Cerebral palsy (CP) is an abnormality of motor function (as opposed to mental function) and postural tone that is acquired at an early age

, even before birth. Signs and symptoms of cerebral palsy usually show in the first year of life. This abnormality in the motor system is the result of brain lesions that are nonprogressive. The motor system of the body provides the ability to move and control movements. A brain lesion is any abnormality of brain structure or function. "Non-progressive" means that the lesion does not produce ongoing degeneration of the brain. It is also implies that the brain lesion is the result of a one-time brain injury, that will not occur again. Whatever

Cerebral palsy affects approximately one to three out of every thousand children born. However, it is much higher in infants born with very low weight and in premature infants. Interestingly, new treatment methods that resulted in an increased survival rate of low-birth weight and premature infants actually resulted in an overall increase number of children with cerebral palsy. The new technologies, however, did not change the rate of cerebral palsy in children born full term and with normal weight.

Many cases of CP have unknown causes. The disorder occurs when there is abnormal development or damage to areas in the brain that control motor function. It occurs in approximately two to three out of every 1,000 live births. Risk factors for CP include the following: prematurity very low birthweight (especially in babies weighing less than 1,000 grams, or 2.2 lbs.) viruses chemical/substance abuse during pregnancy infection bleeding in the brain trauma

The following are the most common symptoms of CP. However, each child may experience symptoms differently. The child may have muscle weakness, poor motor control, or have shaking, also called spasticity, of the arms or legs. Muscle stiffness in the form of stiff legs or clenched fists may also be seen. Cerebral palsy is classified according to the kind of motor function the child may have, including the following:

spastic diplegia ("di" - means two) - spastic movements of the arms or legs. Diplegia is also called paraplegia. spastic quadriplegia ("quad" means four) spastic movements in all four limbs (arms and legs). spastic hemiplegia ("hemi" means half) spasticity affecting one half, or side, of the body (such as right arm and right leg). spastic double hemiplegia - spasticity in both sides of the body, but the amount of shaking is different when comparing the right side to the left side.

Children with CP may have additional problems, including the following: seizures vision, hearing, or speech problems learning disabilities and behavior problems mental retardation respiratory problems bowel and bladder problems bone abnormalities, including scoliosis (a lateral, or sideways, curvature and rotation of the back bones, giving the appearance that the person is leaning to one side)

Babies with CP are often slow to reach developmental milestones, such as learning to roll over, sit, crawl, or walk. They may also have certain reflexes present that normally disappear in early infancy. The symptoms of CP may resemble other conditions. Always consult your child's physician for a diagnosis.

The diagnosis of CP is made with a physical examination. During the examination, the physician obtains a complete prenatal and birth history of the child. The diagnosis of CP is not usually made until the child is at least 6 to12 months old. This is the time when the child should be achieving developmental milestones, such as walking, and hand and head control. Diagnostic tests may include the neurological examination (to evaluate following: reflexes and brain/motor function) x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp. blood tests gait lab analysis (to evaluate the walking pattern of the child) magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and

computed tomography scan (Also called CAT or CT scan.) - a diagnostic imaging procedure that uses a combination of xrays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. genetic studies - diagnostic tests that evaluate for conditions that have a tendency to run in families. metabolic tests - diagnostic tests that evaluate the absence or lack of a specific

Specific treatment for cerebral palsy will be determined by your child's physician based on: your child's age, overall health, and medical history the extent of the disease the type of CP your child's tolerance for specific medications, procedures, or therapies expectations for the course of the disease

Since CP is a life-long condition that is not correctable, management includes focusing on preventing or minimizing deformities and maximizing the child's capability at home and in the community. A child is best treated with an interdisciplinary team that may include the following pediatrician/family practitioner healthcare providers: orthopaedic surgeon - a surgeon who specializes in conditions of the muscles, ligaments, tendons, and bones. neurologist - a physician who specializes in conditions of the brain, spinal cord, and nerves. neurosurgeon - a surgeon who specializes

ophthalmologist a physician specializes in eye problems. Dentist Nurse

who

orthotist - an individual who specializes in making braces and splints. rehabilitation team (i.e., physical, occupational, speech therapy, audiology)

Management of CP includes non-surgical and surgical options. Non-surgical interventions may include: Rehabilitation positioning aids (used to help the child sit, lie, or stand) braces and splints (used to prevent deformity and to provide support or protection) medications (used to help control seizures or to decrease spasticity in the muscles; the medications may be

Surgical interventions may be used to manage the following conditions: orthopaedic problems that may include managing curvatures in the back, hip dislocations, ankle and foot deformities, and contracted muscles spasticity

A child with cerebral palsy may be hospitalized for orthopedic surgery to correct contractures and for treatment of other complications. Assign the child a room with children in the same age-group. Speak slowly and distinctly. Encourage the child to ask for things he wants. Listen patiently and don’t rush him. During meals, maintain a quiet, unhurried atmosphere with as few distractions as possible. The child may need special utensils and a chair with a solidfootrest. Teach him to place food far back in his mouth to facilitate swallowing.

Encourage the child to chew food thoroughly, drink through a straw, and suck on a lollipop between meals to develop the muscle control needed to minimize drooling. Allow the child to wash and dress independently, assisting only as needed. Give all care in an unhurried manner; otherwise, muscle spasticity may increase. Encourage the child and his family to participate in the care plan so they can continue it at home. Minimize muscle spasms that increases postoperative pain by moving and turning

After orthopedic surgery, give good cast care. Wash and dry the skin at the edge of the cast frequently, and rub it with alcohol. Reposition the child often, check for foul odor, and ventilate under the cast with a blow dryer. Use a flashlight to check for skin breakdown beneath the cast. Help the child relax, perhaps by giving a warm bath, before reapplying a bivalved cast. Help parents deal with their child’s handicap. A good understanding of normal growth and development will enable you to work with parents to set realistic goals. Assist in planning crafts and other activities.

Stress the child’s need to develop peer relationships; warn against being overprotective. Identify and deal with family stress. Parents may feel unreasonable guilt about their child’s handicap and may need psychologic counseling. Make a referral to supportive community organizations.

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