MANAGEMENT OF CEREBRAL PALSY: A MULTI DISCIPLINARY APPROACH

BY

DR. C.S. UMEH

DEPT. OF PSYCHIATRY, CMUL.

What is Cerebral Palsy?

Cerebral Palsy (CP) is a group of non-inherited neuromuscular disorders resulting from damage primarily to the motor region of the brain, causing impairment in control over voluntary muscles.

It may occur through anoxia (lack of oxygen during birth.

It is one of the commonest neurodevelopmental disorders seen in clinics.

What is CP Contn’d

The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later. The early signs of cerebral palsy usually appear before a child reaches 3 years of age. 

What is CP Contn’d

The most common symptoms are: a lack of muscle coordination when performing

voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes

(spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a

“scissor” gait; and muscle tone that is either too stiff or too

floppy. 

What is CP Contn’d

A small number of children have cerebral palsy as the result of:

brain damage in the first few months or years of life,

brain infections such as bacterial meningitis or viral encephalitis,

or head injury from a motor vehicle accident, a fall, or child abuse.

What is CP Contn’d

The brain damage that leads to cerebral palsy can also lead to other health issues, including:

vision, hearing, speech problems, and learning disabilities.

Types of CP

spastic cerebral palsy — causes stiffness and movement difficulties

Dyskinetic: which can be either athetoid cerebral palsy — leads to involuntary and uncontrolled movements or ataxic cerebral palsy — causes a disturbed sense of balance and depth perception

Mixed: This is a mixture of different types of cerebral palsy. A common combination is spastic and athetoid

Causes of Cerebral Palsy

The exact causes of most cases of CP are unknown, but many are the result of problems during pregnancy in which the brain is either damaged or doesn't develop normally. This can be due to:

infections, maternal health problems, a genetic disorder, or something else that interferes with normal brain

development.

Causes of CP contn’d

Problems during labor and delivery can cause CP in some cases, but this is the exception.

Premature babies — particularly those who weigh less than 3.3 pounds (1,510 grams or 1.5kg) — have a higher risk of CP than babies that are carried full-term.

Falls and birth traumas

Treatment of CP

Cerebral palsy can’t be cured, but treatment will often improve a child's capabilities and quality of life.  

Many children go on to enjoy near-normal adult lives if their disabilities are properly managed.

In general, the earlier treatment begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them.   

Treatment of CP contn’d

CP usually affects several areas of functioning, as a result, several disciplines are involved in its management.

The activities of the disciplines must be coordinated in order to yield effective treatment outcome.

The disciplines usually involved in CP management include:

Treatment of CP contn’d

Pediatricians – they take care of development, care and diseases of children and are in the position to coordinate the management of CP.

Surgeons – they carryout surgeries to correct anatomical abnormalities or release tight muscles.

Occupational therapists- they take care of fine motor activities.

Treatment of CP contn’d

Physiotherapists- they take care of gross motor activities.

Speech therapists -they apply remedies, treatment, and counselling for the improvement of speech functions.

Clinical Psychologists- they provide emotional wellbeing as well as cognitive evaluation for school placement.

Treatment of CP contn’d

Special need educators – the provide the kind of education CP children with cognitive impairment could benefit from.

Other CP treatment Aids

The quality of life of CP clients could be improved using the following aids:

Prosthetic devices such as braces and other orthotic devices;

wheelchairs and rolling walkers; and communication aids such as computers

with attached voice synthesizers. 

Prognosis

Cerebral palsy doesn’t always cause profound disabilities.  

While one child with severe cerebral palsy might be unable to walk and need extensive, lifelong care, another with mild cerebral palsy might be only slightly awkward and require no special assistance.

Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.

Conclusion

CP is a non progressive brain disorder, meaning the brain damage does not continue to worsen throughout life, and usually develops by age 2 or 3.

However, the symptoms due to the brain damage often do change over time -- sometimes getting better and sometimes getting worse.

CP is one of the most common causes of chronic childhood disability. It may not be curable but could be managed.

Thanks for your attention