Cerebral Palsy
Cerebral palsy is a lesion, or injury to the brain that is nonhereditary and does not get worse over time. Cerebral palsy (CP) may show itself in different fashions and is usually accompanied by one or more impairments, may they be of speech, vision, hearing, and/or perceptual function. For every 1000 births in the United States it is reported that on average 3 of those babies will have CP. That adds up to anywhere in the area of 10,000 children per year with the disability. It is also recorded that males will have a higher chance of developing CP than females. CP is also the second most neurological impairment for children, while mental retardation is the first.
The exact cause of CP is unknown to us, and is often multifactorial in nature. In children who have CP related disabilities about 80% of those disabilities are results of factors occurring prenatally. These factors might include infection, malnutrition, and fetal anoxia. Factors that make up the other 20% can occur during or after birth, such as breech birth, low birth weight, falls, or abuse. In many cases it is impossible to determine exactly when the brain trauma occurred, but any action or condition that results in lack of brain oxygen (anoxia), hemorrhage, or brain damage can be the cause of CP.
Since there are a variety of different ways in which CP may present itself it is classified into different types. The types are determined by muscle tone, which limbs are involved, and the level of skilled function they can perform.
Types of cerebral palsy include: spastic (hypertonicity), athetoid/dyskensis (involuntary and uncontrolled movement), ataxic (balance and coordination deficit), flaccid child or floppy baby (low to no tone), and mixed (combo of hypotonicity and athetoid). The spastic type is the most common with about a 50-60% occurrence rate. This can manifest in monoplegia (one limb), diplegia (trunk and LE), hemiplegia (one side), and quadriplegia (all four limbs). The athetoid type can show up with spasticity, tonic spasms, chorea-athetoid (tone fluctuates), and pure athetoid (tone from hypotonic to normal). The ataxic type demonstrates hypotonic accompanied by variable degree of weakness. This may fluctuate between hypotonic and normal. With floppy baby you will see hypotonia atonic. Finally, the mixed category is a combo of hypertonicity and athetoid and it occurs at about a 20-40% rate. The level of severity of CP dependents on the level of function affected. In a mild form of CP the patient will exhibit ADL and fine motor movement within normal limits but have slower decreased quality of overall movement. A moderate case will have some limitations in ADL and have to use adaptive devices to walk. In a sever case they will be totally dependent in ADL and need a caregiver. Those who are characterized as having either mild or moderate CP are expected to have a normal life expectancy while those who have severe cases have a lower life expectancy due to respiratory or heart complications brought on by their immobility. The deficits associated with CP are as follows: seizure, possible mental retardation, speech impairment, sensory impairment, and contractures. Speech problems can be spastic or athetoid. Spastic speech is slow labored but understandable. While athetoid is difficult to understand it exhibits as poor tongue control. Contractures in spastic CP can effect: plantarflexion, adductors, hip flexors, hamstrings, and internal rotators. Even though there is no cure for CP there are different physical interventions which can improve and prevent side effects associated with CP. However, observation and history by the parents and the doctor will provide the necessary information needed to make pre-diagnosis and decide if in fact they are dealing with a case of CP. Diagnostic studies are ordered to further help with diagnosis. Electroencephalography (EEG) is indicated when seizures