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Understanding Cerebral Palsy

What is Cerebral Palsy?

Cerebral Palsy (CP) is a term used to describe a group of disorders affecting body movement and muscle co-ordination. The medical definition of cerebral palsy is a "non-progressive" but not unchanging disorder of movement and/or posture, due to an insult to or anomaly of the developing brain. Development of the brain starts in early pregnancy and continues until about age three. Damage to the brain during this time may result in C.P.

This damage interferes with messages from the brain to the body, and from the body to the brain. The effects of cerebral palsy vary widely from individual to individual. At its mildest, cerebral palsy may result in a slight awkwardness of movement or hand control. At its more sever, CP may result in virtually no muscle control, profoundly affecting movement and speech. Depending on which areas of the brain have been damaged, one or more of the following may occur:

  1. muscle tightness or spasms
  2. involuntary movement
  3. difficulty with "gross motor skills" such as walking or running (developmental delay)
  4. difficulty with "fine motor skills" such as writing or doing up buttons
  5. difficulty in perception and sensation

These effects may cause associated problems such as difficulties in feeding, poor bladder and bowel control, breathing problems, and pressure sores. The brain damage which caused cerebral palsy may also lead to other conditions such as: seizures, learning disabilities developmental delay. It is important to remember that limbs affected by cerebral palsy are not paralyzed and can feel pain, heat, cold and pressure. It is also important to remember that the degree of physical disability experienced by a person with cerebral palsy is not an indication of his/her level of intelligence.

Cerebral palsy is not a progressive condition- damage to the brain is a one-time event so it will not get worse – and people with cerebral palsy have a normal life-span. Although the condition is not progressive, the effects of CP may change over time. Some may improve: for example, a child whose hands are affected may be able to gain enough hand control to write and to dress him/herself. Others may get worse: tight muscles can cause problems in the hips and spine of growing children which require orthopaedic surgery; the ageing process can be harder on bodies with abnormal posture or which have had little exercise.

Medically it is important to remember that Cerebral Palsy is not contagious, hereditary or life-threatening.
 

What are the types of Cerebral Palsy?

A. Classification by Gross Motor Function

  • Level 1 – Walks without restrictions, limitations in more advanced gross motor skills
  • Level 2 – Walks without assistive devices; limitations walking outdoors and in the community
  • Level 3 – Walks with Assistive Mobility devices; limitations walking outdoors and in the community
  • Level 4 – Self mobility with limitations; children are transported or use power mobility outdoors
  • Level 5 – Self mobility is severely limited even with the use of Assistive technology

B.  Classification by Number of Limbs Involved

  1. Quadriplegia – all four limbs are involved
  2. Diplegia – all four limbs are involved. Both legs are more severely affected than the arms
  3. Hemiplegia – one side of the body is affected. The arm is usually more involved than the leg
  4. Triplegia – three limbs are involved, usually both arms and a leg
  5. Monoplegia – only one limb is affected, usually an arm

C.  Classification by Movement Disorder

  1. Spastic CP – Spastic muscles are tight and stiff, and have increased resistance to being stretched. They become overactive when used and produce clumsy movements. Normal muscles work in pairs: when one group contracts, the other group relaxes to allow free movement in the desired direction. Spastic muscles become active together and block effective movement. This muscular "tug-of-war" is called co-contraction. Spasticity may be mild and affect only a few movements, or severe and affect the whole body. The amount of spasticityusually changes over time. Therapy, surgery, drugs and adaptive equipment may help to control spasticity. Damage to the brain’s cerebral cortex is generally the cause of spastic cerebral palsy.
  2. Athetoid CP – Athetosis leads to difficulty in controlling and co-ordinating movement. People with athetoid cerebral palsy have many involuntary writhing movements and are constantly in motion. They often have speech difficulties. Athetoid cerebral palsy results from damage to the basal ganglia in the midbrain. It was once common as a result of blood type incompatibility, but is now rarely seen.
  3. Ataxic CP – Ataxic CP is the least common form of cerebral palsy. People with ataxic CP have a disturbed sense of balance and depth perception. They usually have poor muscle tone (hypotonic), a staggering walk and unsteady hands. Ataxia results from damage to the cerebellum, the brain’s major centre for balance and co-ordination.

D.  Combined Classification

The classifications of movement disorder and number of limbs involved are usually combined (e.g. spastic diplegia). These technical words can be useful in describing the type and extent of cerebral palsy, but they are only labels. A label does not describe an individual.
 

