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✨The Calm Within​✨
Curated by Dr. Karen Singh, where modern neuroscience meets ancient wisdom. This space is dedicated to exploring the powerful connection between the nervous system, mind-body medicine, and holistic health practices that transform lives from the inside out. 

Cerebral palsy

17/5/2021

 
Cerebral palsy (CP) is a group of non-progressive motor conditions that cause physical disability. CP is caused by damage to the motor control centers of the developing brain, which can occur before a baby is born, during childbirth, or after birth up to age five. ‘Cerebral’ refers to the cerebrum, which is the affected area of the brain (although the disorder may involve other parts of the brain, such as the cerebellum), and ‘palsy’ refers to a disorder of movement.

The effects of cerebral palsy can vary dramatically from one individual to the next. Some have only minor impairments and are totally independent; others struggle greatly with the tasks of daily life and require extensive assistance and 24-hour care. 
Currently, cerebral palsy has no cure, but there are a variety of treatments and therapies that can alleviate certain symptoms and improve function.

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Types of cerebral palsy

Although there are many different ways of describing or categorizing the way cerebral palsy affects an individual (this will be discussed more in the next section), people often divide it into the following four subtypes:

  • Spastic cerebral palsy
  • Ataxic cerebral palsy
  • Athetoid/dyskinetic cerebral palsy
  • Mixed cerebral palsy

Spastic cerebral palsy
Spastic cerebral palsy is by far the most common type of cerebral palsy, comprising roughly 80% of all cases. Children with spastic cerebral palsy have lesions in the upper motor neurons of the central nervous system. This damage leads to hypertonia (extreme muscle tension) in the muscles that receive signals from damaged portions of the brain. Hypertonia can cause involuntary muscle contractions, spasms, and secondary pain and/or stress. Additional side effects of spastic cerebral palsy include joint deformities, scoliosis, hip dislocation and more.

Ataxic cerebral palsy
Ataxic cerebral palsy is the least common type, occurring in roughly 5-10% of all CP cases. It is caused by damage to the cerebellum and affects controlled movements and fine motor skills. This includes balance and coordination (particularly while walking) and precise movements such as writing. In young children, hypotonia is a common manifestation of ataxic CP. Unlike the rare form of degenerative neurological disease ataxia, ataxic cerebral palsy is a non-progressive condition. It is common for children with ataxic cerebral palsy to have difficulty with visual processing (depth perception and eye movement control) and/or speech.

Athetoid/dyskinetic cerebral palsy
Athetoid/dyskinetic cerebral palsy (ADCP) occurs in roughly 0.27 per 1,000 live births and comprises 15-20% of CP cases. This subtype is the result of damage to the basal ganglia, the part of the brain responsible for regulating voluntary movements. In many cases, ADCP is caused by hypoxic-ischemic encephalopathy/HIE (brain damage due to a lack of oxygenated blood) or kernicterus (brain damage due to severe or improperly-managed jaundice).  

ADCP causes a combination of hypertonia, hypotonia, and involuntary motions. Children with ADCP may have trouble sitting upright, walking, grasping objects, performing fine motor tasks, sucking, swallowing, and talking. ADCP is further characterized into three subgroups based on the nature of the movements: 

  • Dystonia (dystonic cerebral palsy): Involuntary muscular contractions that cause repetitive twisting motions, postural abnormalities, and painful movement.
  • Athetosis: Abnormal muscle contractions that cause slow, involuntary writhing movements.
  • Chorea: Irregular, unpredictable jerking movements. When chorea occurs in conjunction with athetosis, it is known as choreoathetosis.

Mixed cerebral palsy
Mixed cerebral palsy involves a combination of symptoms that don’t all fit within a single subtype of CP. For example, a child may have both hypertonia and hypotonia. In other words, some of their muscles are too tight, while others are too loose.
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Signs and symptoms of cerebral palsy

Although “signs” and “symptoms” are often used as interchangeable terms, they have their own specific definitions:
  • Signs can be detected, measured, and confirmed in a clinical setting by medical practitioners. Examples include seizures and tremors.
  • Symptoms are solely based on a patient’s personal experience of his or her medical conditions. Examples include pain and irritability.

