Cerebral Palsy is basically a disorder of movement involving posture or muscle tone & which is usually caused by an insult to the immature & developing brain, most often prior to birth. Signs & symptoms of cerebral palsy generally appear during infancy or during preschool years. Cerebral palsy normally causes impaired movement in children which is largely associated with exaggerated reflexes, abnormal posture, unsteady in walking, involuntary movements, floppiness or rigidity of limbs & trunk or some combination of these factors. People suffering with cerebral palsy may also have difficulty in swallowing & commonly display eye muscle imbalance. Cerebral palsy patients may have reduced range of motion at various joints within the body due to muscle stiffness. Effects of cerebral palsy on functional abilities greatly vary. While some people are able to walk with difficulty, others are not able to do so. Some people display normal to near normal functions of the intellect, while others may have intellectual disabilities. Blindness, epilepsy or deafness may also be present in some cases. Nevertheless, cerebral palsy patients often have some or the other underlying developmental brain abnormalities.
Signs & symptoms of cerebral palsy can greatly vary. Coordination & movement problems which are commonly associated with cerebral palsy include the following.
Variations in muscle to like being too stiff or too floppy
Spasticity – Stiff muscles & exaggerated reflexes
Rigidity – Stiff muscles with normal reflexes
Ataxia – Lack of muscle coordination
Tremors – Involuntary movements
Athetosis – Slow writhing movements
Delay in reaching motor-skills milestones like crawling, sitting up alone or pushing up on arms
Favoring one side of the body like dragging a leg while crawling or reaching with only one hand
Difficulty in walking like walking on toes, scissors-like gait with knees crossing, crouched gait or wide gait
Problems with swallowing or excessive drooling
Difficulty eating or with sucking
Difficulty in speaking or delay in speech development
Difficulty with precise motions like picking up a spoon or crayon
Disabilities associated with cerebral palsy may often be primarily limited to one limb or to one side of the body, or may even sometimes affect the whole body. Brain disorder which is causing cerebral palsy does not change with time; therefore symptoms generally do not worsen with age even though shortening of muscles & muscle rigidity may however worsen in case they are not treated aggressively.
Other Neurological Problems Associated with Cerebral Palsy
Abnormalities of the brain which are associated with cerebral palsy may also be contributing to many other neurological problems. People with cerebral palsy may also display the following conditions.
Difficulty in hearing & vision
Abnormal pain or touch perceptions
Psychiatric – mental health conditions
Time to Seek Appointment with Doctors
It is very important to seek prompt diagnosis to any disorders of movement or possible delays in the development of children. It would be sensible to seek services of a children’s doctor in case you have any questions or concerns regarding coordination, muscle movement, muscle tone or any other issues about development of the child in question.
Causes for Cerebral Palsy
Cerebral palsy is generally caused by a disruption or abnormality in development of brain which is typically caused before the child is born, exact factor triggering this abnormality is however still unknown. Factors which may be the cause leading to this problem with the development of brain include the following.
Random mutations in genes which control development of brain.
Maternal infections which affect the development of fetus.
Fetal stroke which is causing a disruption of blood supply to the brain under development.
Asphyxia – lack of oxygen to brain which is related to difficulty in labor or delivery. However, this is a rare cause.
Infant infections which cause inflammation in & around brain.
Traumatic head injuries to infants from a fall or motor vehicle accident.
Risk Factors Associated with Cerebral Palsy
Following are a number of factors which are associated with increased risk of developing cerebral palsy.
Maternal Health – Certain health problems or infections during pregnancy are found to significantly increase risk of giving birth to babies with cerebral palsy. Infections of particular concern include some of the following.
Rubella – German Measles – Rubella basically is a viral infection which can cause serious birth defects, but can be effectively prevented with a vaccination.
Varicella – Chickenpox – This is a contagious viral infection which causes rashes & itching & complications in pregnancies. However, this can also be prevented with a vaccination.
Cytomegalovirus – It is a common virus which causes flu-like symptoms & may often lead to birth defects in case mothers experience their first active infection during the period of pregnancy.
Toxoplasmosis – This is a parasitic infection which is cause by a particular parasite found in soil, contaminated food & feces of infected cats.
Syphilis – It is a sexually transmitted (STD) bacterial infection.
Exposure to Toxins – Especially, toxins like methyl mercury can increase risk of birth defects.
Other Conditions – There are various other conditions which may increase risk of cerebral palsy like seizures, intellectual disabilities & thyroid problems.
Infant Illness – Illnesses in newborn babies which can greatly increase risk of cerebral palsy include the following.
Bacterial Meningitis – This is a type of bacterial infection which causes inflammation in membranes which surround the brain & spinal cord.
Viral Encephalitis – This type of viral infection generally causes inflammation in membranes which are surrounding the brain & spinal cord.