What Are the Causes of Cerebral Palsy?

Any damage to the developing brain, whether caused by genetic or developmental disorders, injury or disease, may produce cerebral palsy. During pregnancy, anything which tends to produce a premature or low birth weight baby who is not developed enough to cope with the stresses of independent life will increase the likelihood of cerebral palsy. Factors which may cause cerebral palsy include:

  1. multiple births (e.g. twins, triplets)
  2. a damaged placenta which may interfere with fetal growth
  3. sexually transmitted infectious diseases, e.g. AIDS, herpes,
  4. syphilis
  5. poor nutrition
  6. exposure to toxic substances, including nicotine, alcohol
  7. and drugs
  8. Rh or A-B-O blood type incompatibility between mother
  9. and infant
  10. chromosome abnormalities, biochemical genetic disorders
  11. chance malformations of the baby’s brain
  12. a labour which is too long or too abrupt, small pelvic
  13. structure, poor oxygen supply
  14. German measles during pregnancy
  15. Premature delivery
  16. Effects of anaesthetics, analgesics

In early childhood, cerebral palsy can occur if a young child’s brain is damaged by infections such as meningitis, brain haemorrhages, head injury, drowning accidents and poisoning.


Diagnosis

CAT scans (Computerized Axial Tomography) and MRI (Magnetic Resonance Imaging), can help identify lesions in the brain, however, for the majority of people with CP it will be months, and sometimes years, before a diagnosis is confirmed.


Therapy

Physical therapy usually begins in the first few years of life, soon after the diagnosis is made. Physical therapy programs use specific sets of exercises to work toward two important goals: preventing the weakening or deterioration of muscles that can follow lack of use (called tissue atrophy) and avoiding contractures, in which muscles become fixed in a rigid, abnormal position.

Contracture is one of the most common and serious complications of cerebral palsy. Normally, a child whose bones are growing stretches the body’s muscles and tendons through running and walking and other daily activities. This ensures that muscles will grow at the same rate. But in children with cerebral palsy, spasticity prevents the stretching and, as a result, muscles do not grow fast enough to keep up with lengthening bones. The resulting contracture can disrupt balance and trigger loss of previous abilities. Physical therapy alone, or in combination with special braces (sometimes called orthodic devices), works to prevent this complication by stretching spastic muscles.

Surgery to lengthen the muscles is often recommended when contractures are severe enough to cause movement problems. Because lengthening a muscle makes it weaker, surgery for contractures is usually followed by months of recovery.


Living with Cerebral Palsy

CP is not a life-threatening condition and, in itself, is no barrier to leading a long and productive life. People with CP enjoy satisfying careers, university education, social life, and become parents. Some limitations are unavoidable, but very few people manage to achieve their dreams of becoming Olympic athletes, concert pianists or brain surgeons.

Some key elements to minimizing the handicapping effects of cerebral palsy are:

  • Attitudes: Prejudice and teasing can be very damaging. A good sense of self-esteem is required to cope with the negative attitudes of others. Children can also be handicapped if they are over-protected and become too dependent.
  • Access: You cannot lead an independent life if public buildings, washrooms and transportation are not accessible.
  • Maintaining physical health: a good general fitness level will help with range of motion and flexibility, and cardiovascular fitness can improve endurance and help offset age-related changes that lead to fatigue. Having cerebral palsy does not make you immune to other conditions. People with CP are as likely as anyone else to contract heart disease, cancer, etc.
  • Aging and Cerebral Palsy: Although people with cerebral palsy are considered to have a normal life span, the physical challenges of CP may intensify with age (such as increased spasticity, fatigue, loss of strength and declining mobility).
  • Maintaining Mental Health: The importance of learning skills to increase independence and self-confidence throughout an individual’s lifetime cannot be over-emphasized. The stresses associated with ageing will be lessened if a person is able to maintain a positive and personal attitude, if he is involved in meaningful activities, and is he has developed a supportive environment.

Resources

Learning and Working with Disabilities – Information Resource Guide
Toronto Board of Education, Employment Equity Office, 1997

Ontario Cerebral Palsy Association
104- 1630 Lawrence Avenue West, Toronto, ON, M6L 1C5 CANADA
Phone: (416) 244-9686 Fax: (416) 244-6543 Toll-Free: 1-877-244-9686

Cerebral Palsy- A Lifelong Journey (a video)
The Ontario Federation for Cerebral Palsy (as above)

Web Sites:
www.ofcp.on.ca/index.html
www.cerebralpalsy.org