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Cerebral
palsy refers to a group of non-progressive disorders that
affect the control of movements and posture. These disorders
are caused by brain damage before or during birth. The
lesion does not produce an ongoing degeneration of the
brain, so the condition does not worsen. The children can
improve their functioning abilities with rehabilitation
management
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The common finding in cerebral palsy is the developmental delay of
motor skills, such as reaching, sitting, rolling, crawling, walking and so
on. In addition, there may be associated defects, such as
seizures,
speech disorders, hearing impairments, visual problems and mental
retardations.
Cerebral Palsy can be divided into four categories: spastic, athetoid,
ataxic and mixed forms. These classifications reflect the type of
movement disturbance displayed by the patient.
Spastic CP is the most common type. It afflicts somewhere between half
and three-quarters of all patients with cerebral palsy, causing the
muscles to be stiff and permanently contracted. Doctors often further
subdivide spastic cerebral palsy into one of five types, describing the
limbs that are affected. These names combine a Latin prefix describing the
affected limbs with the term plegia (or sometimes "paresis"), meaning
paralyzed or weak:
- diplegia affects either both arms or both legs;
- hemiplegia affects the limbs on only one side of the body;
- quadrapelgia affects all the limbs;
- monoplegia affects only one limb; and
- triplegia affects three limbs.
Children with spastic quadriplegia have other problems due to extensive
brain damage. These include swallowing difficulties, speech
abnormalities, visual impairment, hearing impairment, intellectual dysfunction
and seizures.
Athetoid cerebral palsy occurs in about 20% of the cases. Symptoms
include:
- Loss of control and fluctuation of muscle tone including facial
muscles (twisting, jerking, grimacing, speech difficulty)
- Uncontrolled movements -- more severe during stress, and disappear
entirely during sleep.
Ataxic cerebral palsy accounts for about 5 to 10% of all cases, and is
characterized by an unsteady gait
(ataxia),
tremors and difficulty with
fine movements resulting from a loss of balance and coordination.
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Early
diagnosis is important for effective treatment and
prevention of complications. An examination indicates the
delayed development of motor skills, abnormal muscle tone
and persistent primitive reflexes that generally disappear
by 6 to 12 months of age. Some specialized tests help to
diagnose cerebral palsy.
- Brain imaging test (MRI, CT scan or Ultrasound)
- Auditory evoked potential (AEP) -- screening test for hearing impairment
- Visual evoked potential (VEP) --
screening test for visual
impairment
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There is no
specific cure for cerebral palsy, but proper management
helps to prevent complications and maximize functional
independence.
- Physical therapy and occupational therapy enhances motor skills (such as sitting and walking) and functional skills required for daily living. Physical therapy also improves muscle strength and prevents contractures (shortening of muscles that limits joint movement).
- Braces, splints, casts or orthopedic surgery may prevent or release contractures, improving the function of the hands or legs.
- Mechanical AIDS include walkers and wheelchairs
- Management of spasticity -- oral drugs, botulinum injection directly into spastic muscles, or a surgery called selective dorsal rhizotomy.
- Drugs for seizure control
- Feeding tube placement for
serious swallowing
impairment
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Cerebral palsy is not a curable disease. The extent of the disability depends on the severity of brain damage. It is extremely difficult to predict your child's prognosis. Children who can sit without assistance within 2 years of their birth can usually walk independently.
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