Cerebral palsy is a term used to describe a broad spectrum of motor disability which is non progressive and is caused by damage to brain at or around birth. It is a disorder which develops due to damage to cns and this damage can take place before, during or immediately after the birth of the child.
Causes Of Cerebral Palsy
Delayed Cry: Causes asphyxia to the brain causing CP.
Severe Jaundice: presence of high levels of bilirubin causes basal ganglia damage leading to athetoid cerebral palsy and high tone deafness.
Trauma: fall of the body after birth
Infection: like meningitis,or encephalitis can cause brain damage.
NEONATAL CAUSES :
Prematurity: Premature babies are more prone to brain damage either due to trauma during delivery and later on due to immature respiratory and cardiovascular systems. Therefore they are likely to develop hypoxia and low blood pressure also, they are more likely to develop low blood sugar,jaundice, and hemorrhage because of liver immaturity.
Vascular causes: occlusion of internal carotid and mid cerebral artery during birth can on many occasions lead to hemiplegia.
Trauma: Trauma can occur either due to disproportion, breech delivery, forceps delivery, rapid delivery, distortion of head and tearing tentorium.
Asphyxia: It can occur by accidents and burns which could be as a result of knotted umbilical cord, cord around the neck or prolapsed cord. Multiple deliveries can cause asphyxia of the second or third infant.
Neonatal Meningitis: Usually associated with severe residual brain damage.
ANTENATAL CAUSES :
Genetic causes: first or second degree consanguineous marriage.
Intrauterine virus infection: rubella and cytomegalovirus infections. Which lead to severe brain damage along with associated visual and hearing problem with cataract.
Hypoglycemia: low blood sugar for long period lead to brain damage and epilepsy. Cerebellum is more vulnerable leading to ataxia and visual problems. Infants of diabetic mothers are more prone to hypoglycemia.
Trauma to mother;
Infection to mother can make the baby prone to develop it.
Malnourishment of the fetus especially in case of twins.
Exposure of the mother"s abdominal area to repeated x-ray radiation.
Prolong use of medications like steroids by mother. .
Causes Of Cerebral Palsy
Physical therapy is one of the most important treatment for cerebral palsy. That usually begins soon after being diagnosed and often continues through out life. Some people with cerebral palsy may begin physical therapy before being diagnosed,depending on their symptoms. Special devices and equipment are needed for some people with cerebral palsy to help them with specific problems. For example:
- A child who develops uneven leg length may need to wear special shoes with a higher sole and heel on the shorter leg.
- Some people who are not able to walk alone may need to use canes, crutches, walkers, or wheelchairs.
- Phelps Technique
- Passive movement
- Active assisted movements
- Proprioceptive neuromuscular facilitation
- Brunstrom"s approach
- Roods approach
- Vojta"s technique for trigger points were used to reflexly stimulated creeping
- Rolling or crawling activities. Collis technique for dressing
- Feeding, toileting and washing
- Conductive education
- Bobath approach;integrated approach for cerebral palsy
- Normalizing tone of muscles, stretching and mobility
- Developing postural reaction
- Sensory integration
- Oromotor control training,nutitional counseling
PRINCIPLES OF TREATMENT:
- Careful assessment and recording of the child should be an ongoing process and not an isolated one
- Realistically plan and measures should be derived from the assessment
- Early treatment should be incorporated in to daily management of the child
- Repetition and reinforcement are essential for learning and establishing of modified motor pattern.
- Maximize sensory motor experiences
- Involvement of the child as an active participant.
- Motivation of the child should be kept high through the course of the treatment.
- The treatment of the child is a team work and the therapist should involve the family members in the treatment of the child
- There should be adequate consideration for developmental training
- The abnormal tone should be modified so as to facilitate development of function.
- The therapist should try to use adequate afferent stimuli
- All the purposeful active movements should be facilitated.
- Secondary impairments like contractual and deformity should be kept to the minimum
- It is essential to give functional independence which may be with or without compensation.