Because cerebral palsy affects different people in different ways, there is no one sign or symptom used individually to diagnose it. Most people with cerebral palsy are diagnosed as infants or toddlers, but others do not show clear signs or express symptoms until they are a bit older and developmental delays (missed milestones) become more obvious. Click here to learn more about early signs of cerebral palsy.

Neonatal predictors of cerebral palsy
  • Seizures
  • Low birth weight
  • Unusually small or large head circumference
  • Low Apgar scores
  • Low activity 
  • Diminished cry
  • Problems with temperature regulation
  • Feeding problems
  • Breathing problems (e.g. apnea) or need for resuscitation
  • Hypotonia (baby appears floppy)
  • Hypertonia (baby appears stiff)
  • Low red blood cell count (anemia)
  • Metabolic acidosis

Other common signs of cerebral palsy
  • Involuntary movements (spasms, writhing, etc.)
  • Poor coordination (ataxia) or balance
  • Unusual posture or limb positioning
  • Difficulty bringing hands together or manipulating objects
  • Favoring one side of the body over another (i.e. a strong preference for reaching out with one hand)
  • Failure to reach (or delay in reaching) developmental milestones such as sitting up, crawling, or walking
  • Speech-language problems
  • Difficulty swallowing or excessive drooling
  • Cognitive impairments
  • Vision or hearing problems
  • Behavioral and emotional problems
  • Incontinence
  • Retention of primitive reflexes (e.g. Moro reflex)

Birth injuries and other causes of cerebral palsy

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Cerebral palsy can be caused by environmental and/or genetic factors.  However, in most cases, it is attributable to a birth injury (i.e. something that goes wrong during pregnancy, birth, or the neonatal period). Unfortunately, birth injuries that result in cerebral palsy are often linked to medical malpractice. 
The following are some examples of birth injuries and other environmental factors that can cause or increase the risk of cerebral palsy:
  • Abnormal fetal position/presentation
  • Birth asphyxia/hypoxic-ischemic encephalopathy (HIE)
  • Birth trauma
  • Brain bleeds (intracranial hemorrhages)
  • C-section errors and delays/failure to timely deliver
  • Forceps and vacuum extractor injuries
  • Low birth weight
  • Maternal infections
  • Meconium aspiration syndrome (MAS)
  • Mismanaged fetal distress (or failure to provide proper fetal monitoring)
  • Mismanaged high-risk pregnancy (or failure to diagnose a high-risk pregnancy)
  • Periventricular leukomalacia (PVL)
  • Placental abruption
  • Premature birth
  • Prolonged and arrested labor
  • Twin or multiples pregnancy
  • Umbilical cord problems
  • Uterine tachysystole/hyperstimulation
  • Uterine rupture
It is worth noting however, that these issues do not guarantee that a child will necessarily develop cerebral palsy. In many cases, cerebral palsy is a preventable condition. This means that medical practitioners can avoid cerebral palsy by following the standards of care for a given pregnancy, labor, or birth. If they mismanage the conditions above, cerebral palsy is much more likely to result.

Conditions associated with cerebral palsy

No two cases of cerebral palsy are identical. Depending on the location and severity of the initial brain injury, the conditions and side effects associated with cerebral palsy will vary. Factors such as treatment, therapy, environment and age also affect a person’s functional potential. However, common conditions associated with CP – aside from mobility impairments – include the following. Please note that incidence estimates have been rounded to the nearest five and that some come from studies with small sample sizes:

  • Chronic pain (50-75%) (25)  
  • Cognitive disabilities (50%) (11)
  • Speech-language problems (40-50%; approximately 25% are nonverbal) (11, 25)
  • Epilepsy (25-45%) (11, 25)  
  • Visual impairments (30-50%) (11)
  • Hearing impairments (5-20%) (11, 25)
  • Hip displacements (35%) (25) 
  • Scoliosis (20-65%) (26) 
  • Behavioral disorders from cerebral palsy (25%) (25)
  • Bladder control problems (25%) (25)  
  • Sleep disorders from cerebral palsy (20-45%) (25, 27) 
  • Saliva control problems (20%) (25) 
  • Eating problems (5% use a feeding tube) (25)
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Diagnosing Cerebral Palsy

The diagnosis of cerebral palsy is typically based on a physical examination and the child’s medical history.  Neuroimaging with CT or MRI is warranted when the cause of a child’s cerebral palsy has not been established. These tests can also help to determine the timing of the initial damage and the likelihood of associated conditions such as epilepsy and developmental disabilities.

