Let's Prevent, Diagnose Early & Help Manage the Cases of Cerebral Palsy...
Let's Prevent, Diagnose Early & Help Manage the Cases of Cerebral Palsy...
Commemorating the World Cerebral Palsy Day 2022...
1 in 4 children with cerebral palsy cannot talk
1 in 4 cannot walk
1 in 2 have an intellectual disability
1 in 4 have epilepsy.
Cerebral Palsy (CP) is an unwelcome global phenomenon.
World Cerebral Palsy Day, which occurs annually on October 6, reminds us that there over 1.7 Crore people impacted by this disorder.
More than 10 Lakh Cases are reported in India alone…
CP is one of the most common physical disabilities affecting the most vulnerable among us — children.
Unfortunately, CP occurs over the span of a child’s entire lifetime with no cure.
Cerebral palsy
is a congenital disorder of movement, muscle tone or posture.
is due to abnormal brain development, often before birth.
Symptoms include (which appear by early childhood)
exaggerated reflexes,
floppy or rigid limbs and
involuntary motions.
Long-term treatment includes
physical and other therapies,
drugs and
sometimes surgery.
People may experience
Muscular Symptoms
difficulty walking,
difficulty with bodily movements,
muscle rigidity,
permanent shortening of muscle,
problems with coordination,
stiff muscles,
overactive reflexes,
involuntary movements,
muscle weakness,
muscle spasms, or
paralysis of one side of the body
Developmental Issues
failure to thrive,
learning disability,
slow growth, or
speech delay in a child
Speech Issues
speech disorder or stuttering
Other Common Issues
constipation,
difficulty raising the foot,
difficulty swallowing,
drooling,
hearing loss,
leaking of urine,
paralysis,
physical deformity,
scissor gait,
seizures,
spastic gait,
teeth grinding, or
tremor
Diagnosis
The diagnosis of cerebral palsy has historically rested on the person's history and physical examination and is generally assessed at a young age.
A general movements assessment, which involves measuring movements that occur spontaneously among those less than four months of age, appears most accurate.
Children who are more severely affected are more likely to be noticed and diagnosed earlier. Abnormal muscle tone, delayed motor development and persistence of primitive reflexes are the main early symptoms of CP.
Symptoms and diagnosis typically occur by the age of two, although depending on factors like malformations and congenital issues, persons with milder forms of cerebral palsy may be over the age of five, if not in adulthood, when finally diagnosed.
Cognitive assessments and medical observations are also useful to help confirm a diagnosis. Additionally, evaluations of the child's mobility, speech and language, hearing, vision, gait, feeding and digestion are also useful to determine the extent of the disorder.
Early diagnosis and intervention are seen as being a key part of managing cerebral palsy.
Machine learning algorithms facilitate automatic early diagnosis, with methods such as deep neural network and geometric feature fusion producing high accuracy in predicting cerebral palsy from short videos. It is a developmental disability.
Once a person is diagnosed with cerebral palsy, further diagnostic tests are optional. Neuroimaging with CT or MRI is warranted when the cause of a person's cerebral palsy has not been established. An MRI is preferred over CT, due to diagnostic yield and safety. When abnormal, the neuroimaging study can suggest the timing of the initial damage. The CT or MRI is also capable of revealing treatable conditions, such as hydrocephalus, porencephaly, arteriovenous malformation, subdural hematomas and hygromas, and a vermian tumour (which a few studies suggest are present 5–22% of the time). Furthermore, an abnormal neuroimaging study indicates a high likelihood of associated conditions, such as epilepsy and intellectual disability. There is a small risk associated with sedating children to facilitate a clear MRI.
The age when CP is diagnosed is important, but medical professionals disagree over the best age to make the diagnosis. The earlier CP is diagnosed correctly, the better the opportunities are to provide the child with physical and educational help, but there might be a greater chance of confusing CP with another problem, especially if the child is 18 months of age or younger.
Infants may have temporary problems with muscle tone or control that can be confused with CP, which is permanent.
A metabolism disorder or tumors in the nervous system may appear to be CP; metabolic disorders, in particular, can produce brain problems that look like CP on an MRI.
Disorders that deteriorate the white matter in the brain and problems that cause spasms and weakness in the legs, may be mistaken for CP if they first appear early in life. However, these disorders get worse over time, and CP does not (although it may change in character).
In infancy it may not be possible to tell the difference between them.
In the UK, not being able to sit independently by the age of 8 months is regarded as a clinical sign for further monitoring.
Fragile X syndrome (a cause of autism and intellectual disability) and general intellectual disability must also be ruled out.
Cerebral palsy specialist John McLaughlin recommends waiting until the child is 36 months of age before making a diagnosis because, by that age, motor capacity is easier to assess.
Treatment (depends on severity) can help, but this condition can't be cured
Requires a Medical Diagnosis
Lab Tests or Imaging rarely required
Chronic: can last for years or be lifelong
Self-Care
Physical Exercise :: Aerobic activity for 20–30 minutes 5 days a week improves cardiovascular health.
Special Education :: An approach to education that focuses on addressing the unique needs of individual students.
Therapies
Occupational Therapy :: Improves daily living and work skills of patients.
