Cerebral Palsy

A while back I watched Miss You Can Do It (be sure to have enough tissues if you can muster up the courage to do so). It is about Abbey Curran, Miss Iowa USA 2008 and the first woman with a disability to compete at the Miss USA Pageant. Abbey was born with Cerebral Palsy but didn’t let that hold her back for one second. I was amazed at this beautiful, strong and wonderful woman that didn’t let her disability define her.

Thereafter I did some reading on the internet and realised that the public is really uninformed regarding Cerebral Palsy and what the diagnosis means. That is why, in today’s article we will take a closer look at what it means, causes, the different types and the management thereof.

Introduction

Cerebral Palsy (CP) is a neurological disorder caused by a non-progressive brain injury or malformation. Although Cerebral Palsy can be defined, having Cerebral Palsy does not define the person.

Defining Cerebral Palsy

Cerebral Palsy is caused by brain damage (by brain injury or abnormal development of the brain that occurs while a child’s brain is still developing — before birth, during birth, or immediately after birth).

Every case is unique and how a brain injury affects a child’s motor functioning and intellectual abilities is highly dependent on the nature of a brain injury, where the damage occurs, and how severe it is.

Generally, it affects body movement, muscle control, muscle coordination, muscle tone, reflex, posture and balance. It can also impact fine motor skills, gross motor skills and oral motor functioning.

Individuals affected were likely born with the condition, although some acquire it later.

The brain damage that causes Cerebral Palsy is a result of either:

• Prenatal disturbance of brain cell migration – genetic and environmental factors disturb brain cell migration as cells move to their appropriate location during brain development.
• Prenatal poor myelination (insulation) of developing nerve cell fibres – brain function is impeded when poor myelin provides an inadequate protective covering over nerve cells that aid in the transmission.
• Perinatal brain cell death – events in the birthing process that rupture blood vessels or starve oxygen to the brain.
• Postnatal non-functional or inappropriate connections (synapses) between brain cells – trauma, infections, and asphyxia that damage connections developed in the brain.

Types and forms

Classification based on severity level

Cerebral Palsy is often classified by severity level as mild, moderate, severe, or no CP. These are broad generalizations that lack a specific set of criteria.

• Mild – Mild Cerebral Palsy means a child can move without assistance; his or her daily activities are not limited.
• Moderate– Moderate Cerebral Palsy means a child will need braces, medications, and adaptive technology to accomplish daily activities.
• Severe– Severe Cerebral Palsy means a child will require a wheelchair and will have significant challenges in accomplishing daily activities.
• No CP– No CP means the child has Cerebral Palsy signs, but the impairment was acquired after completion of brain development and is therefore classified under the incident that caused the Cerebral Palsy, such as traumatic brain injury or encephalopathy.

Classification based on topographical distribution

Topographical classification describes body parts affected. The words are a combination of phrases combined for one single meaning.

• Paresis means weakened
• Plegia/Plegic means paralyzed

The prefixes and root words are combined to yield the topographical classifications commonly used in practice today.

• Monoplegia/monoparesis means only one limb is affected. It is believed this may be a form of hemiplegia/hemiparesis where one limb is significantly impaired.
• Diplegia/diparesis usually indicates the legs are affected more than the arms; primarily affects the lower body.
• Hemiplegia/hemiparesis indicates the arm and leg on one side of the body are affected.
• Paraplegia/paraparesis means the lower half of the body, including both legs, is affected.
• Triplegia/triparesis indicates three limbs are affected. This could be both arms and a leg, or both legs and an arm. Or, it could refer to one upper and one lower extremity and the face.
• Double hemiplegia/double hemiparesis indicates all four limbs are involved, but one side of the body is more affected than the other.
• Tetraplegia/tetraparesis indicates that all four limbs are involved, but three limbs are more affected than the fourth.
• Quadriplegia/quadriparesis means that all four limbs are involved.
• Pentaplegia/pentaparesis means all four limbs are involved, with neck and head paralysis often accompanied by eating and breathing complications

Classification based on motor function

The brain injury that causes Cerebral Palsy affects motor function, the ability to control the body in a desired matter. Two main groupings include spastic and non-spastic. Each grouping has multiple variations and it is possible to have a mixture of both types.

• Spastic Cerebral Palsy is characterized by increased muscle tone.
• Non-spastic Cerebral Palsy will exhibit decreased or fluctuating muscle tone.

Motor function classification provides both a description of how a child’s body is affected and the area of the brain injury. Using motor function gives parents, doctors, and therapists a very specific, yet broad, description of a child’s symptoms, which helps doctors choose treatments with the best chance for success.

Non-spastic Cerebral Palsy is divided into two groups, ataxic and dyskinetic. Together they make up 20% of Cerebral Palsy cases. Broken down, dyskinetic makes up 15% of all Cerebral Palsy cases, and ataxic comprises 5%.

Ataxic/ataxia

Ataxic Cerebral Palsy affects coordinated movements. Balance and posture are involved. Walking gait is often very wide and sometimes irregular. Control of eye movements and depth perception can be impaired. Often, fine motor skills requiring coordination of the eyes and hands, such as writing, are difficult. It does not produce involuntary movements, but instead indicates impaired balance and coordination

Dyskinetic

Dyskinetic Cerebral Palsy is separated further into two different groups; athetoid and dystonic.

• AthetoidCerebral Palsy includes cases with involuntary movement, especially in the arms, legs, and hands.
• Dystonia/DystonicCerebral Palsy encompasses cases that affect the trunk muscles more than the limbs and results in fixed, twisted posture.

Because non-spastic Cerebral Palsy is predominantly associated with involuntary movements, some may classify Cerebral Palsy by the specific movement dysfunction, such as:

• Athetosis— slow, writhing movements that are often repetitive, sinuous, and rhythmic.
• Chorea— irregular movements that are not repetitive or rhythmic, and tend to be more jerky and shaky.
• Choreoathetoid— a combination of chorea and athetosis; movements are irregular, but twisting and curving.
• Dystonia— involuntary movements accompanied by an abnormal, sustained posture.
• Mixed

A child’s impairments can fall into both categories, spastic and non-spastic, referred to as mixed Cerebral Palsy. The most common form of mixed Cerebral Palsy involves some limbs affected by spasticity and others by athetosis.

Managing Cerebral Palsy

There’s an adage that knowledge is power. This is certainly true, but something parents may not consider – it can be a source of comfort.

Suggestions

• Use a care plan outline as a guide for possible ways to manage your child’s condition.
• Understand your medical aid; is it working for you? If not, learn about ways to seek the coverage your family needs and your child deserves.
• Work the therapy received at the clinic into a routine at home, and reinforce daily.
• Explore support group options.
• Be good to yourself, so you can be good to your family. Give yourself a pat on the back for adjusting to your new demands.
• Seek counselling to find your balance, regain energy, and form a healthy perspective.
• Include proper nutrition, sleep and exercise into your daily routines.
• With the increase in medical-related expenses, explore avenues to reduce your monthly expenses by other means.
• Accept help and support from others, especially family and friends. They need to be needed, and sometimes you just need a break.
• Find ways in which they can socialize with their siblings and peers – this may require creativity, but you are also teaching your child valuable workarounds and life coping skills.

I reiterate again, although Cerebral Palsy can be defined, having Cerebral Palsy does not define the person. Although the diagnosis comes with numerous challenges, there is help out there.

Retha Booyens (RD) SA