CP: briefly about everything

Introduction

Cerebral palsy, or CP is a group of disorders that affects the ability of a person to move and maintain balance and posture. The word “cerebral” refers to a condition relating to the brain, and “palsy” means “weakness”, difficulties in muscle control.

Cerebral palsy develops as a result of a central nervous system developmental disorder or brain damage, which affects one’s ability to control muscles. The manifestations of the disease are diverse and correspond to the severity of the condition of a child with cerebral palsy: from the need for third-party care throughout their lives to the ability to walk using special means or even entirely independently.

Cerebral palsy (CP) does not progress over time, but some symptoms may change: if you do not treat a child with cerebral palsy, muscle contraction and muscle “stiffness” may increase.

In all cases, cerebral palsy (CP) manifests with motor disorders. Many other pathological conditions may be accompanied by disorders of movement: seizures, hearing, vision and pronunciation problems, mental retardation, etc. Cerebral palsy (CP) is one of the most frequent causes of childhood disability: the incidence in Ukraine and Europe reaches 2-3 per 1,000 live births and up to 100 per 1,000 live births among the premature infants.

Forms of cerebral palsy

There are four basic forms of cerebral palsy (CP), depending on the type of muscle tone disorders:

1. Spastic form – tense muscles. Spastic cerebral palsy is the most common form and accounts for 80% of all cases. The muscle tone is increased, and muscles are constantly in a state of contraction, which complicates the activity.
2. Atactic form – the lack of balance and coordination. Children with an atactic form of cerebral palsy have difficulties in balance and coordination. It manifests in difficulties with walking, as well as rapid movements or actions that require concentration and control (for example, writing).
3. Dyskinetic form – an uncontrolled motor activity. In the case of a dyskinetic cerebral palsy, uncontrolled movements of arms or legs are observed; they can be either slow and flexible or fast and tedious. Usually, it creates difficulties in the children’s motor activity; first and foremost they face difficulties in sitting and walking. Sometimes, face and tongue muscles are affected, which leads to problems with swallowing and speech. One of the subtypes of this cerebral palsy form is dystonic CP. Its manifestation includes the inconsistency in muscle tone when the period of complete relaxation is replaced by a period of intense tension. Changes can occur either once for a couple of days or several times a day.
4. Mixed form – it is impossible to distinguish the signs of only one form of cerebral palsy, which prevails, the symptoms of different types occur simultaneously instead. The most common combination is spastic-dyskinetic.

Also, CP is classified according to the following features:

• The affected parts of the body:   
  • Hemiplegia (affects one half of the body – right or left).   
  • Diplegia (a paralysis that affects either both lower or both upper extremities, but to a greater extent legs).   
  • Tetraplegia (involvement of the hands and feet).
• The extremities movement disorders:   
  • The Gross Motor Function Classification System (GMFCS) is used for the classification of large motor functions.

Risk factors and causes of cerebral palsy

CP occurs as a result of an affection of the child’s nervous system, intrauterine (80% of cases), or after birth (20%). Various factors influence and damage the child’s brain, in particular those areas that are responsible for movement.

None of the listed factors necessarily leads to the onset of the disease, but the presence of these factors increases the risk of CP development.

The most common risk factors are the following:

• Prematurity and low body weight of the newborn;
• Intrauterine fetal hypoxia, hypoxia during the delivery or immediately after birth;
• Infectious diseases of the child’s brain;
• Disorders of the blood coagulation system of the child;
• Traumatic brain damage or hemorrhage in the child’s brain;
• Viral and infectious diseases of the mother and the fetus during pregnancy;
• Thyroid disease in mother;
• Chemical substances influence and harmful habits during pregnancy (including occupational hazards, smoking, drug use);
• Hemolytic disease of the newborn;
• Gene mutations;
• Complications during pregnancy and delivery (a rarer cause of CP than is commonly believed, ranging from 5 to 10% of cases).

More on the risk factors and causes of cerebral palsy in this article: Causes and Risk Factors of Cerebral Palsy. Cerebral Palsy During Pregnancy.

Symptoms of cerebral palsy

Sometimes the symptoms of CP can be detected right at birth when a physician examines a child and assesses her condition, but most often the diagnosis is established only at the age of one to two years. Cerebral palsy can be accompanied by symptoms that vary greatly in patients depending on the type of the disease.

The main symptom that can help suspecting the risk of CP development is motor impairment. It manifests during the child’s development (the ability to hold the head, roll over from back to stomach, sit, crawl, stand, and walk are the most important «milestones» to be checked ).

Symptoms include:

• Changes in muscle tone: from full relaxation to strong contraction.
• Strong muscle tension + elevated reflexes (spasticity) – often in the form of bending the child’s body in one direction, the asymmetric position of the extremities.
• Movement coordination disorders (ataxia).
• Slow, flexible movements (athetosis).
• Tremor or uncontrolled, chaotic movements.
• Children show unreasonable anxiety or laziness.

Secondary manifestations are:

• Disorders of sucking, swallowing, and salivation.
• Delay in language development.
• Seizures (epilepsy).
• Visual and hearing impairment.
• Mental retardation.

You may read more about symptoms of CP in this article: Cerebral Palsy Symptoms

How to treat cerebral palsy?

There are many conservative and alternative methods used to treat patients with cerebral palsy. Today, it is impossible to cure these patients fully, but there are therapeutic regimens that are aimed at developing lacking functions to live life as fully as possible:

• Kinesiotherapy (massage, therapeutic physical training).
• The author’s complex integrated methods of rehabilitation:
  • Kozyavkin V.I. method
  • Semenova K.O. method
  • The concept of K. and B. Bobat.
  • Voit V. method and others.
• Drug treatment (botulinum toxin type A preparations, central muscle relaxants).
• Sensory integration, touch room.
• Acupuncture therapy.
• Means of orthopedic correction: stepping gypsum, orthosis, orthopedic footwear, tires (by indications).
• Surgical treatment (elongation of the tendons, reduction of the tone of the affected muscles).
• Hippo therapy, aqua therapy in specialized centers and swimming pools.
• Medical devices for rehabilitation.

In young children, the brain has a high potential for regeneration, and therefore the treatment of cerebral palsy should begin as soon as possible. Only the synergy of the efforts of the multidisciplinary team of specialists from different fields of medicine, rehabilitation, and psychology can maximize the effectiveness of treatment and help to achieve its maximum results. Undoubtedly, this is difficult, complex and, importantly, highly specialized work, but we should never forget that the main goal of patients with cerebral palsy treatment is not only improving the state of health or adaptation to the requirements of our time, but also a significant improvement in their quality of life.

If you want a more detailed overview, read our article on treatment approaches for cerebral palsy.

About the author

Halyna Lun

Deputy Director of the Elita Rehabilitation Center, pediatrician, and mentor with over 30 years of practice. She leads the medical department, consults families, and trains future doctors.