Cerebral palsy (CP) is a group of disorders that cause problems with movement, balance, and posture. CP affects the cerebral motor cortex. This is the part of the brain that directs muscle movement. In fact, the first part of the name, cerebral, means having to do with the brain. The second part, palsy, means weakness or problems with using the muscles.
Cerebral palsy is classified according to the Gross Motor Function Classification System (GMFCS).
There are five levels of the GMFCS. Higher levels are associated with decreasing mobility.
• Level 1 cerebral palsy
Level 1 cerebral palsy is characterized by being able to walk without limitations.
• Level 2 cerebral palsy
A person with level 2 cerebral palsy can walk long distances without limitations, but they cannot run or jump.
They may need assistive devices, such as leg and arm braces, when first learning to walk. They may also need to use a wheelchair to get around outside of their home.
• Level 3 cerebral palsy
A person with level 3 cerebral palsy can sit with little support and stand without any support.
They need handheld assistive devices, such as a walker or cane, while walking indoors. They also need a wheelchair to get around outside of their home.
• Level 4 cerebral palsy
A person with level 4 cerebral palsy can walk with the use of assistive devices.
They’re able to move independently in a wheelchair, and they need some support when sitting.
• Level 5 cerebral palsy
A person with level 5 cerebral palsy needs support to maintain their head and neck position.
They need support to sit and stand, and they may be able to control a motorized wheelchair.
The symptoms of cerebral palsy vary from person to person and range from mild to severe. The effects of the condition can become more or less obvious or limiting as a child grows and develops motor skills. They also vary depending on the part of the brain that was affected.
Generally, signs and symptoms include problems with movement and coordination, speech and eating, development, and other problems.
▪︎ Movement and coordination
• Stiff muscles and exaggerated reflexes (spasticity), the most common movement disorder
• Variations in muscle tone, such as being either too stiff or too floppy
• Stiff muscles with normal reflexes (rigidity)
• Lack of balance and muscle coordination (ataxia)
• Tremors or jerky involuntary movements
• Slow, writhing movements
• Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling
• Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait
• Difficulty with fine motor skills, such as buttoning clothes or picking up utensils
▪︎ Speech and eating
• Delays in speech development
• Difficulty speaking
• Difficulty with sucking, chewing or eating
• Excessive drooling or problems with swallowing
• Delays in reaching motor skills milestones, such as sitting up or crawling
• Learning difficulties
• Intellectual disabilities
• Delayed growth, resulting in smaller size than would be expected
▪︎ Other problems
Damage to the brain can contribute to other neurological problems, such as:
• Seizures (epilepsy)
• Difficulty hearing
• Problems with vision and abnormal eye movements
• Abnormal touch or pain sensations
• Bladder and bowel problems, including constipation and urinary incontinence
• Mental health conditions, such as emotional disorders and behavioral problems
The brain disorder causing cerebral palsy doesn’t change with time, so the symptoms usually don’t worsen with age. However, as the child gets older, some symptoms might become more or less apparent. And muscle shortening and muscle rigidity can worsen if not treated aggressively.
CP is divided into four main types, based on the movement involved –
▪︎ Spastic cerebral palsy
The most common kind is spastic CP. If you have it, your muscles are stiff or tight, or they spasm.
Doctors divided spastic CP into three groups:
• Spastic diplegia mostly involves muscle stiffness in the legs. Tight muscles in your legs and hips might cause trouble walking because your legs turn in at the knees. This is also called scissoring.
• Spastic hemiplegia means one side of your body is affected. Your arm and leg on that side may be shorter and thinner, which might cause you to walk on your tiptoes. Some people with this type have a curved spine, called scoliosis. Seizures and speech problems can also be part of spastic hemiplegia.
• Spastic quadriplegia means all of your limbs are affected, as well as your torso and your face. You may also have seizures and trouble speaking if you have this type of CP. It’s the most serious kind of spastic CP.
▪︎ Dyskinetic cerebral palsy
If you have dyskinetic CP, your muscle tone might be too tight or too loose. Your movements are uncontrolled: slow and twisting, or quick and jerky. If the muscles in your face or mouth are affected, you might frown, drool, and have trouble speaking.
Dyskinetic CP can be divided further into these types:
• Athetoid. Movements are writhing, slow, and curvy.
• Choreoathetoid. Movements are aimless and not controlled.
• Dystonic. Muscle tone is not normal.
▪︎ Ataxic cerebral palsy
Ataxic CP, which is rare, causes problems with coordination and balance. You might be unsteady when you walk. You might also shake, which could make it hard to do tasks that need steadiness, such as writing.
