Overview of Cerebral Palsy
‘Cerebral Palsy’ is a term which covers a number of neurological conditions, which impact upon movement and co-ordination in those affected. It is caused when the child’s brain is damaged, usually sustained either before, during or shortly after birth. As well as affecting the brain directly, cerebral palsy also affects the nervous system.
Cerebral palsy varies significantly in severity. The part of the brain affected in children with cerebral palsy is the cerebrum: this controls muscles, which causes the physical spasms many of those affected suffer with, as well as communication skills, vision, hearing and memory, all of which in turn can hinder the ability to learn.
In the majority of cases, the damage to the brain occurs prior to birth, when the baby is still in-utero. However, in approximately 5 – 10% of cases, the damage is caused by asphyxia: the temporary deprivation of oxygen to the baby’s brain during the birthing process. This is sometimes a symptom of a difficult or complicated birth.
Very rarely, the damage can occur after birth, but in these circumstances it will almost always be in the baby’s first few months of life. As the brain develops it becomes more able to withstand moderate damage, and adapt accordingly, but very young babies will not have developed that resilience. In cases of post-natal cerebral palsy the damage is most often caused by either an infection in the brain (such as meningitis) or trauma to the head.
Types of Cerebral Palsy
Cerebral palsy is classified in five different ways:
- Spastic hemiplegia. This affects one side of the body only and results in varying degrees of muscle stiffness, and/or muscle overactivity. It can also cause a curvature of the spine.
- Spastic diplegia. This results in muscle stiffness in the legs.
- Ataxic cerebral palsy. This affects balance and depth perception.
- Athetoid (dyskinetic) cerebral palsy. This affects muscle tone, and can cause either over development or under development of muscles. It can also affect speech.
- Spastic quadriplegia. This is the most severe form of cerebral palsy and often renders a child unable to walk. They are also often unable to support their neck, meaning that sitting up can be difficult. Children with this type of cerebral palsy may also have learning difficulties, ranging from moderate to severe.
Symptoms of Cerebral Palsy
It is often not possible to diagnose a child with cerebral palsy at birth, or indeed in the first few months or years of their lives. Sometimes, it may be evident early in their life if they have muscle problems, as this will mean they cannot contract or relax muscles as needed; they may appear to be very floppy (hypotonic) or very rigid (hypertonic). However, in some children it may be when they start reaching an age at which developmental goals would ordinarily be met, such as crawling.
Even then, it is often difficult for doctors to diagnose the type of cerebral palsy your child is suffering from, and the extent of it, until they are 5 years old or so. A number of different scans will often be required to confirm a diagnosis, which are unpleasant. However, when the correct diagnosis has been made the treatment offered to your child and the care regime put in place can be much more targeted, and therefore more beneficial. A support package can be put together with their nursery or school to ensure they receive supported learning where necessary, and adaptations can be made to your home if necessary to help both you and your child. It is therefore important to seek that diagnosis, to ensure your child can lead as full a life as possible in spite of their condition.
This will manifest by way of muscle stiffness on one side of the body, often only affecting the upper limbs. A curvature of the spine may be present. Children with this type of cerebral palsy may have speech difficulties, but their intelligence should not be affected.
It is not uncommon for children with this type of cerebral palsy to suffer with epilepsy.
This will present by way of stiffness in the legs, making it difficult for your child to walk.
This type of cerebral palsy should not affect intelligence, or restrict your child’s ability to communicate at all.
Ataxic cerebral palsy
A child suffering from this type of cerebral palsy may often appear clumsy. Their motor co-ordination is affected; they struggle to co-ordinate precise movements. Communication and intelligence should not be affected.
Athetoid cerebral palsy
Uncontrolled body movements are symptomatic of this type of cerebral palsy. It can affect a child’s ability to communicate as they cannot always control their tongue or their vocal cords. The random nature of the muscle spasms can lead to difficulty eating, and can cause some children to drool.
Normally, their intelligence will not be affected.
A child suffering with this type of cerebral palsy will, sadly, have suffered extensive damage to their brain. Often, they will be unable to walk as the level of limb stiffness will be severe, although their neck muscles, by contrast, will be weak and they may therefore be unable to support their head.
They will often be unable to communicate easily as they will have affected speech. Learning difficulties are common and range from moderate to severe.
Children with this type of cerebral palsy often have epilepsy as well, and frequent seizures are common.
Effects of cerebral palsy
For some people, living with cerebral palsy does not cause them too many difficulties in every day life. They are able to live independent lives without any assistance at all. However, for others, the condition can cause profound disability and mean that they require lifelong care.
Cerebral palsy does not get worse. The problems your child has from birth will not deteriorate as a result of this condition, as it is not progressive or degenerative in nature. However, as a child grows the effect cerebral palsy has on them may change.
Physically, in someone suffering with a mild form of cerebral palsy, the strain on their legs for example can increase as they grow bigger. That can cause consequential problems with pain, wearing of the joints, arthritis etc. In someone with a more severe form, caring for them as they grow into adulthood can become ever more challenging for parents or carers.
Emotionally, a child who has an insight into their condition may find it very difficult as they grow older, and realise that they are perhaps limited in terms of what activities they can join in with, and what options are available to them in terms of education and employment. This can prove to be very isolating for the individual. Living with a chronic condition such as cerebral palsy is a challenge in itself for many sufferers, and depression often stems from the feelings of stress and anxiety brought about by it.
However, there are many ways in which symptoms can be relieved now, and in which a child’s sense of independence and self-esteem can be increased. Support in schools, universities and work places is improving all the time, both in terms of those with learning difficulties and those with physical disabilities. There is much more awareness in society in general now of disability as a whole, and less of a stigma; although clearly, there is still a long way to go here.
There are a range of treatments available which can help improve the physical effects of cerebral palsy, ranging from therapies (occupational therapy, physiotherapy, speech and language therapy) to drug treatment and surgery. Equipment is much improved in recent years, and allows those with disabilities to get around independently whilst simultaneously relieving some of the symptoms brought about by the physical strain this condition can put their body under.
Mental health care still has a long way to go in general in the UK, but treatment such a cognitive behavioural therapy, which is available on the NHS, can help people suffering with cerebral palsy and a consequential depressive illness.