What is cerebral palsy and how is it treated?

Cerebral palsy is a serious disease that still occurs in a large percentage of newborns. Cerebral palsy completely changes the life of both parents and children. You need to know a number of features of this disease and how to cope with them. Educational work among the young population planning to have a child is no less important.

It is worth noting that speaking about cerebral palsy, we will be discussing a whole syndrome complex, and not just one disease. The reasons can be both trauma to the baby at birth and abnormal development of the fetus. Based on this, we can indicate that infantile cerebral palsy is a system of syndromes of a different nature that arose as a result of trauma to the baby at birth, or because of the pathological development of the fetus during pregnancy. The manifestations of cerebral palsy can be very different: mental characteristics, cognitive disorders, disorders of the musculoskeletal system. Also, there is a hypothesis that cerebral palsy is a genetic disease.

Short information about cerebral palsy

The physiological basis of trauma, which can lead to such serious consequences as infantile cerebral palsy, is as follows: irreversible organic damage to the brain occurs, namely, damage to cortical cells as a result of prolonged oxygen starvation. This can be the result of hypoxia or fetal asphyxia (insufficient oxygen), as well as mechanical trauma in the prenatal or postpartum period. Thus, it can be determined that cerebral palsy syndrome is a chronic non-progressive syndromic complex, represented by a violation of the musculoskeletal system against the background of brain abnormalities.

Cerebral palsy is a chronic disease of the brain that is not progressive in nature, which includes a number of symptom complexes: disorders of the motor system and secondary abnormalities that arise as a result of underdevelopment or damage to the structures of the brain during pregnancy or childbirth. Despite the high achievements of modern medicine and preventive measures, cerebral palsy has a fairly high number of cases - 1.7 - 5.9 per thousand newborn babies. Boys get sick a little more often than girls in a ratio of 1.3:1.

Features of the development of a child with cerebral palsy

Cerebral palsy is characterized by impaired motor, voluntary, muscle activity, and sometimes the intellectual sphere, speech, emotional-volitional sphere of the personality, vision and hearing can suffer. Some of the symptoms of the disease can remain throughout life and are the cause of a person's disability.

A child with such developmental features, throughout their life, is faced with a number of specific physiological and psychological difficulties. Support from parents and people around them directly affects the quality of life and psychological comfort of the baby. Obtaining education and self-realization of children with developmental disabilities requires tolerance and patience from society, and from teachers - knowledge about the developmental features and the specifics of working with them.

Symptoms and stages of the disease

Signs and symptoms of the disease can often be detected immediately after the birth of a baby, but some signs appear over time, and it is very important to notice them in the early stages, since early treatment and correction is the key to the successful adaptation and socialization of children with cerebral palsy.

Movement disorders are the main signs of cerebral palsy, age determines the severity of symptoms, and their type, there are distinguished three stages of the disease:

Early - 0-5 months.
The initial residual stage – from 6 months up to 3 years.
Late residual stage – 3 years and older.

Symptoms of cerebral palsy at an early stage are characterized by a delay in motor development, the absence of extinction of certain unconditioned reflexes in accordance with age, abnormalities in muscle tone, and the use of only one limb during manipulations.

The pathology of intrauterine development, as well as birth trauma, provoke the appearance of residual phenomena (residual effects from damage to the nervous system) at the initial residual stage. At this stage, it becomes possible to determine the form of the disease, which is associated with the formation of persistent muscle hypertension (spastic forms of cerebral palsy).

Formation of pathological motor stereotypes, deformities, are characteristic of the late residual stage from 3 years of age and older.

Moving on to concretizing the features of this ailment, we should highlight its main symptoms. The first and most obvious signs are:

- Deformation of the skeleton.
- Lability of muscle tone - muscles are either too relaxed or too tense.
- Predominant one-handed movements up to 18 months of age.
- Pathology of movement: either too sharp or too sluggish.
- Mental retardation.
- Frequent convulsions.
- Problems with speech apparatus - children cannot speak and problems with swallowing also occur.
- Problems with the control of the excretory systems of organs.
- Dental problems.
- Hearing impairment.
- The child is not walking, or the gait is abnormal, for example, toe gait with eversion of the foot.

Thus, it can be seen that cerebral palsy symptoms have a very wide range, and affect almost all vital structures of the human constitution.

Mental health of a child with cerebral palsy

Against the background of aggravated organic changes in the brain, secondary mental illnesses can develop.

Cerebral palsy can be combined with Intellectual disability (ID), mental retardation (MR), disorders of the emotional-volitional personality sphere (autism spectrum disorders), epilepsy and other mental illnesses.

Often, the mental sphere of children with this disease does not suffer, the intellect corresponds to the age norm, and such children can study in general education institutions or in inclusive classes.

Forms of infantile cerebral palsy

Currently, there are six main forms of cerebral palsy. Each has its own distinctive set of symptoms and constitutional features. It is worth noting that the first doctor who combined the syndromic complex into a single disease and distinguished the gradation of forms of the disease was Sigmund Freud.

