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(CP), a disorder caused by damage to the brain,
especially affecting ability to control movement and
posture. Palsy is a synonym for paralysis, although a
more accurate description of the usual muscular symptoms
might be weakness (paresis), and inability to make
voluntary movements and suppress involuntary ones.
Depending on the location and extent of the damage, cerebral palsy can be
mild, revealing itself as a kind of awkwardness, or
severe, largely incapacitating a child from infancy. It
is sometimes associated with other problems such as
seizures (epilepsy), mental retardation, ear and hearing
problems, eye and vision problems, communication problems
(see communication skills and disorders), and impairment
of other senses. Some of the children most severely
affected with cerebral palsy may not survive infancy, but
most will have a normal life span.
Cerebral palsy is
not contagious. It is not progressive-it does not get
worse as time passes, and may instead improve somewhat
with therapy (see below). It is not inherited, except in
rare cases where it is associated with a genetic
disorder, notably Lesch-Nyhan syndrome.
Most cases are
caused by brain damage during pregnancy, childbirth, or
the neonatal period (just after birth); this is called
congenital cerebral palsy, because it is present at or
around the time of birth. However, approximately 10
percent of the cases are acquired cerebral palsy, in
which CP has been triggered by events after birth, such
as a traumatic brain injury, infections such as
meningitis, and other types of brain damage, including
injury from child abuse and neglect.
Just why CP occurs
is far from clear. Approximately 58% of the cases of
cerebral palsy occurred in children who were born at full
term and full weight, and in whom doctors could discern
no cause of brain damage, at the present state of
knowledge and technology. However, studies have shown
that numerous conditions are risk factors for cerebral
palsy, not necessarily leading to it, but increasing the
risk that a child will have it. Among the main risk
Infections in the
mother during pregnancy, including rubella (German
measles); sexually transmitted diseases such as
gonorrhea, chlamydia, and syphilis; and various other
bacterial and viral infections, some of which attack the
baby's nervous system.
Low birth weight,
though some infants who weighed under 2 pounds at birth
and spent months in neonatal intensive care have been
abnormal delivery, especially awkward fetal presentation
(position at birth), lengthy or too abrupt labor, or
obstruction of the umbilical cord.
insufficient oxygen, in the brain, for a variety of
reasons, such as premature separation of the placenta
during delivery or swelling of the brain due to illness.
between parents' and fetus's blood types, especially Rh
Jaundice of the
newborn or hyperbilirubinemia (see liver and liver
problems), sometimes associated with Rh incompatibility.
drug abuse taken by the mother.
Smoking by the
Alcohol abuse by
knowledge, developing technology, and enhanced prenatal
care, the risks of CP can be much diminished, even if it
cannot be completely prevented. Precise figures are hard
to come by, because of the wide variation in the disorder
and lack of requirement that doctors report it, but the
United Cerebral Palsy Association estimates that
approximately 3000 infants are born with cerebral palsy
each year, and some 500 other preschool-age children
later acquire the condition.
Cerebral palsy is
generally recognized in the early years, as developmental
delay becomes apparent. Though various kinds of medical
scans can help doctors identify some brain abnormalities,
the disorder is most often seen in its symptoms. These
primitive reflexes, involuntary reactions to particular
stimuli that are normally found only in newborns.
and "floppiness" (hypotonia).
abnormal, awkward positions, which (if uncorrected) can
lead to skeletal disorders.
Favoring one side
of the body over the other.
Poor muscle control
and lack of coordination.
Muscle spasms or
sucking, chewing, and swallowing.
and irritability in infancy.
control bladder and bowels (incontinence).
concentrating, which has adverse effects on learning.
interpreting sense perceptions, such as inability to
identify objects by touch.
Other problems with
the senses, especially hearing and vision.