▪︎ Mixed cerebral palsy
People with this type of CP have symptoms of more than one type. Most people with mixed CP have a combination of spastic and dyskinetic
In most cases, the exact cause of cerebral palsy is unknown.
Atypical brain development or injury to the developing brain can cause cerebral palsy. The damage affects the part of the brain that controls body movement, coordination, and posture. This brain damage usually occurs before birth, but it can also happen during birth or the first years of life.
Other possible causes include:
• head injuries as a result of a car accident, fall, or child abuse
• intracranial hemorrhage, or bleeding into the brain
• brain infections, such as encephalitis and meningitis
• infections acquired in the womb, such as German measles (rubella) and herpes simplex
• asphyxia neonatorum, or a lack of oxygen to the brain during labor and delivery
• gene mutations that result in atypical brain development
• severe jaundice in the infant
Risk Factors –
CP is more common among boys than girls. It affects black children more often than white children.
Certain medical conditions or events that can happen during pregnancy and delivery that may increase a baby’s risk of being born with cerebral palsy, including:
• Being born too small
• Being born too early
• Being born a twin or other multiple birth
• Being conceived by in vitro fertilization (IVF) or other assisted reproductive technology (ART)
• Having a mother who had an infection during pregnancy
• Having a mother with certain health problems in pregnancy, such as thyroid problems
• Severe jaundice
• Having complications during birth
• Rh incompatibility
• Exposure to toxins
People with cerebral palsy may have complications, including:
• communication difficulties, such as speech and language disorders
• spinal issues, such as scoliosis, lordosis (swayback) and kyphosis (hunchback)
• contractures, which occur when the muscles get locked into painful positions
• osteopenia, or poor bone density that can make bones easily breakable
• dental problems
Any parent who is concerned about their child’s development should see their doctor.The doctor will ask the parents about the infant’s history and development and the mother’s medical history during her pregnancy.
The doctor will examine the child and observe their posture, movements, muscle tone, motor skills, and they will check the child’s reflexes.
Other conditions with similar symptoms may need to be ruled out, such as a tumor or muscular dystrophy.
Tests that can help with diagnosis include:
• Blood tests
• Head ultrasound
• MRI or CT scan
At the age of 2 to 3 years, a more comprehensive diagnosis of cerebral palsy is usually possible, but the severity is not usually fully assessed until the age of 4 to 5 years.
A diagnosis of cerebral palsy requires regular assessments, to make comparisons and determine what the developmental needs and issues are.
Children and adults with cerebral palsy may require lifelong care with a medical care team. Besides a pediatrician or physical medicine and rehabilitation specialist (physiatrist) and possibly a pediatric neurologist to oversee your child’s medical care, the team might include a variety of therapists and mental health specialists.
There is no cure for cerebral palsy. However, there are many treatments options that may help improve your child’s daily functioning.
Medications that can lessen muscle tightness might be used to improve functional abilities, treat pain and manage complications related to spasticity or other cerebral palsy symptoms.
• Muscle or nerve injections.
To treat tightening of a specific muscle, your doctor might recommend injections of onabotulinumtoxinA (Botox), or another agent. The injections will need to be repeated about every three months.
• Oral muscle relaxants.
Drugs such as baclofen, tizanidine (Zanaflex), diazepam (Valium) or dantrolene (Dantrium) are often used to relax muscles.
• Medications to reduce drooling.
One option is Botox injections into the salivary glands.
A variety of therapies play an important role in treating cerebral palsy:
• Physical therapy.
Muscle training and exercises can help your child’s strength, flexibility, balance, motor development and mobility. You’ll also learn how to safely care for your child’s everyday needs at home, such as bathing and feeding your child. Your therapist can provide guidance on how you can continue muscle training and exercise at home between therapy visits.
Braces, splints or other supportive devices might be recommended for your child to help with function, such as improved walking, and stretching stiff muscles.
• Occupational therapy.
Occupational therapists work to help your child gain independence in daily activities and routines at home and school and in the community. Adaptive equipment recommended for your child can include walkers, wide-based canes, standing and seating systems, or electric wheelchairs.
• Speech and language therapy.
Speech-language pathologists can help improve your child’s ability to speak clearly or to communicate using sign language. They can also teach the use of communication devices, such as a computer and voice synthesizer, if communication is difficult. Speech therapists can also address difficulties with eating and swallowing.
• Recreational therapy.
Some children benefit from regular or adaptive recreational or competitive sports, such as therapeutic horseback riding or skiing. This type of therapy can help improve your child’s motor skills, speech and emotional well-being. Both adults and children benefit from regular physical activity and exercise for general health and fitness.
