Cerebral Palsy

Cerebral Palsy is a collective term used to describe a group of motor conditions that cause physical disability associated with body movement and posture. The impairments cause activity limitation and affect the level of functional independence. These conditions, which range in severity, are due to abnormalities that occurred in the developing fetal or infant brain (up until about the age of three). The majority of children are born with it, but a diagnosis may not be given until a later age. Although the disorder itself is not progressive, its appearance or expression may change over time as the brain matures.

Causes of Cerebral Palsy include: problems during intrauterine development, asphyxia before birth, hypoxia of the brain, birth trauma, and complications in the perinatal period or during childhood. However, it is possible that no cause may be identified. It has also been shown that Cerebral Palsy is more common in multiple births.

The early signs of cerebral palsy usually appear before a child reaches the age of 3. The most common are a lack of muscle coordination when performing voluntary movements, stiff or tight muscles and exaggerated reflexes. Children with CP can be observed walking with one foot or leg dragging; walking on the toes, using a crouched gait pattern, or a “scissored” gait. Some children with CP have low tone and are very floppy babies and toddlers.

Simple actions that are performed subconsciously by others, require marked effort and concentration, and often fail in patients with Cerebral Palsy. For example, in severely affected individuals, the extension of all the fingers may accompany extension of the wrist. Discrete movements, such as that of an individual finger, may be impossible.

The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour. Epilepsy and secondary musculoskeletal problems may occur.

To date, no type of Cerebral Palsy has a known cure. However, therapy can help individuals function more effectively. Early intervention is highly recommended as young children have a strong ability to learn new motor plans (neural plasticity).

Cerebral Palsy can be classified into four major categories, based on their types of movement impairments:

Spastic Cerebral Palsy

Individuals with this type of Cerebral Palsy are hypertonic and their nervous system is unable to receive gamma amino butyric acid in the area(s) affected by the disability. This is by far the most common type, occurring in 70% to 80% of all cases.

Spastic Cerebral Palsy can be further divided into the following, based on the region of the body affected:

• Spastic hemiplegia (one side)
• Spastic diplegia (lower extremities, but not, or barely, upper-body)
• Spastic quadriplegia (four limbs, equally)

Ataxia

Can be caused by damage to the cerebellum. Some of these individuals have hypotonia and tremors. Motor skills such as writing, typing, or using scissors might be affected, as well as balance, especially while walking. It is common for individuals to have difficulty with visual and/or auditory processing. This type occurs in no more that 10% of all cases.

Athetoid or dyskinetic

Individuals have mixed muscle tone; they have trouble holding themselves in an upright, steady position for sitting or walking, and often show involuntary motions. For some people with athetoid Cerebral Palsy, it takes a lot of work and concentration to get their hand to a certain spot. Because of their mixed tone and trouble keeping a position, they may not be able to hold onto objects (such as a toothbrush or pencil). This occurs in 10% to 20% of all cases. Complex, coordinated movements are very difficult to master due to the complexity of the condition.

Hypotonic

People with hypotonic Cerebral Palsy have low tone in the proximal and distal muscles. They appear limp and may have difficulty with weight bearing activity and movements. Seating and postural activities are of the essence for this population.