Cerebral Palsy: an Overview of This Neurological Development Disorder

Cerebral Palsy (CP) is a broad term that refers to a brain injury before the child’s brain is fully developed, resulting in a motor disorder affecting the person’s ability to move. Cerebral Palsy is the most common neurological developmental disorder that causes a physical disability. CP is a non-progressive disability that cannot be reversed, but it can be managed through different types of therapies. Cerebral Palsy happens either before, during or after childbirth and before the age of three. Some symptoms of CP include difficulty with coordination, balance, posture, ability to move, communicate, resulting in effecting a person’s lifestyle . There is a universal system used to determine an individual's functioning level, called the Gross Motor Function Classification System, or CMFCS. The earlier that a child begins therapy the more effective the outcomes will be. There are several different types of therapies that can help an individual with CP reach their goals.

The two words forming Cerebral Palsy can be broken down into “cerebral” referring to the cerebrum, the part of the brain that if affected, and “palsy” recognized as muscle (Volcker). Since CP affects the motor portion of the brain, it can cause a person to have poor coordination, balance and abnormal movement patterns . A person can either have one area affected or they could have all three, it varies from person to person. CP is a static disorder meaning it is permanent and cannot get worse over time. Cerebral Palsy can create problems other than motor disorders, similarly to those seen in people who have a brain-related injury. People may experience medical complications such as epilepsy, learning disabilities, Attention Deficit Hyperactivity Disorder, speech impediments, and a variety of other disabilities . The largest percentage of children are diagnosed with congenital Cerebral Palsy, which means that they were born with CP. There is a very small percentage of children who are diagnosed with Cerebral Palsy resulting from head trauma, car accidents, falling, or abuse. Babies who are shaken and experience Shaken Baby Syndrome are at risk of CP. Shaken Baby Syndrome is when the baby is shaken so forcefully that their brain repeatedly hits their skull, causing increased pressure. Children need to be diagnosed before the age of 5 years in order to get the label of CP. After the age of 5 a child would be diagnosed with a traumatic brain injury or a stroke. Most babies are not diagnosed immediately after birth unless their symptoms are severe and well-defined, since medical professionals like to be 100% sure about getting it correct. Having a diagnosis can be a relief for families so they can identify and seek help. Once a child does receive a diagnosis their treatment and therapies will not change .

Medical professionals do not know how to totally prevent Cerebral Palsy, but they do know a few causes. Rubella is one known cause for CP, which can be prevented with the vaccination of the mother. Another known cause of Cerebral Palsy is toxoplasmosis, when the mother is exposed to cat feces and uncooked meat. Cytomegalovirus is the last known cause which there is no known immunization to prevent it. Additionally, another known cause to Cerebral Palsy is very sever meningitis. To prevent a child from CP or a brain injury the caretaker of the child must be careful to avoid asphyxia, poisoning to the child, chocking on food or foreign objects and near drowning.

There are different subtypes of Cerebral Palsy, that can be classified further as a unilateral or bilateral diagnosis. Spastic CP is the most common kind, 85%-91% of people diagnosed have this type of Cerebral Palsy. Spastic CP causes a person’s movements to be jerky and stiff. People use certain muscle groups to do certain tasks, when one group of muscles are turned on to do that job the other groups that are not needed turn off. In people with spastic Cerebral Palsy the wrong muscle groups could be turned on to do a task when they are not needed therefore making their movement look unnatural and jumpy. If the wrong group of muscles is turned on for a task the movement the person is looking to do might be impossible. Within a Spastic Cerebral Palsy diagnosis there are other sub groups, the first being Spastic Diplegia. Spastic Diplegia CP is when a person’s legs are more affected than the person’s arms, which is mostly associated with prematurity. Spastic Quadriplegia is when a person’s four limbs, trunk and muscles that move their mouth, tongue, and pharynx are affected. Spastic Quadriplegia can result in other more serious disabilities as well, such as intellectual disabilities, seizures, sensory impairments and medical problems. Spastic hemiplegia is when one side of someone’s body is more effected than the other side. Another subcategory is Dyskinetic CP, only 4-7% of people diagnosed have this type of Cerebral Palsy. Dyskinetic CP is where the person’s movements are rapid, random, and jerky, and they might also have abnormalities in their muscle tone throughout their whole body. The next subcategory is ataxic Cerebral Palsy, in which the person struggles to keep their balance. People with Ataxia appear very wobbly and unstable, because their equilibrium and depth perception have been affected. Only 4-6% of people with Cerebral Palsy have ataxic. Children can also be diagnosed with having a mix of different subcategories as well.