Severe or Untreated Jaundice – Jaundice basically is a condition which appears as yellowing of skin. This generally occurs when certain wasted byproducts of ‘used’ blood cells are not filtered out from the bloodstream.
Other Factors of Pregnancy & Birth – These other factors listed below are generally associated with increased risk of cerebral palsy.
Premature Birth – Normal pregnancies generally last for 40 weeks. Babies born lesser than 37 weeks into pregnancy are at high risk of developing cerebral palsy. The earlier babies are born, greater the risk of developing cerebral palsy.
Low Birth Weight – This includes babies who weigh less than 2.5 kilograms (5.5 pounds) who are also at high risk of developing cerebral palsy. Moreover, this risk increases as the birth weight of babies drop.
Breech Births – Babies born with cerebral palsy are most likely to be in a breech presentation or feet-first position at the start of labor rather than being in the headfirst position.
Multiple Babies – Risk of developing cerebral palsy is found to increase with the number of babies which are sharing the uterus. In case one or more of these babies die, chances of survivors developing cerebral palsy increases.
Complications Associated with Cerebral Palsy
Muscle spasticity, muscle weakness & coordination problems associated with cerebral palsy can often contribute to a number of complications either during childhood or sometime later during adulthood are listed below.
Contracture – Contracture basically involves shortening of muscle tissue due to severe tightening of muscle. Also known as spasticity, contracture can also inhibit bone growth & cause bones to bend or result as deformities in joints. Chances of dislocation or partial dislocation are also complications associated with cerebral palsy.
Malnutrition – Problems with swallowing or feeding can make life difficult for people with cerebral palsy, particularly when they are infants & are required to get enough nutrition. This problem can eventually cause weaker bones & impaired growth in children. They might in such instances even need a feeding tube for adequate nutrition.
Lung Disease – Cerebral palsy patients may at times develop breathing disorders including lung disease.
Mental Health Conditions – Cerebral palsy patients may often also have psychiatric or mental health conditions like depression. Factors contributing to depression can include social isolation & challenges of coping with disabilities.
Osteoarthritis – Pressure on abnormal alignment of joints or on joints as well resulting from multiple spasticity may sometimes result in early osteoarthritis or development of painful joints.
Neurological Conditions – Cerebral palsy patients may also be more likely to develop disorder of movement or worsening of neurological symptoms over time.
Preparing for Cerebral Palsy Initial Appointment
Learning about conditions of children having cerebral palsy will depend upon the severity of the disabilities when problems first appeared & whether there were any type of risk factors involved during pregnancy or at the time of delivery.
Well-Baby Visits – It is important that parents take their children regularly for scheduled well-baby visits & annual appointments during childhood. These visits generally are an opportunity for the child’s doctor so as to monitor development in key areas including the following.
Sensory Abilities like touch, hearing & vision
Age-Appropriate Motor Skills
Doctors may also ask several questions to patients during these well-baby appointments including some of the following.
What type of concerns are you having regarding growth & development of your child?
How well does your child eat?
How is your child responding to touch?
Have you observed your child favoring any one side of the body?
Is the child reaching certain milestones in development like crawling, sitting up, pushing up, rolling over, walking or speaking?
Talking to Doctors about Cerebral Palsy
When the family doctor or pediatrician believes that the child is exhibiting signs of cerebral palsy, parents may want to discuss the following questions with doctors.
Which diagnostic tests will we need to confirm?
When will we know results of these tests?
Which specialists will we need to consult?
How are we going to screen for disorders that are commonly associated with cerebral palsy?
How will my child’s health & development be monitored?
Will you suggest educational materials that are available & local support services regarding cerebral palsy?
Will it be possible to follow my child through a multidisciplinary program which addresses all his/her needs on the same visit, like a cerebral palsy clinic?
Tests & Diagnosis for Cerebral Palsy
In case doctors or pediatricians suspect that the child is having cerebral palsy, they will start by evaluating signs & symptoms of the particular case. They will also review the medical history of the child & conduct a thorough physical examination. Doctors may also refer some cases to pediatric neurologists who are specially trained in treating brain & nervous system conditions in children. Doctors will also order the patient to undergo a series of tests which are designed to make diagnosis & rule out the possibilities of some other causes.
Brain Scans – Brain-imaging technologies can effectively reveal areas of damage or abnormal development within the brain. Some of these tests include the following.
MRI – Magnetic Resonance Imaging – MRI effectively uses a combination of radio waves & a magnetic field so as to produce detailed 3-D or cross-sectional images of the child’s brain. MRI also can often identify presence of any lesions or abnormalities in the brain of a child. MRI is noisy but painless & can take about 60 minutes to complete. Children are most likely to receive a mild sedative prior to test. MRI generally is the preferred imaging test applied for cerebral palsy.
