On the heels of a packed National Cerebral Palsy Awareness Week here (May 28 - June 3, 2012) we speak to Dr. Siromi Panditharatne, Consultant Paediatrician about the condition that is believed to be one of the most common congenital disorders to affect children.
What is Cerebral Palsy? What are the different forms it can take?
Cerebral Palsy (CP) is a condition where abnormal development or injury to the brain tissues results in problems with movement, posture and co-ordination.
There are different types of Cerebral Palsy:
Spastic CP – this is when certain muscles of the body are tight, stiff and weak resulting in poor control of movements.
Diplegic CP – here the lower limbs are affected resulting in stiffening of legs making walking difficult.
Athetoid CP – control of muscles is disrupted resulting in unwanted, spontaneous writhing movements. Control of posture is affected and even the muscles of speech and mastication can be affected resulting in poor speech and feeding.
Ataxic CP – problems include difficulty with balance.
Mixed CP – a combination of one or more of the above
What are the signs and symptoms of the condition?
Signs and symptoms of CP may appear soon after birth or may take a few months to be apparent.
The main problem is with movement, posture and co-ordination. Therefore these children would have a delay in their gross motor development. They may not turn, sit and walk at the expected age. They could also have abnormal tone resulting in stiffness or floppiness of the limbs and body. They also may have an abnormal gait.
As the muscles of the mouth may be affected they may have difficulty with feeding such as gagging, vomiting and slow feeding. Their speech can be affected with slow development of speech. They also may have seizures or epilepsy and impaired vision and hearing.
Some children may have learning difficulties but this is more due to difficulty in movement and speech rather than lack of intelligence.
How is Cerebral Palsy
diagnosed?
There is no diagnostic tool to confirm CP. It is generally diagnosed from the history and examination of the child.
What causes it? Have clear risk factors been identified?
There are many causes which have been identified.
Some of them are lack of oxygen to the baby’s brain during pregnancy or delivery, premature births, intra ventricular haemorrhage or bleeding into the baby’s brain, maternal infections during pregnancy eg. Rubella , Toxoplasmosis, genetic problems, malformations of the brain and infections of the brain in young children – meningitis or encephalitis
Since there is no cure, what can be done to help children with Cerebral Palsy?
Although there is no cure for these children, there are plenty of therapies which can be used to optimize the potential of these children. These will reduce the disabilities of these children and help them to do their daily activities independently. It also helps them to improve their communication skills.
Physiotherapy, Occupational therapy and Speech therapy all play an important role. Children with CP improve better if these therapies are started at an early age. Most children improve with Conductive education which helps them to overcome movement problems and gain some control through special education and rehabilitation.
Physiotherapy is the most important of all treatments. It helps with the posture and movement. It is very important to start physiotherapy as soon as you have identified these children as it’s the mainstay of treatment.
Speech and language therapy helps to overcome speech difficulties as well as helps with eating, drinking and swallowing. Occupational therapy helps children overcome difficulties associated with normal daily activities. This enables them to lead an independent life.
Surgery is sometimes needed to correct any deformities that may develop as a result of the abnormal muscle development. Medication may be helpful to control seizures in children with epilepsy. Other drugs can be used to reduce the stiffness of the muscles.
What can therapy accomplish in a child with Cerebral Palsy?
Many treatments are available to help a child function at the highest level possible. Since no two children are affected by Cerebral Palsy in exactly the same way, individual treatment programmes vary widely. But because all children with Cerebral Palsy have movement problems, you can expect that an important component of your child’s treatment will be a therapeutic exercise programme. Depending on your child’s needs, a physiotherapist, an occupational therapist, and a speech-therapist will work with your child to help him or her improve posture and movement.
Physiotherapists use specific sets of exercises to work toward the prevention of musculoskeletal complications like preventing the weakening of muscles that can result from lack of use, help avoid contractures, in which muscles become fixed in a rigid, abnormal position, as well as helping your child perform common everyday activities.
The Bobath approach to the management of children with Cerebral Palsy was pioneered and developed by Dr. Karel and Mrs Berta Bobath in the 1940s. The main aim of treatment is to encourage and increase the child’s ability to move and function in as normal a way as possible.
An occupational therapist specializes in improving the development of the small muscles of the body, such as the hands, feet, face, fingers and toes. These therapists also teach daily living skills such as dressing and eating, as well as making sure children are properly positioned in wheelchairs. They may teach your child better or easier ways to write, draw, cut with scissors, brush their teeth, dress, and feed themselves. Occupational therapists will also help your child find the right special equipment to make every day activities a little easier.
A speech and language therapist helps develop better control of the jaw and mouth muscles, which can improve speech and language skills and eating, drinking, and swallowing abilities of children with Cerebral Palsy. They also help develop creative communication methods for those who cannot speak.
In addition, Sensory Integration Therapy (SIT) is used to help overcome problems experienced by many young children in absorbing and processing sensory information. Encouraging these abilities ultimately improves balance and steady movement.
Conductive education, a combined educational and therapeutic task-oriented approach for children with Cerebral Palsy, focuses on their hand motor functions and activities of daily living (ADLs). Conductive Education is a unique form of special education and rehabilitation, which is beneficial for children and adults with Cerebral Palsy. Conductive Education is a learning process and not a treatment or therapy.
What are the most common misconceptions about the
condition?
It is often thought that children with CP have no future. These children have no intelligence and that they are a burden to society. But contrary to that idea most of these children have a normal or near normal intelligence. With the correct treatment options most are able to live a normal, independent life.
Where can families in Sri Lanka go to find support and information about cerebral palsy?
There are a number of facilities available for these children. Most government hospitals have Physiotherapy Departments with qualified physiotherapists who are able to help them. The bigger hospitals have speech and occupational therapists as well.
Showing the way
Cerebral Palsy Lanka Foundation (CPLF), a non-profit organization is the first body in Sri Lanka set up to provide educational and therapeutic services for children with cerebral palsy and associated movement disorders. At present they have two centres at Wattala and Moratuwa to provide services to children from South and North Colombo. The Cerebral Palsy Helpline is 0717777355.
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