A child who is diagnosed with Cerebral Palsy does not go through a medical testing to confirm their diagnosis, rather there are several factors that medical professionals have to consider when making the diagnosis. A child can get a magnetic resonance imaging (MRI) to see what part of their brain is damaged. This will help aid medical professionals conclude what disability that they have. For a child to be diagnosed with CP they would not meet developmental milestones, have developed reflexes and noteworthy abnormalities in their motor functions. A medical profession will observe the child while they are in a comfortable environment to watch their motor skills as well. All of these factors contribute to a child being diagnosed with Cerebral Palsy.

Since Cerebral Palsy has no cure it is important for parents and children to find different ways to manage their symptoms so they can live their lives to the fullest. A common drug prescribed to help a lot of people with spasms is Baclofen. Managing a child’s symptoms should not be viewed as a temporary measure since Cerebral Palsy is a life-long disability. A child with CP should be involved as much as they can be at school, in the community, and at home. Management of Cerebral Palsy should be individualized and tackle all of the person’s disabilities not just CP. A medical professional should participate with the management of Cerebral Palsy as well as the child’s therapists, parents and the child. Family-centered services allow both the parent and the child’s concerns to be met and addressed. Family-centered services are especially beneficial when the child is facing a transition in their life. The child’s management goals should be aimed at improving their overall health, be able to ease any pain they are feeling, and accelerate their participation.

There are many different types of therapies that can help a child with Cerebral Palsy. The goal of therapy is to maximize the child’s independence, prevent acquired problems, decrease their disability, improve their function and participation. The parents of a child with CP should be enforcing all of their therapy goals at home, increasing the positive outcomes of the different types of therapy that the child is receiving. The earlier the child is able to start therapy the more beneficial and effective it will be in the long run for them. There are no specific therapies that can help a child control their spasticity.

There are several different settings with advantages and disadvantages in which a child with Cerebral Palsy can receive therapy. A child can have home-based services where the therapist will come into their home. This is the ideal setting for early interventions services, the therapist will set goals for the child that are appropriate for their environment. At home-services are more convenient for a parent with a young child and it is more comfortable for the child. At home therapy sessions can also be useful for a child who has just undergone surgery, cannot easily be transported in a car, or a child who is physically hard to move. The downside to therapy in the child’s home is that there is limited equipment and space. The therapist also spends the majority of their time traveling, which causes the sessions to be more expensive.

Therapy can also take place in a clinical and outpatient setting. These are the most ideal settings for therapy since it is an established therapy location. There is equipment that is readily available for the children to use as they grow. The child goes to a clinical setting with the purpose to work. An outpatient therapy session is the most cost effective but they have limited hours for working parents. School-based therapy is when the child is pulled out of the classroom to receive therapy sessions. The goals of school-based therapy is to further the child’s education and the therapist might work on skills the child would use in the classroom. Services in the school are available after the child is 3 years old. They are low intensity and happen only once a week for about 30 minutes. A child cannot be pulled out of an academic class to receive school-based therapy but they might be pulled out of an elective. A person who has received therapy for their whole life might not want to continue once they are an adult if they have not seen a significant difference in their abilities, or if they feel they can accomplish the same skills on their own.

One type of therapy that a child with Cerebral Palsy might receive is speech and language therapy. The speech and language pathologist would set goals related to eating, drinking and speaking for the child based on their needs. Some people assume that because a child can talk, that they can independently eat but this is not always the case. A lot of children with CP get frustrated since they have the cognitive ability to be able to feed themselves but their muscles do not listen to what their brain tells them to do. A speech and language pathologist would determine if a child who could not speak would benefit from augmentative or alternative communication systems .

