for Children with Cerebral Palsy
Cerebral palsy (CP) is an umbrella term encompassing a group of
non-progressive, non-contagious motor conditions that cause physical disability
in human development, chiefly in the various areas of body movement.
Cerebral refers to the cerebrum, which is the affected area of the brain
(although the disorder most likely involves connections between the cortex and
other parts of the brain such as the cerebellum), and palsy refers to disorder
of movement. Furthermore, "paralytic disorders" are not cerebral palsy – the
condition of quadriplegia, therefore, should not be confused with spastic
quadriplegia, nor Tardive dyskinesia with dyskinetic cerebral palsy, nor
diplegia with spastic diplegia, and so on.
Cerebral palsy's nature as an umbrella term means it is defined mostly via
several different subtypes, especially the type featuring spasticity, and also
mixtures of those subtypes.
Cerebral palsy is caused by damage to the motor control centers of the
developing brain and can occur during pregnancy, during childbirth or after
birth up to about age three. Resulting limits in movement and posture cause
activity limitation and are often accompanied by disturbances of sensation,
depth perception and other sight-based perceptual problems, communication
ability; impairments can also be found in cognition, and epilepsy is found in
about one-third of cases. CP, no matter what the type, is often accompanied by
secondary musculoskeletal problems that arise as a result of the underlying
Improvements in neonatology, (specialized medical treatment of newborn babies),
have helped reduce the number of babies who develop cerebral palsy, and
increased the survival of babies with very low birth weights; babies more likely
to have cerebral palsy. 2007 6 country survey found an incidence of CP of
2.12–2.45 per 1,000 live births, indicating a slight rise in recent years.
Of the many types and subtypes of CP, none has a known cure. Usually, medical
intervention is limited to the treatment and prevention of complications arising
from CP's effects.
Cerebral palsy (CP) is divided into four major classifications to describe
different movement impairments. These classifications also reflect the areas of
the brain that are damaged. The four major classifications are: spastic, ataxic,
athethoid/dyskinetic and mixed.
All types of cerebral palsy are characterized by abnormal muscle tone (i.e.
slouching over while sitting), reflexes, or motor development and coordination.
There can be joint and bone deformities and contractures (permanently fixed,
tight muscles and joints). The classical symptoms are spasticities, spasms,
other involuntary movements (e.g. facial gestures), unsteady gait, problems with
balance, and/or soft tissue findings consisting largely of decreased muscle
mass. Scissor walking (where the knees come in and cross) and toe walking (which
can contribute to a gait reminiscent of a marionette) are common among people
with CP who are able to walk, but taken on the whole, CP symptomatology is very
diverse. The effects of cerebral palsy fall on a continuum of motor dysfunction
which may range from slight clumsiness at the mild end of the spectrum to
impairments so severe that they render coordinated movement virtually impossible
at the other end the spectrum.
Babies born with severe CP often have an irregular posture; their bodies may be
either very floppy or very stiff. Birth defects, such as spinal curvature, a
small jawbone, or a small head sometimes occur along with CP. Symptoms may
appear or change as a child gets older. Some babies born with CP do not show
obvious signs right away. Classically, CP becomes evident when the baby reaches
the developmental stage at six and a half to 9 months and is starting to
mobilise, where preferential use of limbs, asymmetry or gross motor
developmental delay is seen.
Secondary conditions can include seizures, epilepsy, apraxia, dysarthria or
other communication disorders, eating problems, sensory impairments, mental
retardation, learning disabilities, urinary incontinence, fecal incontinence
and/or behavioral disorders.
Speech and language disorders are common in people with cerebral palsy. The
incidence of dysarthria is estimated to range from 31% to 88%. Speech problems
are associated with poor respiratory control, laryngeal and velopharyngeal
dysfunction as well as oral articulation disorders that are due to restricted
movement in the oral-facial muscles. There are three major types of dysarthria
in cerebral palsy: spastic, dyskinetic (athetosis) and ataxic. Speech
impairments in spastic dysarthria involves four major abnormalities of voluntary
movement: spasticity, weakness, limited range of motion and slowness of
movement. Speech mechanism impairment in athetosis involves a disorder in the
regulation of breathing patterns, laryngeal dysfunction (monopitch, low, weak
and breathy voice quality). It is also associated with articulatory dysfunction
(large range of jaw movements), inappropriate positioning of the tongue,
instability of velar elevation. Athetoid dysarthria is caused by disruption of
the internal sensorimotor feedback system for appropriate motor commands, which
leads to the generation of faulty movements that are perceived by others as
involuntary. Ataxic dysarthria is uncommon in cerebral palsy. The speech
characteristics are: imprecise consonants, irregular articulatory breakdown,
distorted vowels, excess and equal stress, prolonged phonemes, slow rate,
monopitch, monoloudness and harsh voice. Overall language delay is associated
with problems of mental retardation, hearing impairment and learned
helplessness. Children with cerebral palsy are at risk of learned helplessness
and becoming passive communicators, initiating little communication. Early
intervention with this clientele often targets situations in which children
communicate with others, so that they learn that they can control people and
objects in their environment through this communication, including making
choices, decisions and mistakes.
In order for bones to attain their normal shape and size, they require the
stresses from normal musculature. Osseous findings will therefore mirror the
specific muscular deficits in a given person with CP. The shafts of the bones
are often thin (gracile) and become thinner during growth. When compared to
these thin shafts (diaphyses), the centers (metaphyses) often appear quite
enlarged (ballooning). With lack of use, articular cartilage may atrophy,
leading to narrowed joint spaces. Depending on the degree of spasticity, a
person with CP may exhibit a variety of angular joint deformities. Because
vertebral bodies need vertical gravitational loading forces to develop properly,
spasticity and an abnormal gait can hinder proper and/or full bone and skeletal
development. People with CP tend to be shorter in height than the average person
because their bones are not allowed to grow to their full potential. Sometimes
bones grow to different lengths, so the person may have one leg longer than the
Pain and sleep disorders
Pain is common, and may result from the inherent deficits associated with the
condition, along with the numerous procedures children typically face. There is
also a high likelihood of suffering from chronic sleep disorders associated with
both physical and environmental factors. Pain is also associated with
tight and/or shortened muscle, abnormal posture, stiff joints, unsuitable orthosis etc.
Louis Center Seremban, N.S. Malaysia Phone 06 631 6971