Stretching :: Stretching exercises can improve flexibility and improve physical function.
Physical Therapy :: Restores muscle strength and function through exercise.
Medication
Muscle Relaxant :: Reduces muscle tension and helps relieve muscle pain and discomfort.
Sedative :: Causes drowsiness, calmness and dulled senses. Some types may become addictive.
Surgery
Gastrostomy :: Surgical insertion of a tube through the abdomen and into the stomach. Used for feeding or drainage.
Causes
Cerebral palsy is caused by abnormal brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. In many cases, the cause isn't known. Many factors can lead to problems with brain development.
Some include:
Gene mutations that result in genetic disorders or differences in brain development
Maternal infections that affect the developing fetus
Fetal stroke, a disruption of blood supply to the developing brain
Bleeding into the brain in the womb or as a newborn
Infant infections that cause inflammation in or around the brain
Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical abuse
Lack of oxygen to the brain related to difficult labor or delivery, although birth-related asphyxia is much less commonly a cause than historically thought
Risk factors
A number of factors are associated with an increased risk of cerebral palsy.
Maternal health
Certain infections or toxic exposures during pregnancy
can significantly increase cerebral palsy risk to the baby. Inflammation triggered by infection or fever can damage the unborn baby's developing brain.
Cytomegalovirus. This common virus causes flu-like symptoms and can lead to birth defects if a mother has her first active infection during pregnancy.
German measles (rubella). This viral infection can be prevented with a vaccine.
Herpes. This infection can be passed from mother to child during pregnancy, affecting the womb and placenta.
Syphilis. This is a sexually transmitted bacterial infection.
Toxoplasmosis. This infection is caused by a parasite found in contaminated food, soil and the feces of infected cats.
Zika virus infection. This infection is spread through mosquito bites and can affect fetal brain development.
Intrauterine infections. This includes infections of the placenta or fetal membranes.
Exposure to toxins. One example is exposure to methyl mercury.
Other conditions. Other conditions affecting the mother that can slightly increase the risk of cerebral palsy include thyroid problems, preeclampsia or seizures.
Infant illness
Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:
Bacterial meningitis. This bacterial infection causes inflammation in the membranes surrounding the brain and spinal cord.
Viral encephalitis. This viral infection similarly causes inflammation in the membranes surrounding the brain and spinal cord.
Severe or untreated jaundice. Jaundice appears as a yellowing of the skin. The condition occurs when certain byproducts of "used" blood cells aren't filtered from the bloodstream.
Bleeding into the brain. This condition is commonly caused by the baby having a stroke in the womb or in early infancy.
Factors of Pregnancy & Birth
While the potential contribution from each is limited, additional pregnancy or birth factors associated with increased cerebral palsy risk include:
Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. The risk also can be related to the likelihood of premature birth and low birth weight. If one or more of the babies die, the survivors' risk of cerebral palsy increases.
Premature birth. Babies born prematurely are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
Delivery complications. Problems during labor and delivery may increase the risk of cerebral palsy.
Complications
Muscle weakness, muscle spasticity and coordination problems can contribute to a number of complications either during childhood or in adulthood, including:
Contracture. Contracture is muscle tissue shortening due to severe muscle tightening that can be the result of spasticity. Contracture can inhibit bone growth, cause bones to bend, and result in joint deformities, dislocation or partial dislocation. These can include hip dislocation, curvature of the spine (scoliosis) and other orthopedic deformities.
Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral palsy, particularly an infant, to get enough nutrition. This can impair growth and weaken bones. Some children or adults need a feeding tube to get enough nutrition.
Mental health conditions. People with cerebral palsy might have mental health conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression. Behavioral problems can also occur.
Heart and lung disease. People with cerebral palsy may develop heart disease, lung disease and breathing disorders. Problems with swallowing can result in respiratory problems, such as aspiration pneumonia.
Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity may lead to the early onset of this painful degenerative bone disease.
Osteoporosis. Fractures due to low bone density can result from several factors such as lack of mobility, inadequate nutrition and anti-epileptic drug use.
Other complications. These can include sleep disorders, chronic pain, skin breakdown, intestinal problems and issues with oral health.
Prevention
Most cases of cerebral palsy can't be prevented, but you can reduce risks.
If you're pregnant or planning to become pregnant, you can take these steps to keep healthy and minimize pregnancy complications:
Make sure you're vaccinated. Getting vaccinated against diseases such as rubella, preferably before getting pregnant, might prevent an infection that could cause fetal brain damage.
Take care of yourself. The healthier you are heading into a pregnancy, the less likely you'll be to develop an infection that results in cerebral palsy.
Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight and infections.
Avoid alcohol, tobacco and illegal drugs. These have been linked to cerebral palsy risk.
Rarely, cerebral palsy can be caused by brain damage that occurs in childhood. Practice good general safety. Prevent head injuries by providing your child with a car seat, bicycle helmet, safety rails on the bed and appropriate supervision.
For a more personalised preventing & management counselling and getting connected to credible consultants, you may seek an appointment with
Dr. Surbhi Vaish Mittal
by pinging her on Whatsapp 8700603112
Dr. Surbhi Vaish Mittal
by pinging her on Whatsapp 8700603112