There are many different approaches to physical therapy, one is called the Neurodevelopmental Treatment Approach; Bobath Technique. This approach was created by Dr. and Mrs. Bobath in the 1940’s, which focused on three key concepts in their physical therapy to help children with Cerebral Palsy. One is to fix abnormal muscle tone through range of motion exercises, encouraging normal motor patterns of those muscles. The second concept is to reduce abnormal primitive reflexes. The last concept is to work on the child’s automatic reactions, like putting their hand out if they feel like they are falling. Dr. and Mrs. Bobath believed that if this type of therapy was done enough that the child’s muscles would remember what the “normal” movement felt like.

Another type of therapy that might help a child with CP gain motor skills is aquatic therapy, which is done in a pool. For some children, the water is soothing and can help with their muscle spasms. There are several benefits to aquatic therapy; it provides resistance, takes away the stress and stiffness in the muscles and joints, and can reduce a child’s pain level while they are in the water. Aquatic therapy can improve a child’s muscle tone, increase their strength, maximize their range of motion, boost endurance and their flexibility.

Hippotherapy can be helpful for some children with Cerebral Palsy. This is therapy that uses horses. “The movement of the horse can help develop and enhance the child’s physical and neurological functioning”. A child who goes to hippotherapy benefits physically, cognitively, and physiologically. Physically, a child gains core strength, respiratory control and improves the child’s overall gross motor skills. Cognitively, the child will have increased attention, visual coordination and be able to express their thoughts and needs. Psychologically, the child will enjoy interaction with the horse and gain self esteem. It is very important to make sure that the child is comfortable getting onto the horse to ensure that the session will go smoothly.

Occupational therapy is another type of therapy that a child could benefit from. This type of therapy is to help the child increase their ability to accomplish daily routines and activities. The therapist will help the child adapt to their environment so they can achieve being more independent. A child might work on skills including eating, getting dressed, picking up objects, cooking, and whatever the child would most benefit from. Occupational therapy teaches the child how to develop and maintain independence.

The motor skills of children who have been diagnosed with Cerebral Palsy can be characterized into five levels using a tool called the Gross Motor Function Classification System, GMFCS (Volcker). A higher rating in the GMFCS scale signifies that the child has less motor functioning. The scores are a combination of the age of the child and a set of activities that they can accomplish on their own. The Gross Motor Function Classification System can be used for every kind of Cerebral Palsy and can help with determining the child’s treatment and therapy. The first level of GMFCS indicates the child is able to walk without any help from a railing, they are able to run and jump and have good balance and coordination. The second level is when the child walks in most settings with some assistance from railings. The child might have difficulties walking long distances and not be able to balance on uneven ground. Level three of the GMFCS is when the child would need adaptive equipment to aid their mobility. The child would be able to sit on their own with very little support, and be able to manually move a wheelchair when going short distances. The fourth level in the Gross Motor Function Classification System is when the child uses a powered wheelchair, since self mobility is difficult. The child would need support when they are sitting but could stand for transfers. The most severe level in the GMFCS is Level five, this is when the child experiences very limited head and trunk control. The child would rely on assistive technology and other’s help to complete tasks. The child would be in a wheelchair and could learn alternative ways to operate it, such as moving their eyes or head in specific directions.

Cerebral Palsy is the most common neurological developmental disorder that causes physical disabilities. It can range in severity and specific types that a child might be diagnosed with. A child’s CP can be managed through different types of therapies . The functioning level of a child can be determined through the universal system called the Gross Motor Function Classification System. This system can help medical professionals and therapist determine what types of therapies the child would most benefit from. No two children are the same even if they have been diagnosed with the same type of Cerebral Palsy, they may react differently to the same therapies, and each child should have an individualized program. Children with Cerebral Palsy may attend several different types of therapies to maximize their independence and skills.