Cerebral Palsy
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Cerebral palsy is a term used to define a group of conditions which impair movement, with “palsy” meaning disorder of movement or posture. Typically, this impairment is caused by trauma to the brain, either before or after birth, but to be clinically diagnosed with cerebral palsy it must occur very early in life, usually before the age of three. There is no gender or race more prone to cerebral palsy however, how the pregnancy was carried can play a role. The use of drugs and/or alcohol may cause damage to the developing brain of the fetus, perhaps leading to congenital cerebral palsy.
Typically, children with cerebral palsy are slow to reach developmental milestones, such as sitting up or smiling. Depending on which area of the brain was damaged, different muscle groups can be affected. However, once the damage occurs, the condition does not progress any further. In contrast, a child with very mild cerebral palsy may recover completely before school age, but in general, cerebral palsy is a life long disability. Although each individual may exhibit unique symptoms, some typical symptoms are: difficulty with fine motor tasks, such as writing or utilizing scissors; involuntary movements, such as writhing of limbs or thrusting of the tongue; difficulty maintaining balance and/or correct posture; tightness in the muscles or muscle spasms; possible impairment of sight, hearing, or speech; and disturbances in perception and/or sensation. Seizures and mental retardation may also occur with cerebral palsy, but does not always appear. Depending on which symptoms the child has, they can be classified into separate break-downs of cerebral palsy.
The most common type of cerebral palsy is spastic cerebral palsy. These children have stiff groups of muscles, resulting in stiff, jerky movements. Often times, the child with spastic cerebral palsy will have difficulty grasping objects and letting go of objects. Individuals with spastic cerebral palsy have increased muscle tone due to the tensing of the muscles.
The second type of cerebral palsy is athetoid cerebral palsy, which occurs when damage occurs to either the basal ganglia or cerebellum. The characteristics of athetoid cerebral palsy is similar to other disorders of the basal ganglia, such as Huntington’s Disease, which produces involuntary, writing-type, movements. These writing motions usually afflict the upper torso, including the trunk, upper limbs, and face. This type of cerebral palsy is particularly difficult as it usually affects the tongue and mouth, causing purposeless thrusting that leads to drooling, dysphagia, and slurred or absent speech. Also, the ability to accurately grasp objects is significantly diminished. Unlike spastic cerebral palsy where the stiff muscles result in increased muscle tone, athetoid cerebral palsy results in a decreased muscle tone. Individuals with athetoid cerebral palsy are most often times confined to a wheelchair.
The third type of cerebral palsy is ataxic cerebral palsy. This type of cerebral palsy is rare, affecting the person’s sense of depth perception and balance. This individual will usually appear to be “shaky”, more often when performing fine motor tasks. To compensate for their poor sense of balance, they may walk with a wide based gait and appear to be very unsteady on their feet.
However, a child does not have to be diagnosed into one of previous categories, as the fourth type of cerebral palsy is mixed. For example, the individual may have increased muscle tone, but experience the writing movements of athetoid cerebral palsy. This is the most common type of mixed cerebral palsy, but there are many different combinations that can occur.
There is no perceived “cure” for cerebral palsy, in the conventional sense. There are medical treatments that can help control and reduce the symptoms of cerebral palsy. Medications may be used to relax the muscles or control seizures if need be. There are also medications to help control salivation if that is a problem as well. There are also surgeries that can be performed in order to assist the individual in becoming more independent, such as lengthening the heel cord to reduce “toe walking” or releasing the adductors to relieve leg spasticity. In addition to these medical treatments, there is adaptive equipment that can increase the independence of the individual. These may include wheelchairs, walkers, special orthopedic bracing, adapted eating utensils, communication devices, head switches, joysticks, adaptive toys, and the list can go on forever. There are therapies that, if started from a young age, can assist the person later in life with daily living tasks. Physical therapy is one way. The purpose of physical therapy is to strengthen the larger muscles in the body such as legs, arms, and torso, also known as gross motor skills. Developing these gross motor skills is integral in preventing future