Cerebral Palsy
Cerebral palsy (CP) is an ‘umbrel a’ term used to describe a group of chronic movement or postural
disorders. “Cerebral” refers to the brain and “palsy” refers to a physical disorder. Cerebral palsy is caused by faulty development of or damage to motor areas in the brain, causing disruption of the brain’s ability to control movement and posture.A diagnosis of “Cerebral Palsy” covers a wide range Cerebral palsy is a permanent physical condition that affects muscle control and occurs in approx. one in every 500 babies with no two children the same. The movement problems vary from barely noticeable to extremely severe. Cerebral palsy is often called ‘CP’ for short.
Cerebral palsy causes problems with motor control and co-ordination, for example weakness and stiffness in muscles, awkwardness, slowness, shakiness and difficulties with balance.
A child with cerebral palsy may have slight clumsiness in one arm or leg (monoplegia), or one side of the body may be affected (hemiplegia), there may be muscle control issues in mostly the lower limbs (diplegia), or in both arms and legs and the torso (quadriplegia).
Other difficulties can include problems with speech, hearing or vision, epilepsy, intellectual or learning difficulties, perceptual difficulties such as judging the size and shape of objects, gastro- oesophageal reflux (heartburn), orthopaedic problems (with bones), constipation, feeding difficulties, saliva control problems or repeated chest infections.
There is a wide range of intellectual ability in children with cerebral palsy. Children with a very severe physical disability can have completely normal intelligence.
The three main types of Cerebral palsy correspond to injuries to different parts of the brain:
Spastic Cerebral palsy is the most common type of cerebral palsy. Spasticity means stiff or tight
muscles. The muscles are stiff because the messages to the muscles are being sent incorrectly from the damaged parts of the brain. It tends to increase with effort or excitement. Children with spastic CP need physiotherapy to help stop their joints and muscles becoming stiff or ‘contracted’.
Dyskinetic Cerebral palsy is when there are abnormal involuntary movements. There are
three different types of movement problems: - Dystonia is when there is frequent twisting or repetitive movements, or abnormal postures.
- Athetosis is when there is uncontrolled extra movement particularly in the arms, hands and feet, and around the mouth. This lack of control is most obvious when the child starts to move - for example, when the child tries to grasp a toy or a spoon. Also, children with athetoid cerebral palsy often have very weak muscles or feel floppy when carried.Children with athetoid CP need physiotherapy to help improve their balance, symmetry and control of movement.
- Chorea is when there are rapid jerky involuntary movements.
Ataxic Cerebral palsy (or ataxia) is the least common type. Children with ataxia have unsteady
shaky movements or tremors, and problems with balance. Physiotherapy can help children with ataxic CP improve the quality of their movements Cerebral palsy can also be classified by the parts of the body affected:
Children with quadriplegia have movement difficulties with all their limbs.
Children with hemiplegia have problems with the movement of one side of their bodies.
Children with diplegia have difficulties with the movements in their legs. Often they also have difficulty with fine, dextrous movements of their hands.
Children with monoplegia have problems with just one limb.
Some children also have dystonia. This means that they have involuntary muscle contractions (which they cannot control) causing abnormal movements and/or postures.
Many children have a mixture of several of these movement patterns.
Causes of Cerebral palsy
There are many different causes of cerebral palsy. A problem with the brain can occur: • If the brain does not form or grow properly during pregnancy.
• During labour - for example, if the baby does not receive enough oxygen.
• In the first few days or weeks of life - for example, when an infant develops a severe infection, such as meningitis or there is a bleed into part of the brain.
• In children having accidents in the first two years of life which causes permanent brain injury.
• Children born extremely prematurely are particularly at risk of developing cerebral palsy.
In some children, despite a careful review and various tests, the cause of cerebral palsy remains unknown. With new technologies such as MRI brain scans and sophisticated blood tests, more Management of Cerebral palsy
Management of Cerebral palsy is focused on the problems of muscle control and movement, and the treatment of additional health issues. Empowering, supporting and educating families is the most Many children with CP are hardly affected, others have problems walking, feeding or talking. Some children manage all activities independently, whilst others are unable to sit up without support and need help with all aspects of daily living. Sometimes other parts of the brain are also affected, resulting in sight, hearing, perception, learning difficulties and epilepsy.
Treatment includes:
• Physiotherapy and occupational therapy to encourage motor development.
• Orthotics for the lower limbs and splints for the upper limbs.
• Botulinum toxin A (Botox): to relax tight muscles. Given by injection, requiring light anaesthesia.
• Oral medications including Diazepam and Baclofen.
• Intrathecal baclofen: medication is given into the space around the spinal cord.
• Orthopaedic surgery: such as soft tissue surgery for the hip, or hamstring surgery for the knee.
• Plastic surgery: tendon transfers and releases to improve arm use.
• Speech athology to help with any communication problems and to provide help with eating, Key points to remember
• Early intervention is the key to getting the best outcome for children with cerebral palsy.
• Access to services including therapy and integration support are essential to increase the child’s progress in all areas of development.
• Management requires a team approach with the parents, therapists, doctors, nurses and teachers all contributing to ensure the best progress is made.
This is intended to support, not replace, discussion with your doctor or healthcare professionals. This information sheet has been compiled from various publications and considerable effort has been made to ensure the information is accurate, up to date and easily understood. Therapies for Kids accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in this information sheet.


Case Report Methemoglobinemia Mimics Complicated Malaria Shruti Sarkar, Dipankar Sarkar Department of Pediatrics, Peoples College of Medical Sciences and Research Centre, Bhanpur, Bhopal- 462010 (MP.) Abstract: Methemoglobinemia is an uncommon condition seen in clinical practice. It is generally caused by exposure todrugs, chemicals or solvents. Many drugs are implicated in the causat

Metab Brain Dis (2008) 23:485–492DOI 10.1007/s11011-008-9109-2Effects of the HIV treatment drugs nevirapineand efavirenz on brain creatine kinase activityEmilio L. Streck & Giselli Scaini & Gislaine T. Rezin &Jeverson Moreira & Celine M. Fochesato &Pedro R. T. RomãoReceived: 2 June 2008 / Accepted: 15 August 2008 /Published online: 24 September 2008 # Springer Science +

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