"Many of us take life for granted". As cliché as it may sound, that's the truth.

When I say
life, what I mean is those 'simple things' we do in our daily lives like breathing, walking, running,
taking a car licence,working, learning something new and the list never ends. For most of us, it
doesn't take much effort to perform these activities but for some it does. As a medical student, I
have seen many people struggling to stay alive. They struggle to breathe, they struggle to do
independent activities of daily living such as walking,bathing and many more. Most of them
would be on respiratory support to help them to breathe with less effort. Some patients are
required to use mobility aids like wheelchairs, crutches or walkers to help them to move around
because they have had amputation of legs due to an accident or medical condition such as
diabetes mellitus. Whenever I see a patient struggling, I always remind myself how lucky I am
to have a healthy body.

Few weeks ago, I was posted to a rehabilitation centre for paediatric posting and my
experience over there is the reason I am writing this. Most of the patients in the paediatric ward
were in the teenager age group. Most of the warded patients had cerebral palsy whereas some
had suffered traumatic brain injury. Let me give you a brief description of these two neurological
conditions so you get a rough idea of what they are going through.

Cerebral palsy (CP) is an umbrella term for permanent disorder of movement and/or and
posture and of motor function due to a non progressive lesion in the developing brain (less than
2 years old). Cerebral palsy can be classified according to the movement disorder ; spastic,
dyskinetic, ataxic and mixed. In spastic CP, there is persistently increased limb tone. The limb
involvement may be unilateral known as hemiplegia, bilateral known as quadriplegia where all 4
limbs are involved or diplegia in which all 4 limbs are affected but legs are affected much greater
than arms. In dyskinetic CP, there are uncontrolled involuntary movements. Affected children
often present with floppiness,poor trunk control and delayed motor development in infancy.
These signs are due to damage to basal ganglia as in kernicterus. In ataxic CP, mostly are
genetically determined and the children are presented with reduced tone of trunk and limbs,poor
balance, incoordinate movements, intention tremor and ataxic gait.

Aetiology can be divided into before birth (antenatal period), during delivery of the baby
(perinatal period) and after the birth (postnatal period). About 80% of cerebral palsy is antenatal
in origin. Only 10% of cases are thought to be due to HIE which will be explained further and
another 10% is postnatal in origin.

Antenatal factors that may cause cerebral palsy are prematurity, maternal illnesses such
as TORCH infections, thyroid disease, chorioamnionitis, genetic and metabolic disorders as well
as fetal brain malformation. Approximately 35% of births less than 26 weeks of gestation
develop cerebral palsy. Among the patients I met in the rehabilitation centre, prematurity is the
commonest risk factor. Other than that, some of them also had a history of complications during
delivery such as birth asphyxia. In birth asphyxia, gas exchange is compromised resulting in
cardiorespiratory depression which means cardiac output is compromised as well. This results
in reduced tissue perfusion causing injury to the brain and other organs. This injury to the brain
caused by birth asphyxia is known as hypoxic ischemic encephalopathy (HIE). Hence, any
conditions that compromise placental gas exchange such as placenta abruptio, ruptured uterus,
conditions that interrupt umbilical blood flow such as cord prolapse and shoulder dystocia or
inadequate maternal placental perfusion as in maternal hypotension or hypertension can lead to
birth asphyxia.

The postnatal factors that may contribute to cerebral palsy are severe hyperbilirubinemia
that leads to kernicterus (deposition of bilirubin in basal ganglia), early onset meningitis,
respiratory distress syndrome, neonatal sepsis intraventricular hemorrhage and head trauma
before the age of 3.

Basically, those with spastic CP have increased muscle tone, if it affects the lower limbs,
it makes controlling movements difficult hence making walking difficult. In those with dyskinetic
CP, the involuntary movements of limbs, make daily activities such as walking difficult.

One of the patients that I met in rehabilitation centre, whom I will address as, A in this
context to maintain confidentiality, had suffered traumatic brain injury due to a motor vehicle
accident when the teenager was 10 years old. As a consequence of the right side brain injury,
the person has suffered from left spastic hemiplegia and has been moving around with the aid of
wheelchair ever since. Throughout my posting there, this teenager never fails to smile whenever
A makes eye contact with someone and with a big wide smile that lightens up the whole room.
This teenager definitely has the sweetest smile that can make anyone forget the world for a
moment. In fact, all the patients there are way happier than anyone I have seen in my life.

Even though they are going through hardships to do daily activities as simple as walking
unlike most of us can walk independently, they are much happier than us. During their stay in
the rehabilitation centre, they go through therapies such as physiotherapy, occupational therapy
and many more to improve their quality of life. Despite the hardships, they accept themselves as
how they are and find happiness in every little thing possible. This posting definitely reminded
me to be grateful for having a chance to stay alive. So let's try not to take life for granted.