Note: This article has been localised for an Irish audience.
Cerebral palsy (CP) is an umbrella term encompassing a group of non-progressive, non-contagious conditions that cause physical disability in human development.
Cerebral refers to the cerebrum, which is the affected area of the brain (although the disorder most likely involves connections between the cortex and other parts of the brain such as the cerebellum), and palsy refers to disorder of movement. CP is caused by damage to the motor control centers of the developing brain and can occur during pregnancy (about 75 percent), during childbirth (about 5 percent) or after birth (about 15 percent) up to about age three. Further research is needed on adults with CP as the current literature is highly focused on the pediatric patient.
It is a non-progressive disorder, meaning the brain damage does not worsen, but secondary orthopedic difficulties are common. For example, onset of arthritis and osteoporosis can occur much sooner in adults with cerebral palsy. In addition, motor disorder(s) may be accompanied by "disturbances of sensation, cognition, communication, perception, and/or behavior, and/or by a seizure disorder".
There is no known cure for CP. Medical intervention is limited to the treatment and prevention of complications arising from CP's effects.
What is cerebral palsy?
The growth of a human brain is an incredible feat of nature. Even before a baby is born, many billions of neurones have to fit together as precisely as the pieces of a puzzle. With that kind of complexity, it's no wonder that there's sometimes a glitch in the assembly. If the part of the brain that controls muscles is damaged or undergoes deviations while the brain is growing, it can lead to a condition called cerebral palsy ("cerebral" refers to the brain and "palsy" to the state of the muscles).
Cerebral palsy can take many different forms: some children with the condition simply appear clumsy, while others are unable to walk. Many have trouble lifting their hands or holding a crayon, and some must struggle to talk or even breathe. Children with cerebral palsy are also at greater risk for seizures, mental retardation, and problems with hearing and vision. All can be helped through therapy and a loving, supportive environment.
How will I know if my child has cerebral palsy?
The wide range of symptoms can seem confusing, but there are a few reliable hallmarks to watch for. A baby over two months old may feel stiff or floppy, and may arch his back and stretch out his neck when you hold him in your arms. An older baby might use only one hand to reach for a toy, or use only one side of his body when crawling. Many babies with cerebral palsy are slow to reach milestones such as rolling over, sitting up, smiling, or jabbering. They may also have trouble swallowing and sucking.
Parents are often the first ones to notice unusual behaviour in their child. This can be troubling, so it's important to share concerns with your general practitioner right away to get a clearer sense of what might be going on. It's normal for infants to develop at different rates, of course. But if you sense that your child is noticeably behind the curve, or if there are other behaviours that worry you, seek advice. Regular check-ups also help screen for cerebral palsy and other problems.
Since there's no single test for cerebral palsy, your GP may make the diagnosis through careful observation. However, it is usual for the baby or child with suspected cerebral palsy to be referred to a paediatrician. You may be given reassuring news, but if it's confirmed that there is a problem, you will be offered helpful information and put in contact with support services.
What causes cerebral palsy?
For any particular child, it's often impossible to pinpoint the cause of the problem. Doctors do know, however, that anything that interferes with a growing brain can trigger the condition. The risk of cerebral palsy increases dramatically if a pregnant woman smokes, drinks heavily, has diabetes, or catches German measles (also known as rubella). Some children with cerebral palsy didn't get enough oxygen in the womb, perhaps because of a small kink in the umbilical cord. Premature babies, who tend to suffer complications before and after birth, are much more likely than full-term babies to develop cerebral palsy are; twins or triplets are also at greater risk for the condition. In some cases, cerebral palsy is caused by a head injury or a brain infection such as meningitis during the child's first two years of life.
As in the case of any serious disorder, parents often feel guilty about the diagnosis. A mother, in particular, may wonder if she should have done something different during her pregnancy. It's important that parents not blame themselves: most cases of cerebral palsy have no identifiable cause. The best thing for families to do is to concentrate on developing their child's potential to the fullest extent.
Can cerebral palsy be prevented?
The best way to prevent cerebral palsy is to protect your child's growing brain. If you are planning to get pregnant and have not been vaccinated against German measles, talk to your doctor about getting vaccinated. Fortunately, almost all women in Ireland have already been vaccinated against German measles. If you are already pregnant, try to stay as healthy as possible. Get regular prenatal medical care, eat a nutritious diet, avoid smoking and alcohol, and always talk to your doctor before taking over-the-counter or prescription medicines or herbal supplements. If you learn that you have maternal diabetes, which occurs during some pregnancies, get treated for it right away and be vigilant in caring for yourself.
Since serious head injuries in the first two years of life can result in cerebral palsy, supervise your child carefully, childproof your home to reduce the chance of a fall, and always use car safety seats and bicycle helmets.
If my child has cerebral palsy, what can be done to help? While cerebral palsy lasts a lifetime, much can be done to help children manage their disabilities, and the results are often excellent. In some cases, doctors use medicines and surgery to improve muscle co-ordination or use medication to control seizures. Although some people equate cerebral palsy with mental retardation, many children with the condition are highly intelligent -- and all can benefit from the therapies and services available to them.
Children with mild cerebral palsy may not need any extra help, but children more severely affected by the condition often benefit tremendously from a variety of therapies and services. These include physiotherapy, which improves muscle movement and co-ordination through exercises and routines; occupational therapy, which concentrates on daily tasks such as brushing teeth and dressing; and speech or language therapy.
These therapies may work wonders for your child. They generally focus on teaching independence, or helping your child learn to do as much as possible on his own without assistance. If he has mild cerebral palsy, physiotherapy may help him to build arm strength by repeatedly lifting toys or blocks. If the case is more severe, the therapy may teach him to use a wheelchair or to sit upright. Speech therapy can help with enunciation or teach your child how to use a computer for communication. Many children with cerebral palsy go on to live full, productive lives.
A range of services and counsellors is also available to help you deal with the emotional and psychological difficulties that commonly arise when your child has cerebral palsy. Certain therapists and social workers specialise in treating children with disabilities and their families. Later, when a child reaches school age, special education teachers or school counsellors are important resources.
You can also redesign your home environment to give your child extra support. Specially designed equipment, toys, and household items including spoons, cups and chairs are available for children with muscle control problems; many of these items can be tailor-made for your child. Children who have trouble grasping a pen or holding a book can learn to read and write with the help of computers.
Are there any new treatments in development?
Yes. Researchers are working on two experimental procedures that show some promise. In one, electrodes are used to stimulate certain nerves in the cerebellum, the part of the brain that controls movement coordination. Research thus far shows mixed results. In the other technique, parts of the thalamus, which relays messages to and from muscles, are surgically cut. This procedure appears to help control tremors.
In addition, there is much current research on ways to prevent or reduce the incidence of low birth weight and prematurity. Extensive research is also being done on how to prevent or minimise brain damage in developing babies and newborns.
If my child has cerebral palsy, where can I turn for support?
Several nonprofit organisations and government agencies assist people with cerebral palsy and their families. If your child has cerebral palsy, it's important to remember you're not alone. There is a large community of specialists and people familiar with cerebral palsy available for support.
More information is available in this wikipedia article.
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This article may contain, among other things, information or medical practices that are unique to Ireland. Neither the Clare Crusaders nor the original author make any warranty as to the accuracy of the article as revised, and assume no responsibility for modified content.