Description of the forms of cerebral palsy sounds like this:

- Spastic diplegia - the main feature of this form is that the disease mostly affects the lower extremities, provoking the so-called X-shaped gait. This is the most common form of cerebral palsy, and it also has the name Little's disease. Distinctive features of symptomatology are such signs as: dysarthria, strabismus, damage to the optic nerve, which leads to decreased vision, hearing impairment, mental retardation. According to statistics, this form of cerebral palsy is most favorable in terms of correction and possible adaptation. People with such disabilities, if properly corrected, can function as healthy, having only gait peculiarities.
- Double hemiplegia is one of the most severe forms, the cause of which lies, in most cases, in fetal hypoxia and has the most severe consequences. It can be expressed throughout the body, or cause more damage to the upper limbs. Most often, double hemiplegia is accompanied by epileptic seizures and, in some cases, microcephaly (head is smaller than the norm), which is secondary. Patients with this form of cerebral palsy have a number of mental disorders, the main feature of which is a complete lack of motivation. It is because of severe violations in the constitution of the limbs, regular seizures and lack of motivation that children suffering from a similar ailment need regular help from an adult in the field of self-care.

- Hyperkinetic form - is a consequence of the hemolytic disease in an infant. This form is best characterized by symptoms such as hearing loss, dysarthria (difficult or unclear articulation of speech that is otherwise linguistically normal), hyperkinesis (involuntary movements), nystagmus (repeated uncontrolled movements of the eyes), paralysis and paresis (partial paralysis). But the main distinguishing feature is the child's retained intelligence. Children with such disabilities, with the correct correction, can adapt, finish school and even get higher education. They can independently acquire self-service skills.
- Atonic - astatic form - the main characteristics of this form are low muscle tone, high tendon reflexes. It is often accompanied by impaired activity of the cerebellum, the cause of which is birth injury. In another variant of the origin of this form of cerebral palsy, the difference is the dysfunction of the cortex as a result of trauma. Mostly the frontal part is injured, which leads to a number of mental characteristics and diseases. Cerebral palsy of the atonic-astatic form is often accompanied by various degrees of oligophrenia (severe mental retardation), which does not allow the child to function independently.
- Hemiplegic form - a clear sign of this form is unilateral lesion of the limbs, sometimes the hand can be more affected. In addition, the hemisphere opposite to the constrained side is more affected. At the same time, the depth of the defect can vary, because children can develop more slowly, but still adapt. A delay in speech development is also possible. Focal epileptic seizures sometimes occur.
- Mixed form - sometimes there is a syndromocoplex, which is very difficult to differentiate. This form can act as the most complex, including symptoms that exclude the acquisition of self-care skills, and relatively adaptable, depending on the depth of the lesions.

Diagnosis and treatment of cerebral palsy

The disease of cerebral palsy manifests itself from birth, but the diagnosis of cerebral palsy is not made immediately, it is very important to observe the development of the baby for some time, since a number of neurological symptoms resembling cerebral palsy may have a different etiology (cause). Cerebral palsy diagnosis is very difficult, on average, doctors come to the conclusion about the presence of this disease when the baby is one year old, but everything can vary depending on the severity, frequency and depth of symptoms.

Now there are many developments that allow children with cerebral palsy to adapt to life. Working with a psychologist, a child can get all the information he or she needs to be sufficiently developed for their age. In addition, there are many developments in the field of physiotherapy exercises for children with cerebral palsy.

For the diagnosis of cerebral palsy, a number of diagnostic methods and analyzes are used, among which the main ones are:

- Computed tomography of the head.
- Ultrasound examination of the brain.
- Questioning parents.

Cerebral palsy treatment is possible. First of all, the main methods of treatment are the training of physical functions and work on the mental development of the child. This helps to reduce the severity of the defect. Occupational therapy and physical therapy also act to improve motor function. Special orthopedic devices such as walkers and braces are often used. In severe muscle spasms muscle relaxers such as Tizanidine or topical injections of Botox are used.  Classes with a speech therapist are no less important, since the speech apparatus suffers greatly. Any correction and treatment is selected individually, due to the severity of symptoms, it is important to deal with it systematically. Parents need to be prepared for the fact that it will take a lot of time, but the result will certainly be. More than once, special psychologists and rehabilitation therapists have succeeded in adapting the child and minimizing movement disorders to a possible minimum.

In such a situation, it is important to be patient. It is important to remember that for all the severity of the disease, children with cerebral palsy are able to love and respond to love. Some toddlers who have retained intelligence do well in school and, over time, are even able to get higher education.

To avoid this disease, you should be serious about family planning and childbirth. The mother-to-be needs to monitor her health, get rid of, or better not have earlier, bad habits and, of course, carefully choose a competent and experienced obstetrician-gynecologist. Knowing all the risk factors, you can not only correct the disease, but also avoid it.

Psychological support of a child with cerebral palsy

Psychological support of the child throughout childhood is very important, since physiological differences from other children can provoke the emergence of internal conflicts, deep feelings of the child and the appearance of a high level of anxiety, aggressive manifestations and other psychological problems.

The process of painful treatment can also negatively affect the emotional sphere of the baby, which requires the provision of psychological assistance to such a child.

Classes with a psychologist will help relieve psychological stress, overcome internal conflicts, reduce the level of anxiety, aggressiveness and stabilize the psychological state of the child.

With reduced intelligence, children need a comprehensive correction of specialists: a defectologist, psychologist, speech therapist and other specialists.

Post by: Jacob Hansen, General healthcare practitioner, National health centre, Stavanger, Norway