Cerebral Palsy

With an average incidence of three per thousand lives, 25 lakh people are estimated to live with Cerebral Palsy (CP) in India. This neurological condition, which occurs due to brain damage before, during or shortly after birth, affects body movements and muscle coordination. People with CP have trouble sitting, learning, feeling, thinking and communicating.

Definitions

The Rights of Persons with Disabilities Act, 2016 defines Cerebral Palsy as a
non-progressive neurological condition affecting body movements and muscle
coordination, caused by damage to one or more specific areas of the brain, usually
occurring before, during or shortly after birth.

While movement problems are the central feature of CP, difficulties with thinking,
learning, feeling, communication and behavior often co-occur, with 28% having epilepsy,
58% having difficulties with communication, at least 42% having problems with their
vision, and 23–56% having learning disabilities. Muscle contractions in people with
cerebral palsy are commonly thought to arise from over activation.

A green ribbon placed on the palm of a person, representing Cerebral Palsy Day | © Pixabay

Variations 

There are different types of CP that affect various parts of the brain. Each type causes
specific movement disorders. The types of CP are:

  • Spastic cerebral palsy: Spastic CP is the most common type of CP, affecting approximately 80 percent of people with CP. It causes stiff muscles and exaggerated reflexes, making it difficult to walk. Many people with spastic CP have walking abnormalities, such as crossing their knees or making scissor like movements with their legs while walking. Muscle weakness and paralysis may also be present. The symptoms can affect the entire body or just one side of the body.
     
  • Dyskinetic cerebral palsy: People with dyskinetic CP have trouble controlling their body movements. The disorder causes involuntary, abnormal movements in the arms, legs, and hands. In some cases, the face and tongue are also affected. The movements can be slow and writhing or rapid and jerky. They can make it difficult for the affected person to walk, sit, swallow, or talk.
     
  • Hypotonic cerebral palsy: Hypotonic CP causes diminished muscle tone and overly relaxed muscles. The arms and legs move very easily and appear floppy, like a rag doll. Babies with this type of CP have little control over their head and may have trouble breathing. As they grow older, they may struggle to sit up straight as a result of their weakened muscles. They can also have difficulty speaking, poor reflexes, and walking abnormalities.
     
  • Ataxic cerebral palsy: Ataxic CP is the least common type of CP. Ataxic CP is characterized by voluntary muscle movements that often appear disorganized, clumsy, or jerky. People with this form of CP usually have problems with balance and coordination. They may have difficulty walking and performing fine motor functions, such as grasping objects and writing.
     
  • Mixed cerebral palsy: Some people have a combination of symptoms from the different types of CP. This is called mixed CP. In most cases of mixed CP, people experience a mix of spastic and dyskinetic CP.

Cerebral palsy is classified according to the Gross Motor Function Classification System (GMFCS). The World Health Organization (WHO) and the Surveillance of Cerebral Palsy in Europe developed the GMFCS as a universal standard for determining the physical capabilities of people with CP.

The system focuses on:

  • the ability to sit
  • the capability for movement and mobility
  • charting independence
  • the use of adaptive technology.

The five levels of the GMFCS increase with decreasing mobility:

  • Level 1 cerebral palsy: Level 1 CP is characterized by being able to walk without limitations.
     
  • Level 2 cerebral palsy: A person with level 2 CP can walk long distances without limitations, but they can’t run or jump. They may need assistive devices, such as leg and arm braces, when first learning to walk. They also may need to use a wheelchair to get around outside of their home.
     
  • Level 3 cerebral palsy: A person with level 3 CP 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 the home.
     
  • Level 4 cerebral palsy: A person with level 4 CP can walk with the use of assistive devices. They’re able to move independently in a wheelchair, and they need some support when they’re sitting.
     
  • Level 5 cerebral palsy: A person with level 5 CP 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.

Causes

Abnormal brain development or injury to the developing brain can cause CP. The damage
affects the part of the brain that controls body movement, coordination, and posture.
The brain damage usually occurs before birth, but it can also happen during birth or the
first years of life. In most cases, the exact cause of CP isn’t known. Some of the possible
causes include:

  • asphyxia neonatorum, or a lack of oxygen to the brain during labor and delivery
  • gene mutations that result in abnormal brain development
  • severe jaundice in infancy
  • maternal infections, such German measles and herpes simplex
  • brain infections, such as encephalitis and meningitis
  • intracranial hemorrhage, or bleeding in the brain
  • head injuries as a result of a car accident, a fall, or child abuse.

Treatments

The goal of treatment is to improve limitations and prevent complications. Treatment
may include assistive aids, medications, and surgery.

Assistive aids

  • eyeglasses
  • hearing aids
  • walking aids
  • body braces
  • wheelchairs

Medications
Oral anticonvulsants and muscle relaxants are commonly used as first-line treatments for
CP. Doctors might prescribe:

  • diazepam (Valium)
  • dantrolene (Dantrium)
  • baclofen
  • tizanidine (Zanaflex)

Doctor might also suggest local injections of botulinum toxin type A (Botox) or
intrathecal baclofen therapy, where the drug is delivered by an implantable pump.

Surgery

Orthopedic surgery may be used to relieve pain and improve mobility. It may also be
needed to release tight muscles or to correct bone abnormalities caused by spasticity.
Selective dorsal rhizotomy (SDR) might be recommended as a last resort to reduce
chronic pain or spasticity. It involves cutting nerves near the base of the spinal column.

Other treatment

  • speech therapy
  • physical therapy
  • occupational therapy
  • recreational therapy
  • counseling or psychotherapy
  • social services consultations

Although stem cell therapy is being explored as a potential treatment for CP, research is
still in the early stages.

Statistics in India

There are an estimated 25 lakh people in India with cerebral palsy. The incidence of
cerebral palsy in the country is three per thousand live births. Spastic cerebral palsy is the
most common type, occurring in 70 to 80 per cent of all cases.

References for More Reading and Understanding/Sources

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