoid/diskinetic, ataxic, and mixed. The classifications are named based on the area of the brain that is damaged.
Spastic Cerebral Palsy is the most common form. It is the named classification in 70-80% of all cases. It involves damage to the motor cortex of the brain. After the condition is named Spastic, it is further classified based on the area of the body that has been affected.
Ataxic is a very uncommon form of Cerebral Palsy. It occurs in at most 10% of all cases. This version involves damage to the cerebellum. Motor skills like writing, typing, or using scissors are commonly affected. Also, balance is a problem as well.
Athetoid, or dyskinetic, occurs second most frequently after Spastic. It involves problems with muscle tone. People with this version have problems holding themselves in an upright, steady position for sitting or walking. They often show involuntary motions and may not be able to grasp objects.
There are 10,000 new cases of Cerebral Palsy in the United States each year. This is true even following the advances in pregnancy care. This is because of the advances made in areas related to the care of premature babies. The causes of Cerebral Palsy are commonly asphyxia, hypoxia of the brain, birth trauma, premature birth, and illness of the mother during pregnancy such as strep.
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