Cerebral Palsy – Diagnosis & Treatment
Domlur, Bengaluru Feb 11, 2017
The term ‘Cerebral palsy’ (CP) was coined several decades ago, which literally means “brain paralysis”. The meaning is somewhat of a misnomer as cerebral palsy generally involves people with abnormalities in movement and posture. This disorder is usually noticed from infancy onwards and seems to persist throughout life. About 85-90% of CP cases are congenital occurring before or during birth. According to WHO (World Health Organization), about 3.8% of the total population in India and 10% of the global population suffer from CP. The estimated incidence of CP is around 3/1000 live births in our country and the expected figure might be towards a higher side in the coming years. Infants affected with CP exhibit abnormal muscle tone, poor crawling abilities, poor head control, and difficulty in rolling, walking and sitting.
There are several types of CP and are generally classified depending upon the symptoms:
- Spastic CP is the most common type occurring in almost 70% of the cases, where the movement of the child is inhibited due to stiff muscles.
- The other types of CP such as hypotonic, choreoathetoid and mixed types are rare and their symptoms seem to develop over the life span of the individual.
A CP affected child can expect to live the same lifespan as any one of us.
Some risk factors that can precipitate CP in children include – Preterm labor (giving birth before the 37thweek of pregnancy) has found to be a prominent risk factor for CP. Genetic predisposition, aberrations during brain development, stroke and brain infections are other factors that can induce CP.
Screening and Diagnosis
Diagnosing CP at an early stage of life is the most crucial part of CP management. Earlier the diagnosis, the more effective and helpful will be the management. As there are no particular tests to detect CP, the medical practitioners rely on certain developmental screening tests. General monitoring during development includes testing of reflexes, muscle tone, posture and coordination, all of which becomes evident over months or might take even years. Further, specific medical evaluations including MRIs, cranial ultrasounds, EEG’sand CT scans have also gained popularity in validating brain anomalies during CP.
There is no direct cure for CP. However, a variety of interventions are available to help the affected individual lead a normal life. Commonly, medications such as anticonvulsants, botulinum toxin injections, bisphosphonates and diazepam to regulate muscle tonicity are recommended. Physiotherapy programs that help in improving movement, muscle tone and bone structure are frequently performed as they are convenient, less invasive and pose no adverse effects when compared to pharmaceutical interventions.Speech therapy helps children with CP to focus on their muscles of mouth and jaw, which aids in improving their communication skills, improve chewing ability and swallowing of food, and also assists in breathing properly. Specialized centers also run a ‘Conductive education (CE) program’ which aims at improving mobility, self-esteem, stamina that can be applied in daily living skills and for generating age-appropriate cognitive, emotional and social skills. Assistive orthotic devices like rolling walkers, braces are also recommended as a support to improve gait. In severe cases, surgeries like rhizotomy can be performed to achieve flexibility in affected limbs/ joints. According to some of the recommendations by ‘The American College of Sports Medicine’, there are few exercises which can be tried may be once or twice a week to reduce the physical resistance a CP affected individual experiences:
- Stretching exercises, yoga (joint exercises) and dynamic stretching can be followed twice a week which can help in increasing muscle strength and endurance.
- Use of stationary bicycles, arm exercises, ergo metersto enhancecardio respiratory fitness.
In addition, there are various therapies that can be extended to a CP person that can not only help the person to overcome his/her physical functioning abilities but can also fine tune their abilities to an extent that they can have a quality life. Some of the therapies which can be applied to different stages of a child’s development are:
- Behavioral therapy, conductive education, occupational therapy and social therapy are appliedfor improving the cognitive function, coordination and reasoning abilities.
- Massage therapy, hippo therapy, chiropractic intervention and aqua therapy are recommended to restore physical functioning and gait.
- Respiratory therapy, nutrition counseling, sensory integration, speech and language therapy and vocational counseling are some of the specialized therapies targeted for the management of individual parameters such as speech, language, motor skills, and respiratory health.
CP is generally used as an umbrella term for non-progressive developmental disabilities. It may or may not affect the mental disposition of the individual but is characteristically visible in the physical traits. An interesting research says that 6 out of 10 people with CP have normal or superior intelligence. There is very little we can do in preventing CP but a coordinated and concerted approach can do wonders in the management of CP throughout the world.
World Cerebral Palsy Day is an innovative movement of people with CP and their families with supporting organizations. Organizations such as Cerebral Palsy Alliance (Australia) and United Cerebral Palsy (USA) running in over 50 countries have been established to create awareness, provide support and to educate the masses about Cerebral Palsy.