Cranial Ultrasound – This test can be obtained during infancy. Cranial ultrasound basically uses high-frequency of sound waves in order to obtain images of the brain. Although ultrasound does not produce a detailed image, it may however be used to produce quick & inexpensive images which can provide a very valuable preliminary assessment of the brain.
CT Scan – Computerized Tomography – CT scans use X-rays so as to obtain cross-sectional images of the brain in children suffering from cerebral palsy. CT scans can ideally be used to identify abnormalities in the child’s brain. CT scanning is painless & may just about take 20 minutes of time. As the child will be required to lie still during the procedure, they are most likely to receive a mild sedative for this purpose.
EEG – Electroencephalogram – In case children have seizures, doctors often order an EEG or electroencephalogram so as to determine they have epilepsy, which quite often occurs among children with cerebral palsy. A series of electrodes are affixed to the scalp of the child during an EEG test. EEG test is designed to record electrical activity of the child’s brain when they have epilepsy. It is common that changes occur in normal patterns of brain waves due to epilepsy attacks.
Laboratory Tests – Child’s blood may also need to be examined so as to rule out possibility of other conditions like blood-clotting disorders which can also cause strokes. Quite often they are found to mimic signs & symptoms of cerebral palsy. These laboratory tests can also screen for metabolic or genetic problems.
Additional Tests – When children are diagnosed with cerebral palsy, they are most likely to be referred to specialists for assessment of other conditions which are often associated with this disorder. The following tests usually conducted to identify other conditions.
Speech Delays or Impairments
Other Types of Developmental Delays
Treatment & Drugs for Cerebral Palsy
Children & adults suffering from cerebral palsy invariably require long-term treatment with a medical care team consisting of the following professionals.
Pediatrician or Psychiatrist – Pediatricians generally oversee treatment plans & medical care of cerebral palsy patients.
Pediatric Neurologist – These are doctors who are trained in diagnosing & treating children who are down with brain & neurological (nervous system) disorders & which may also be involved in the medical care team for caring of children.
Orthopedic Surgeon – These doctors are specially trained in treating bone & muscle disorders & may therefore be involved in diagnosing & treating muscle conditions of cerebral palsy patients.
Physical Therapist – Physical therapist in the cerebral palsy medical care team are meant to help children improve strength, walking skills & stretching of muscles as well.
Occupational Therapist – Occupational therapists in a cerebral palsy medical care team provide therapy to children so as to develop daily skills & to learn how to use adaptive products which are designed to enrich their daily activities.
Speech – Language Pathologist – This doctor is specifically trained in diagnosing & treating speech & language disorders. They may work with children in case they are having difficulties with swallowing, speech or language.
Developmental Therapist – This therapist may provide therapy in order to help children develop age-appropriate behaviors including interpersonal skills & social skills.
Mental Health Specialist – These include a psychiatrist or a psychologist who may be involved in caring for children as a mental health specialist. They may help parents & children to cope with disabilities due to cerebral palsy.
Special Education Teacher – These teachers address learning disabilities, determine educational requirements of cerebral palsy patients & identify appropriate educational resources in order to overcome the problem.
Social Worker – Social workers may also be involved in assisting the patient’s family in finding services for cerebral palsy patients & planning for transitions during care.
Medications for Cerebral Palsy Treatment
Medications which can lessen tightness of muscled are often used to treat pain, improve functional abilities & manage complications which are related to spasticity or other associated symptoms of cerebral palsy. However, it is important to talk about risks of drug treatments with doctors & discuss whether any medical treatment is appropriate for the needs of children. Selection of medications, however depend upon whether the problem is affecting only certain isolated muscles or generally the whole body. Common drug treatments for cerebral palsy include the following.
Isolated Spasticity – Doctors may often recommend Botox (onabotulinumtoxinA) in cases where spasticity is isolated to a single muscle group. This is directly injected into the muscle, nerve or both. Botox injections are also found to help improve drooling in cerebral palsy patients. However, children will require these injections about every three months. Side effects of Botox injections may include bruising, pain or severe weakness. Some other more serious side effects may include difficulty in swallowing or breathing.
Generalized Spasticity – Oral muscle relaxants may effectively help relax stiff & contracted muscles in cases where the whole body is affected. Most common drugs used in this situation include baclofen (Gablofen), dantrolene (Dantrium) & diazepam (Valium). However, there is some risk of dependency with diazepam therefore it is not recommended for long-term usage. Moreover, side effects of its use include drooling, weakness & drowsiness. Side effects of dantrolene include nausea, diarrhea or sleepiness. Side effects of baclofen include nausea, confusion & sleepiness. Baclofen in certain instances is also directly pumped into the spinal cord with help of a tube. This pump is usually surgically implanted under skin of the patient’s abdomen.
