Cerebral palsy Research by Sumon Ghosh (Founder of ACNRC)

Cerebral palsy is a physical disability that’s an umbrella term referring to a group of disorders affecting a person’s ability to move. Cerebral palsy is due to damage to the developing brain during pregnancy, birth, or shortly after birth. Cerebral palsy affects people in different ways and can affect body movement, muscle control, muscle coordination, muscle tone, reflex, posture, and balance. This disability is a lifelong condition, and it’s different for everybody.

While the brain injury that causes it doesn’t change over time, the wear and tear of living with cerebral palsy often means that people with CP experience age-related changes, like increased muscle weakness and decreased balance, much earlier than people without CP.

People who have cerebral palsy may also have visual, learning, hearing, speech, epilepsy, and/or intellectual impairments.

ACNRC Statistics every hour a baby is born with cerebral palsy Cerebral palsy is the most common lifelong physical disability. 1 million people are living with CP in US 18 million people worldwide

This Photo shooed at Mother Teresa Sister House (Farmgate, Dhaka, Bangladesh

Cerebral palsy is described based on the parts of the body it affects, the way it impacts movement, and the type of brain injury that caused it.

By Body Part Quadriplegia This type affects all four limbs — both arms and both legs. A person’s torso, facial, and oral muscles are often affected, too. Triplegia This type affects three limbs — one arm and both legs. A person’s torso, facial, and oral muscles may be affected, too Diplegia This type affects both legs. A person’s arms may be affected to a lesser extent. Hemiplegia This type affects one side of the body. People can either have right-side hemiplegia (affecting their right arm and leg), or left-side hemiplegia (affecting their left arm and leg). Approximately 40% of people with cerebral palsy have hemiplegia.  Monoplegia This type affects only one limb. By Brain Injury Location Spastic Cerebral Palsy

• Spastic cerebral palsy is the most common form, affecting up to 80% of people with CP.
• This type causes muscles to appear stiff and tight.
• This the result of damage to the motor cortex.

Dyskinetic Cerebral Palsy

• Dyskinetic cerebral palsy — also known as athetoid cerebral palsy — occurs in 6% of people with CP.
• This type is characterized by involuntary movements.
• This is the result of damage to the basal ganglia.

Ataxic Cerebral Palsy

• Ataxic cerebral palsy occurs in 6% of people with CP.
• This type is characterized by shaky movements and affects a person’s balance and sense of positioning in space.
• This is the result of damage to the cerebellum.

Mixed Cerebral Palsy Mixed cerebral palsy means that someone’s brain is injured in more than one location and they will experience symptoms from multiple types of CP

Causes of Cerebral Palsy

There’s no single cause of cerebral palsy, though prematurity and stroke are two of the biggest causes. While the personal cause remains unknown for most cerebral palsy cases, researchers now know that only a tiny percentage of cerebral palsy cases arise from birth-related complications, such as lack of oxygen. It’s scientifically accepted that cerebral palsy usually arises from a series of causal pathways — sequences of events that combine to cause or accelerate injury to the developing brain. For example, although premature birth is the largest risk factor for cerebral palsy, it’s the causal pathways that led to this circumstance that may cause the cerebral palsy, rather than the premature birth itself. Risk Factors While risk factors don’t cause cerebral palsy, their existence may increase the chance of a cerebral palsy diagnosis. Some factors include:

• A premature birth earlier than 37 weeks.
• Prolonged oxygen loss during the pregnancy or the birth process.
• Low birth weight.
• Being a twin, triplet, or other multiple birth, as this increases the chances of both prematurity and low birth weight.
• Being male.
• Severe jaundice shortly after birth.
• Blood clotting problems.
• Placental inability to provide a developing fetus with oxygen and nutrients.
• Blood type incompatibility between mother and baby.
• Maternal infection early in pregnancy with German measles or other viral diseases.
• Maternal, fetal, or infant bacterial infection that attacks the child’s central nervous system.

Is Cerebral Palsy Genetic or Hereditary? Familial cerebral palsy is uncommon, as only 1% of people with cerebral palsy will have a sibling who also has it. Cerebral palsy is uncommon in twins as well. When one twin has cerebral palsy, only 10% of co-twins will also have it. Researchers generally believe that a genetic predisposition to certain characteristics like prematurity or heart problems may potentially act as the start of a causal pathway that can result in a person having cerebral palsy.