Some people with cerebral palsy are diagnosed in early infancy, and most receive their diagnosis by age two. However, cerebral palsy may go undetected until children miss major developmental milestones; sometimes, a diagnosis is not made until age four or five. Because clinical signs of cerebral palsy evolve as the nervous system matures, the diagnostic process usually involves multiple trips to the child’s primary physician, as well as several other specialists.
Furthermore, the time at which a cerebral palsy diagnosis is made often depends on the type of cerebral palsy the child has. For instance:
  • Spastic cerebral palsy diagnoses are often made between 9.6 and 11 months if it is bilateral, and between 12.0 and 15.6 months if it is unilateral. 
  • Dyskinetic cerebral palsy diagnoses are often made between 6.0 and 8.4 months.
  • Ataxic cerebral palsy diagnoses are often made between 12.6 and 30.0 months. 
It is important to note that the degree of motor disability also influences diagnostic age. Those with more severe impairments are generally diagnosed earlier because the signs are more obvious.

Preventing Cerebral Palsy

Since cerebral palsy is frequently the result of medical mistakes made during pregnancy, around the time of delivery, or in the neonatal period, it is often preventable. Because the effects of cerebral palsy can be severe, it is tragic that many cerebral palsy diagnoses may be the result of preventable medical errors and birth injuries.

Our best recommendation is to get started with a great prenatal chiropractor, like the doctors at Nandish Chiropractic. Studies show that greater than 90% of women who seek chiropractic care during pregnancy are satisfied with their results.

If you want to make sure your pregnancy is as comfortable as possible, take the next step and book a consultation with one of the doctors at Nandish.
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As an added bonus, we have made a list just for you, to further help reduce pain during pregnancy:
  • Exercise and mobility. Starting this process before becoming pregnant means you’ll most likely have an easier pregnancy. Always consult a healthcare practitioner, including your chiropractor, before beginning a new exercise regime during pregnancy.
  • Place a pillow between your legs while sleeping on your side.
  • Take frequent breaks during the day and elevate your feet.
  • Use a lumbar support pillow for long periods of sitting.
  • If working at a desk take frequent breaks every hour.
  • Don’t be afraid to ask for help when lifting objects.
  • Learn the proper method for getting up from bed to avoid abdominal splitting.
Click here to book now

References

  1. Cerebral Palsy (CP). (2018, March 09). Retrieved September 20, 2018, from https://www.cdc.gov/ncbddd/cp/data.html
  2. Nordqvist, C. (2017, February 21). Cerebral palsy: Symptoms, causes, and treatments. Retrieved September 20, 2018, from https://www.medicalnewstoday.com/articles/152712.php
  3. Cerebral Palsy: Hope Through Research. (n.d.). Retrieved September 20, 2018, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Cerebral-Palsy-Hope-Through-Research#3104_2
  4. Cerebral Palsy (CP). (2018, April 18). Retrieved September 20, 2018, from https://www.cdc.gov/ncbddd/cp/facts.html
  5. Tilton, A. H. (2004, March). Management of spasticity in children with cerebral palsy. In Seminars in Pediatric neurology (Vol. 11, No. 1, pp. 58-65). WB Saunders.
  6. Abdelaziz, T. H., Elbeshry, S. S., Mahran, M., & Aly, A. S. (2017). Flexion deformities of the wrist and fingers in spastic cerebral palsy: A protocol of management. Indian journal of orthopaedics, 51(6), 704.
  7. Cloake, T., & Gardner, A. (2016). The management of scoliosis in children with cerebral palsy: a review. Journal of Spine Surgery, 2(4), 299.
  8. Children’s Hospital. (2014, May 05). Cerebral Palsy Hip Disorders. Retrieved September 20, 2018, from https://www.chop.edu/conditions-diseases/cerebral-palsy-hip-disorders
  9. Ataxia: Causes, Symptoms and Diagnosis. (n.d.). Retrieved September 20, 2018, from https://www.healthline.com/symptom/ataxia
  10. Cerebral Palsy: Causes, Treatment and Prevention. (2016, May 18). Retrieved September 20, 2018, from http://americanpregnancy.org/birth-defects/cerebral-palsy/

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