Children with cerebral palsy are also often prescribed medications in order to reduce drooling. Common medications which help reduce drooling include glycopyrrolate (Robinul Forte, Robinul), scopolamine (Scopace) or trihexyphenidyl.
Therapies as Treatment for Cerebral Palsy
There are a variety of nondrug therapies which can help people with cerebral palsy by enhancing their functional abilities. Some of these therapies include the following.
Physical Therapy – This includes exercises & muscle training which may eventually help children with cerebral palsy develop mobility, motor development, balance, flexibility & strength. Parents with help of this therapy will also learn how to safely care for the child & his or her everyday needs at home including feeding & bathing. Splints & braces may also be recommended for children affected by cerebral palsy. Some of these supports are meant to help with functions like improved walking while others may help stretch stiff muscles so as to prevent contractures (rigid muscles).
Occupational Therapy – Using adaptive equipment & alternative strategies, occupational therapists usually work to promote child’s independent participation in routines & daily activities at home, in school & within the community. Adaptive equipment utilized in occupational therapy may include electric wheelchairs, seating systems, quadrupedal canes & walkers.
Speech & Language Therapy – These experts can effectively help improve cerebral palsy patient’s ability to speak clearly or teach them to communicate by using sign language. Speech language pathologists are also trained to teach these children how to use communication devices like voice synthesizers & computers if communicating is difficult for the patient. Another type of communication device is a board covered with pictures of activities & items which cerebral palsy children may see in their daily lives. Through this device sentences may be constructed by pointing to these pictures. Speech therapists also address difficulties with muscles that are utilized in swallowing & eating by cerebral palsy patients.
Recreational Therapy – Some cerebral palsy children may also benefit from recreational therapies like therapeutic horseback riding. This kind of therapy can effectively help improve speech, motor skills & emotional well being in children suffering from cerebral palsy.
Surgical & Other Procedures for Cerebral Palsy
Surgery may sometimes be needed to lessen tightness of muscles or to correct bone abnormalities caused by spasticity in children affected with cerebral palsy. These treatments may include some of the following.
Orthopedic Surgery – Cerebral palsy children with severe deformities or contractures may often need surgery on bones or joints in order to place their legs, hips or arms in correct positions. These surgical procedures are also designed to lengthen tendons & muscles which are proportionally too short due to severe contractures. However, these surgical corrections can effectively lessen pain & improve mobility in cerebral palsy patients. Moreover, these procedures can also make it easier for these children to use crutches, braces or walkers.
Severing Nerves – Surgeons may at times cut nerves serving the spastic muscles in some cases of cerebral palsy when other treatments have not proved to be helpful. This surgical intervention is known as Selective Dorsal Rhizotomy. It is meant to relax the affected muscle & thereby reduce pain, but is also sometimes found to cause numbness.
Coping & Support for Living with Cerebral Palsy Patients
The whole family faces new challenges when children are diagnosed with a disabling condition. Here are some tips for caring of children with cerebral palsy.
Foster Cerebral Palsy Child’s Independence – Parents of cerebral palsy children must encourage any effort put by these patients at independence, no matter how small it is. Just because others can do it more easily or faster does not demean their efforts.
Be an Advocate for Cerebral Palsy Children – Family is an important part of the cerebral palsy child’s health care team. Parents should therefore never be afraid to speak out on behalf of the child or to ask tough questions to teachers, therapists & physicians.
Find Support for Parents of Cerebral Palsy Patients – Circle of support can make a huge difference in helping parents cope with cerebral palsy patients & its effects on the family. Parents may also at time feel grief & guilt over the disability of the child. Doctors can also be very helpful in locating such support groups, organizations & counseling services within the community. Even cerebral palsy children may benefit from such counseling, school programs & supporting events.
Preventing Cerebral Palsy in Children
Although, cases of cerebral palsy cannot be prevented, risks can however be lessened by taking precautionary measures. Women who are pregnant or planning pregnancy can take the following steps in order to keep healthy & minimize complications arising out of pregnancy.
Make Sure to Get Vaccinated – Vaccinating against diseases like rubella may prevent infections which can cause fetal brain damage.
Taking Care During Pregnancy – Women are far less likely to develop infections which may result in cerebral palsy when they are healthy while heading into a pregnancy.
Seek Early & Continuous Prenatal Care – Timely visits to doctors during pregnancy is a good way to reduce health risks to the mother & the unborn baby. Regularly seeing the doctor will help prevent premature birth, infections & low birth weight in newborn babies.
Practice Good Child Safety – Parents can prevent head injuries to children by providing them with a bicycle helmet, car seat, safety rails on beds 7 proper supervision.
Affordable Treatment for Cerebral Palsy in India
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