Some of children
may show serious symptoms at birth; some may not show any
clear signs for a long time. Most children with cerebral
palsy are diagnosed by age 5. It is important to diagnose
the disorder early so that therapy can minimize
handicaps, learning is not hindered, and the child (and
parents) can adjust more readily.
cerebral palsy in two ways: by the affected limbs and by
the nature of the movement disturbance:
By affected limbs:
limbs on opposite sides are affected, such as both legs.
hemiparesis, where the arm and leg on one side are
quadriparesis, where all four limbs are affected
By the nature of
the movement disturbance:
palsy, where muscles are tense, contracted, and resistant
to movement; the most common form of cerebral palsy,
especially in low birth weight or premature babies.
palsy, where the affected parts of the body perform
involuntary writhing movements, such as turning,
twisting, facial grimacing, and drooling, often
associated with jerky, abrupt, flailing motions (chorea).
This form of cerebral palsy generally involves damage
only to the motor centers, not to other parts of the
brain, but the unknowing often take such
"strange" and "unnatural" movements
as signs of mental or emotional disturbance.
palsy, where the main characteristic is lack of balance
and coordination and disturbed depth perception, due to
damage to the cerebellum. Ataxia involves trouble
maintaining balance and swaying when standing.
muscles are extremely tight and resistant to movement.
muscles uncontrollably shake, interfering with
areas of the brain are involved, so the description of a
particular child's condition may involve several of the
above terms and symptoms.
No cure exists for
cerebral palsy, but various kinds of therapies are used
to help each child do as much as he or she is capable of
doing. Among these are:
the use of therapeutic exercises and activities to extend
the child's range of controlled movement, generally
focusing on gross motor skills. Some of these use the
Bobath technique, in which exercises first focus on
countering primitive reflexes and then on extending the
range of voluntary movement, sometimes with the help of
behavior modification, offering positive reinforcement to
help children act against the body's awkward
inclinations. Physical therapists also help children
learn how to use orthopedic devices, such as wheelchairs
which children are given information about the
functioning of a particular part of the body, often by
electrical machines that produce visual or auditory
signals, and are taught to concentrate on changing the
visual picture or sound. Through such techniques,
children with cerebral palsy can gain increased control
over movements and are sometimes able to do things like
drink from a cup or control their bladder-things
previously beyond their range of skills.
therapy, the use of therapeutic exercises and activities
to extend the child's range of controlled movement,
generally focusing on fine motor skills, many of them
self-help skills. For children that may mean learning how
to dress themselves, comb their hair, brush their teeth,
drink from a cup, or hold a pen or pencil. For young
adults that includes preparation for living as
self-sufficiently and independently as possible (see
vocational rehabilitation services).
Speech and language
therapy, which can help children overcome some speech and
hearing impairments, and also learn to use the great
variety of mechanical and electronic devices that have
been developed to help them, such as voice synthesizers
or specially adapted computers (see ear and hearing
problems; communication skills and disorders).
muscle relaxants for spastic muscles and anti-seizure
drugs, if epilepsy is involved. Drugs are best used
sparingly, however, since the long-term side effects on
the already-damaged and still-developing nervous system
Surgery, which can
be helpful in dealing with certain specific problems,
such as those involving eyes, ears, and gait; brain
surgery may help some, but is still experimental.
such as wheelchairs, walkers, page-turners, specially
equipped automobiles, and the like.
therapists stress that a varied and stimulating
environment is in itself a powerful "treatment"
for the child. Also important to both child and family
are counseling, which can offer emotional support and
relief of stress, advice on handling practical problems,
and training to prepare for the future, as the child
grows into an adult. Many public and private
organizations also provide financial assistance,
diagnostic and treatment centers, vocational training and
guidance, respite care for families of children with
cerebral palsy, special recreational facilities, adapted
work settings, and adapted living arrangements.
Craig,S.(NO DATE) Cerebral Palsy Information[INTERNET].
Available: http://members.aol.com/shellic/private/craigs.htm [1997, July 6].
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