Cerebral Palsy

Introduction
Cerebral palsy is also known as Little's disease. It is a non progressive neurological disease of children affecting the locomotor system. There is damage in certain areas of the brain in a child with cerebral palsy. The child will have weakness and stiffness of muscles and there will difficulty in walking and using their limbs normally. In United States for every thousand newborn children, two are affected. Cerebral palsy is not a familial disease.

What are the causes of cerebral Palsy?
The causative factors could be classified into pre-natal (during pregnancy), natal (during delivery), and post-natal (after delivery).

• Prenatal causes- Genetic factors, premature birth of the baby, infection in the mother
• Natal- Cerebral anoxia due to difficult labour and birth trauma
• Post-natal causes- Infection like encephalitis causing cerebral damage in the child.

What are the types of cerebral palsy?

• Spastic type
• Athetoid type
• Ataxic type
• Rigid type
• Mixed type

The spastic type is the most common and it is due to the damage to the cerebral cortex (outer core of the brain). The athetoid type is due to the damage in the basal ganglia (structure deep inside the brain) and is characterized by involuntary movements of the hand and legs. The ataxic type is due to the cerebellar damage. The spastic type forms 70% of the cases of cerebral palsy. The cerebral palsy can involve one, two or all the four limbs.

What are the symptoms in the child?
The child is usually between the age of 2 and 4. The parents complaint that the child is not able to walk. There is also history of delayed developmental milestones (like delay in sitting, standing when compared with the normal child). There is decrease in movements of the limbs. Mild cases of cerebral palsy have slight stiffness of the limbs. There is crossing of the legs in severe cases. In severe cases, there will be mental retardation and speech will be lost. There is dribbling of saliva form the mouth and there is no control of urine (urinary incontinence).

What is the treatment for cerebral palsy?
The condition must be detected in the early childhood life by the child specialist and treatment should begin at that time. Detailed neurological examination and psychometric analysis is done. The team should involve orthopedic surgeon, neurosurgeon, psychiatrist, physiotherapist and occupational therapist. The child needs the guidance of psychologist, speech therapist and medical social worker. The involvement and co-operation of parents is more important. Physiotherapy is the mainstay of treatment in all cases of cerebral palsy. This helps in preventing deformity of the joints and to relax stiff muscles. The aim of the treatment is to achieve maximum functional ability and the skill that the child can acquire. Each child requires a programme that is appropriate to its intelligence and severity of disability.

• In mild cases with good I.Q. the deformities of the limbs can be corrected with physiotherapy and the child can be made fit for normal school education.
• In moderate cases, in children who are educable, the aim is to correct the deformity with physiotherapy and splints and make them walk independently. The child should be educated in special schools.
• In very severe cases, where the children are bed ridden, the goal is to train them for activities like feeding, attending to their personal toilet and dressing. The need care in special institutions.
• Surgical treatment in cerebral palsy is used to correct deformities and stabilization of joints. Surgery plays only a supportive role in the management of these children.

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