▪︎ Surgical procedures
Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity. These treatments include:
• Orthopedic surgery.
Children with severe contractures or deformities might need surgery on bones or joints to place their arms, spine, hips or legs in their correct positions. Surgical procedures can also lengthen muscles and lengthen or reposition tendons that are shortened by contractures. These corrections can lessen pain and improve mobility. The procedures can also make it easier to use a walker, braces or crutches.
• Cutting nerve fibers (selective dorsal rhizotomy).
In some severe cases, when other treatments haven’t helped, surgeons might cut the nerves serving specific spastic muscles in a procedure called selective dorsal rhizotomy. This relaxes the muscle in the legs and reduces pain, but can cause numbness.
▪︎ Other treatments
As needed, medications and other treatments may be recommended for seizures, pain, osteoporosis, mental health conditions, and problems with sleep, oral health, feeding and nutrition, bladder incontinence, vision, or hearing.
Adults with cerebral palsy
As your child with cerebral palsy becomes an adult, his or her health care needs can change. In addition to general health screenings recommended for all adults, ongoing health care includes evaluation and treatment for conditions that are more common in adults with cerebral palsy.
These can include:
• Vision and hearing problems
• Maintenance of muscle tone
• Seizure management
• Problems with pain and fatigue
• Dental issues
• Orthopedic problems, such as contractures, arthritis and osteoporosis
• Heart and lung disease
• Mental health issues, such as depression
Ayurvedic Perspective –
In Ayurveda, there is no single condition/disease which exactly show similarity with CP. Some conditions explained in Ayurveda, which have shown some similarity with CP are, phakka (a kind of nutritional disorder), pangulya (locomotordisorders), mukatva (dumbness), jadatva (mental disorders), ekanga roga (monoplegia), sarvanga roga (quadriplegia), pakshaghata (hemiparesis) and pakshavadha (hemiplegia) etc., vatavyadhi’s (neurological disorders). Spastic CP can be considered as ‘Avarana janya vata vyadhi/Kaphavrita vata’. Vata vyadhi is the most similar condition to CP.
• AyurvedicPanchakarma (five major ayurvedic procedures and many allied procedures which are intended to cleanse the body) therapy along with appropriate internal medication can provide good improvement in quality of life of CP patients.
• It is well known fact that internal medication along with Panchakarma procedures is more effective when compared with only oral medications.
• Various panchakarma procedures like Udwartana (medicated powder massage), Sarvaanga abhyanga (full body massage with medicated oil), Baashpa sweda & Naadi sweda (steam bath) and Vasti (oil and decoction enemas), Shirodhara, Pizichill, Navarakizhi etc. are found to be beneficial in the management of CP in children.
A Group of herbal medicines which are called ‘Medhya’ used in refining the brains functional capacity and also helps in regeneration of damaged brain cells. These medicines include: Brahmi, Mandukparni, Shankhpushpi, Jyotishmati, Kushmand, Ustukhudoos, Yashtimadhuk, Ashwagandha, Shatavari, Guduchi, Vacha, Haritaki, Abhrak-Bhasma and Suvarna-Bhasma
Medicines which act on ‘Majja’ dhatu (tissue) are helpful in this condition and may include Guduchi, Amalaki, Musta, Panch-Tikta-Ghrut-Guggulu, Pancha-Gavya-Ghruta and Brahmi-Ghruta. Other medicines include Yograj-Guggulu, Kaishor-Guggulu, Vatagajankush-Ras, Tapyadi-Loh-Ras, Mahavat- Vidhwans-Ras, and Vish-Tinduk-Vati.
Benefits of Panchakarma –
Various panchakarma procedures have proved their efficacy in the management of CP.
• Udwartana opens the minute channels and improves blood as well as lymphatic circulation.
Udwartana is kapha, vata hara and removes aavarana or srotorodha. It provides a platform for further procedures like abhyanga, swedana and vasti.
• Sarvanga abhyanga, baashpa & naadi sweda reduce spasticity (especially scissoring phenomenon), improves flexibility of joints, improves circulation and reduces pain.
• Vasti is the major treatment for CP and it improves gross as well as fine motor functions, provides nourishment, improves overall general condition and quality of life in children with CP.
• Shirodhara gives strength to brain tissues and helps it to send proper reflexes to different body parts of the body to respond accurately.
• Pizichill and navarkizhi helps in opening up of spastic channels and gives strength to musculoskeletal system along with nervous system.
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