cp, dystonia

Cerebral palsy is a physical impairment that affects movement and co-ordination. It ranges in severity from one person to another. Some children might experience movement problems that are barely noticeable, while for others these problems might be very severe.

It is estimated that around one child in 400 has some degree of cerebral palsy.

 

The most common cause is that the brain is damaged secondary to prematurity. About 40 per cent of children with cerebral palsy are premature.

This usually affects the cortex which is the biggest section of the brain and is responsible for voluntary muscle movement, communication, and many thought processes including the interpretation of the senses of hearing and sight.

Problems can also develop because of a blocked blood vessel, complications in labour, or as a result of an infection which happens before or after birth, causing meningitis or encephalitis.

The condition is often noticed early in life. A baby may seem ‘floppy’ and could have feeding problems (the muscles in the throat used in swallowing might not be working properly).

Soon afterwards tightness of the muscles (spasticity) might emerge or more jerky chaotic movements (dyskinesia).

Often a child with cerebral palsy will fail to achieve the expected ‘milestones’ of development and their movement patterns are unusual (such as fisted hands or stiff pointed ankles) as though they are trying to walk on tiptoe. Some will go on to have difficulty walking.

Other problems can include speech and feeding difficulties, balance and co-ordination problems, hearing and sight problems and learning difficulties.

Between a quarter and a third of children and adolescents are also affected by epilepsy.

There are three main types of cerebral palsy:

  • Spastic cerebral palsy which affects muscle tone. Muscles can become very stiff and weak.
  • Dyskinetic cerebral palsy where muscle tone can fluctuate.
  • Ataxic cerebral palsy which is the least common and means movements are often jerky and balance is poor.

Different parts of the body can be affected:

  • Hemiplegia means just one side of the body.
  • Diplegia is where the legs are more affected than the arms.
  • Quadriplegia (also called four limb/total body involvement) is where both arms and legs are affected. Quadriplegia is usually the most severe in terms of other problems co-existing.

The conditions don’t progress – in other words brain damage doesn’t get worse – but a person’s physical capacity can change over time.

There isn’t a cure for cerebral palsy. It isn’t yet possible to repair damage to the brain. However there is a lot that can help a child cope with the condition, and to prevent complications (such as deformities or contractures) from happening.

Care is usually co-ordinated through a developmental paediatrician as part of a child development team, where therapists and doctors work together. If there are many professionals involved, a key worker may help with this.

Physiotherapy is usually the first line in treatment. Specific exercises will help keep a child’s muscles flexible. Monitoring of hips and spine is often indicated and sometimes an orthopaedic surgeon is needed if complications develop.

Medication can help control spasms in the muscles and help joints to move more freely. If a child has seizures, these can be controlled with the help of anticonvulsant medication.

Botulinum toxin injections can be useful for some children with cerebral palsy. This helps specific muscles relax so they become less stiff, enabling a child to move around more easily and comfortably.

A specialised speech and language therapist will be able to help with any speech problems, and also with difficulties relating to feeding and swallowing.

An occupational therapist might also become involved if the child needs special seating or equipment.

Problems with hearing or sight can be helped by means of hearing aids or glasses.

The effects of cerebral palsy vary enormously from child to child. Even at its most severe, with the right support and treatment, the symptoms can be eased. Most children with cerebral palsy go on to lead a full and independent life in the future.

Some children won’t experience any learning difficulties while others will need specialist help.

If as a result of their physical and/or learning difficulties a child does have special educational needs, they may still do well in a mainstream school with extra support. Specialist schools may also be an option. The earlier the child can get the right help, the more they will benefit in the long run.

In around one in six cases, cerebral palsy causes involuntary muscle spasms and unwanted movement – this is described as dystonic cerebral palsy (or alternatively dyskinetic orchoreoathetoid cerebral palsy).

The symptoms of dystonic cerebral palsy are usually of muscle spasms which can be difficult to control and sometimes painful.  These are a result of incorrect signals from the brain. The spasms cause a range of different unwanted movements.

Dystonic cerebral palsy often appears in combination with other symptoms of cerebral palsy – usually the dystonic movements appear in combination with high and/or low muscle tone. For this reason, the condition is often described as cerebral palsy withdystonia.
Dystonic cerebral palsy is generally caused by damage to the basal ganglia – part of the brain involved in the recruitment of muscles of movement. Anything that changes or affects the normal development of the brain can lead to problems with the way it transmits information to the muscles, and therefore can cause cerebral palsy.

No two people will be affected by dystonic cerebral palsy in the same way. A child with this type of cerebral palsy can appear restless and constantly on the move. The muscle spasms may cause twisting, repetitive movements or abnormal postures (dystonia) abrupt, irregular, jerky movements (chorea) or slower sinuous movements (athetosis) or sometimes a combination of these movements (choreoathetosis). The child may also have difficulty holding him / herself upright when sitting or walking.

The child may also have difficulty controlling movements of the face, tongue, lips, jaw, throat and muscles of respiration. This will affect someone’s facial expressions, speech, eating, drinking and saliva control.

The abnormal movements often increase with raised emotions, such as excitement or stress.  Relaxation can help reduce these symptoms. The movements usually disappear completely when a person is asleep.