CEREBRAL PALSY

Cerebral palsy (CP) is defined as a non-progressive disorder that consists of motor and other neurological problems resulting from a defect or lesion of the developing brain.

Aetiological factors:

  1. Prenatal causes include
    • Rubella
    • Syphilis
    • Toxoplasmosis
    • Asphyxia.
  2. Perinatal causes include birth asphyxia as the main factor, being responsible for about 50% of the cases.
  3. Postnatal causes include
    • Bilirubin encephalopathy
    • Meningitis
    • Encephalitis
    • Intracranial haemorrhage
    • Hydrocephalus.

Clinical Features

  • Spastic paralysis is the commonest variety.
    • It involves one or more limbs and also the trunk.
    • Posture is that of hyperextension with tendency to contractures.
    • Deep tendon reflexes are increased.
  • The choreoathetoid type of cerebral palsy is less common and is characterized by;
    • Involuntary movements
    • Abnormal posture.
  • Cerebral palsy may also present as ataxia with;
    • Low muscle tone
    • Lack of balance.

Abnormalities associated with cerebral palsy

  • Deafness
  • Visual defects
  • Speech difficulties
  • Mental retardation
  • Convulsions
  • growth retardation.

If the problem dates from birth, neonatal reflexes may persist.

Malnutrition can result from neglect of the child or from difficulties associated with feeding the child.

Management

  • All children should, if possible, be seen once by a doctor with some experience of cerebral palsy children for correct diagnosis.
  • The nature of the motor dysfunction, its distribution and all related abnormalities should be noted and a
    decision made on what could be offered to the child.

Symptomatic Therapy

  • Physical therapy is the mainstay of management of these children.
  • Such therapy should be started as early as possible.
  • The main aim is;
    • Prevent contractures
    • Prevent abnormal patterns of movement
    • To train other movements
    • Build coordination.
  • Depending on the degree of disability, the child can be trained by an experienced therapist to attain some degree of independence.
  • Home training programme for the parents is the most important part.
  • Anal sphincter control may be assisted by administration of stool softeners and enemas where necessary.
  • Anticonvulsive drugs should be given if there are convulsions, and any accompanying problem should be dealt with appropriately.
  • A multidisciplinary approach is recommended for the management of children with cerebral palsy.

Support of Family

  • Parents are encouraged to bring their children early for care and not hide them from the public.
  • The diagnosis should be discussed with the parents in an open and honest manner, explaining that there is no cure for the condition but that physical therapy contributes significantly to the wellbeing of the affected child.