 Treatments (Interventions) for Cerebral Palsy (ACNRC)

Although cerebral palsy is a lifelong disability, there are many interventions that can help reduce its impact on the body and the individual’s quality of life. An intervention is a service that aims to improve the condition of cerebral palsy and the day-to-day experience of the person living with it. Children with cerebral palsy may be supported by a team of professionals including health professionals and community-based support services who work together to help the child and family reach their goals. Through their late teens and early 20s, many young people take increasing responsibility for their own health and wellbeing. Their team may include health professionals and mainstream community providers such as fitness trainers. Interventions for movement issues Medication Medical specialists may prescribe medications that assist movement issues. Some medications are taken orally (e.g. diazepam) and others are injected or delivered through surgically implanted pumps (e.g. Baclofen). Many children with cerebral palsy benefit from Botulinum toxin type A injections into muscles affected by spasticity. This intervention is used from about two years of age and is most effective when used in conjunction with therapy. Surgical procedures Selective Dorsal Rhizotomy (SDR) is a neurosurgical procedure that is used in a small percentage of children with cerebral palsy to permanently reduce spasticity in their legs. Physical therapy and occupational therapy Physiotherapists and occupational therapists focus on encouraging a person’s day-to-day movement skills such as sitting, walking, playing, dressing and toileting. They will use a range of specialist interventions such as movement training and equipment, e.g. walking frames, wheelchairs, supportive seating, footwear and orthotics. Interventions for muscle, bone and joint issues Surgical procedures Orthopedic surgeons correct joint deformities and lengthen muscles. Surgery usually takes place in a child’s late primary years or early adolescence to improve walking quality and reduce pain. Pediatric rehabilitation specialists support the management of some of the conditions associated with cerebral palsy, such as spasticity, musculoskeletal issues and growth. Casts, splints and muscle strengthening Physiotherapists and occupational therapists may also focus on preventing impairments that might affect movement. They use casts, orthotics and muscle strengthening exercises. Interventions for communication issues Speech pathology Speech pathologists assess and provide intervention for communication skills. This includes understanding what is being said and learning to use words and sentences. Treatment (intervention) for communication often involves the use of augmentative or alternative communication systems, such as signing, communication boards and speech generating devices.

• Interventions for intellectual disability and learning difficulties
• Assessments, special education and learning strategies

Psychologists can provide assessment of a child’s learning and development. Special educators work with families to develop a program of interventions to address each child’s learning needs. Occupational therapists can facilitate a child’s active participation in these learning activities.

Psychologists and occupational therapists can provide assessment and recommend learning strategies to compensate for perceptual difficulties. Interventions for epilepsy Medication Medical specialists may prescribe antiepileptic medication to minimise the number of seizures. They will also guide families on the management of seizures when they do occur. Interventions for pain management Medication

• Pain may be treated through medication and by addressing the underlying cause of the pain, e.g. by treating muscle contractures.
• Cognitive-behavioral therapy
• Psychologists may offer cognitive-behavioral therapy for chronic pain. This process works to help a person change the way they think about pain and, in turn, how they feel and behave about pain.
• Massage therapy and hydrotherapy
• Temporary relief of pain may be assisted through massage or hydrotherapy.
• Interventions for sleep disorders

Medication Medical specialists may prescribe medication or treat the associated issues that impact on sleep. Behavior therapy Psychologists may assist with behavior therapy or help families to establish routines to help resolve children’s sleep issues. Sleep systems For children with postural issues that make sleep difficult, occupational therapists and physiotherapists may prescribe special sleep systems to help children feel more comfortable in bed. Interventions for behavior and emotional issues Behavior therapy and counselling Psychologists can offer assessment and support for emotional and behavioral challenges, which may include behavior therapy and cognitive behavior therapy. Social workers support people with cerebral palsy and their families in many ways, including strengths-based counselling and mutual aid groupwork. Interventions for issues with eating, digestion and nutrition Medication and surgery Treatment (intervention) for severe difficulties with digestion, such as gastro-esophageal reflux (GOR) includes medications or sometimes surgery. If the individual has severely limited eating skills or experiences an unsafe swallow, non-oral feeding may be recommended. This involves a surgically inserted feeding tube to the stomach. Medical interventions are performed by medical specialists in hospitals. Speech Pathology and Dietary Advice Speech pathologists provide assessment and treatment (intervention) for eating, drinking and swallowing difficulties. Examples of these are learning to use the muscles of the mouth better, using specially designed utensils and sitting in an optimal position. Dietitians provide advice on improved and balanced nutrition. Interventions for issues with saliva control (dribbling and drooling) Speech pathology Speech pathologists may suggest various strategies to help people manage saliva loss. These include remembering to wipe their mouth and wearing age-appropriate clothing protection. They may also recommend special exercises for the face and mouth, which may lead to better ability to control saliva.