Cerebral palsy

Cerebral palsy is a group of disorders resulting from brain damage that occurs before, during or shortly after birth. It is characterised by loss of movement and nerve functions. Those affected by it have problems in mobility (crawling, creeping, walking), use of hands (eating, writing, dressing) and communication.

• What is Cerebral Palsy?
• What are the causes?
• What are the various kinds of cerebral palsy?
• What are the signs and symptoms?
• How is the problem diagnosed?
• What is the treatment?

What is Cerebral Palsy?

Cerebral palsy is a group of disorders resulting from brain damage that occurs before, during or shortly after birth. It is characterised by loss of movement and nerve functions. Those affected by it have problems in mobility (crawling, creeping, walking), use of hands (eating, writing, dressing) and communication.

What are the causes?

There are many causes that may lead to this disorder. The signs of the problem may be present at birth or they may be seen months or years later. Many causes that can lead to the problem are:

•  Lack of sufficient oxygen – a condition called hypoxia that may damage the brain cells of the child.
•  Infections in the mother such as rubella (German measles), cytomegalovirus or toxoplasmosis in the first 4-5 months of the pregnancy.
•  Metabolic disorders in the mother such as diabetes, a heart problem, severe asthma and thyroid disorders.
•  Use of certain drugs during pregnancy without the doctors consultation.
•  Trauma to the head during labour or delivery, cerebral haemorrhage, use of forceps.
•  Prematurity and other complications at birth such as difficulty in breathing or very low birth weight. However, mostly it is difficult to identify the exact cause of the development of cerebral palsy. In most cases the causation is some abnormality around the time of conception.

What are the various kinds of cerebral palsy?

The four types of cerebral palsy are:

1. Spastic cerebral palsy: This is the most common type. It may affect a single limb, one side of the body (spastic hemiplegia), legs (spastic diplegia), or both arms and legs (spastic quadriplegia). There may be partial (paresis) or full loss of movement (paralysis), abnormalities of sensation and defects of hearing and vision. Epileptic fits, speech problems, mental retardation are other associated problems.
2. Athetoid cerebral palsy: In this type unintentional or uncontrolled movements are seen. The child’s muscles react in a very abnormal fashion resulting in excessive and uncontrolled darting or writhing movements.
3. Ataxic cerebral palsy: is characterised by a lack of coordination and balance due to damage to specific parts of the brain.
4. Mixed cerebral palsy: This occurs when two or more types are present in the same person.

What are the signs and symptoms?

•  Early sucking difficulty with the breast or bottle.
•  Lack of normal muscle tone and slow development of milestones.
•  Unusual body postures.
•  Purposeless body movements and poor coordination.
•  Various degrees of mental retardation and speech impediments.

How is the problem diagnosed?

Early diagnosis is important so that the child can be given help in the early years of development. Regular visits to the doctor are thus important, who confirms the diagnosis with detailed questions about the child's abilities, behaviour and observing the child's muscle coordination and posture. The paediatrician may on his discretion order the following tests such as the MRI, CTscan, blood and urine tests, BERA and VEP to check the hearing and vision, amongst other things. If there is the suspicion of epileptic fits, EEG or electroencephalography to detect their presence may be done.

What is the treatment?

There is no specific cure but the goal of treatment is to make the child independent. This can be done by providing help through physiotherapy, orthopaedic correction, braces, appropriate visual help such as spectacles, hearing aids, medications and special schooling if possible. The child can be sent to a normal school if his physical disabilities or mental development allow. Medications may include drugs to reduce muscle tension or control seizures.

Above all, the parents need to understand and come to terms with the problem that their child has, in order to help him in the best possible way. They can join a support group (like the "The Spastics Society" ), where they can learn more about the problem by experts in the field, they can meet parents having children with similar problems, discuss problems and share experiences common to both thereby working towards better management of the child at home.