Cerebral Palsy

Definition Cerebral Palsy(CP) is the term used for a group of non progressive disorders of movement and posture caused by abnormal develo...

Definition
Cerebral Palsy(CP) is the term used for a group of non progressive disorders of movement and posture caused by abnormal development of, or damage to, motor control centers of the brain. CP is caused by events before, during, or after birth. The abnormalities of muscle control that define CP are often accompanied by other neurological and physical abnormalities. Cerebral Palsy affects body movement, muscle control, muscle coordination, muscle tone, reflex, posture and balance.
NATURE
Though most people refer to cerebral palsy as a single condition, it is actually a condition that incorporates a number of different central nervous system disorders. Each case of this condition is unique and affects a person's development in different ways. Because of the unique nature of this disorder, the care and therapy for this condition should be uniquely tailored to each individual patient. Spastic cerebral palsy is the most common form of this disorder and greatly affects musculoskeletal function. Spastic cases affect the muscles and joints, leaving them very tight and inhibiting their motion. This can result in challenges with motions like walking and extending the hands and arms.
 Other types of cerebral palsy can affect a person's mental development, as well as their sensory and digestive functions. These disorders can affect a person's sight, hearing, and nervous system in harmful ways. Also, the nature of this condition can affect how a person's brain function develops.

ASSOCIATED CONDITIONS OF CEREBRAL PALSY
Primary conditions – These are a direct result of the brain lesion or brain malformation. Primary conditions affect motor coordination, motor control, muscle tone, posture and balance. Gross motor, fine motor, and oral motor functioning are also considered primary conditions of Cerebral Palsy.
Secondary conditions – Primary conditions, in turn, may lead to secondary conditions such as inability to chew, inability to swallow, breathing difficulties, bladder and bowel control issues, and communication difficulties. If the brain lesion or malformation that caused Cerebral Palsy did not exist, these secondary conditions would not be present.
Associative conditions – Research has shown that individuals with Cerebral Palsy often have associative conditions not caused by the same brain injury or malformation which caused Cerebral Palsy, but proven to be common with individuals who have Cerebral Palsy. If the brain injury or malformation that caused the Cerebral Palsy did not occur, these conditions may still be present in the individual. Associative conditions include intellectual impairment, epileptic seizures, hearing impairment, and vision impairment.
Co-mitigating factors – An individual may also have health conditions separate from Cerebral Palsy. Unlike associative conditions, researchers have not concluded that these conditions have a high correlation to Cerebral Palsy. Co-mitigating factors exist regardless of Cerebral Palsy. Examples of co-mitigating conditions of Cerebral Palsy include autism, attention deficit hyperactivity disorder, and asthma.
TYPES OF CEREBRAL PALSY
Based on severity of cp
Mild
Moderate
Severe
Based on involvement of limb
Monoplegia 
Diplegia 
Hemiplegia 
Paraplegia
Triplegia 
Quadraplegia 
Spastic CP
Athetoid CP
Ataxic CP
Mixed CP 
Spastic Cerebral Palsy
It is the most common type of CP
Spastic CP is characterized by jerky movements and muscle and joint stiffness.
This condition prevents the normal development of motor function. 
Spastic cerebral palsy often makes simple tasks difficult, such as walking and picking up small objects.
Some children with spastic  cerebral palsy also develop co-occurring condition as a result of their brain injury. 
These co-occurring conditions range from attention deficit hyperactivity disorder (ADHD) to seizures
Types of spastic cp
Spastic cerebral palsy is classified based on the location of movement issues. Children with spastic CP may have muscle stiffness in an arm, both legs or even on one half of their body. The most common types of spastic CP are:
Spastic diplegia – Muscle stiffness occurs primarily in the legs but may also slightly affect the child’s arms.
Spastic hemiplegia – One side of the body is affected by movement problems, with the arm typically being stiffer than the leg.
Spastic quadriplegia – All four limbs are affected as well as the torso and face. Children with quadriplegia often have co-occurring disorders, such as epilepsy.
Cause of spastic cp
Spastic CP is caused by damage to the motor cortex and the pyramidal tracts of the brain, which connect the motor cortex to the spinal cord.
Motor cortex
    The motor cortex is located in the cerebral cortex, which is the largest part of the brain. The motor cortex is composed of several parts that are responsible for relaying signals to other parts of the brain to control movement. The most important aspect of the motor cortex in relation to cerebral palsy is its regulation of voluntary movement. Damage to this region of the brain makes voluntary movement harder to control and less fluid.
Pyramidal tracts
    The pyramidal tracts in the brain are the roads of communication between the cerebral cortex and the nerves in the spinal cord. If pyramidal tracts are damaged, the motor cortex can’t send proper signals to the spinal cord. The spinal cord is one half of the central nervous system (the other half being the brain and brain stem), which is essential for sensory functions such as sight, touch and movement.

Sign and Symptoms
The signs and symptoms of spastic cerebral palsy are different for every child. Differences in symptoms depend on the severity of the child’s brain injury and any co-occurring disorders that may be present.
In general, the most common symptoms of spastic CP are:
                         -> Exaggerated movements
                         -> Stiff, tight muscles (hypertonia)
                         -> Contractures
                         -> Abnormal reflexes
Co-occurring issues may also present themselves, such as hearing and vision impairment, but these aren’t directly related to the cerebral palsy; they are caused by the initial birth injury.
In the first years of a child’s life, it is hard to recognize the signs of spastic cerebral palsy. This is because the signs do not present themselves until a child begins missing developmental milestones. 
The most common signs of spastic cerebral palsy are:
                           > Abnormal gait
                           > Crossed knees
                           > Joints don’t extend fully
                           > Walking on toes
                           > Tight muscles in one part of the body
Athetoid cerebral palsy
Athetoid cerebral palsy is a condition that causes involuntary movements in children who experienced a brain injury. It is also known as dyskinetic cerebral palsy.
This type of cerebral palsy is characterized by abnormal, involuntary movement. 
Roughly 10 percent of children with cerebral palsy have the athetoid/dyskinetic type.
Children with athetoid CP fluctuate between hypertonia and hypotonia. Hypertonia is unusually high muscle tone, creating stiffness and tension in the muscles. Hypotonia is unusually low muscle tone, causing “floppiness” and low tension. 
The inability to regulate muscle tone is the cause of movement problems in athetoid CP.
Children with athetoid CP have trouble controlling movement in their hands, arms, feet and legs, making it hard to walk and grasp objects. 
Athetoid CP also causes issues with posture.
Involuntary movements often lead to other difficulties, such as drooling and trouble swallowing.
There are many secondary conditions that occur in children with athetoid CP, including seizures and behavioral disorders.
Causes of athetoid cp
In the case of athetoid CP, the damaged parts of the brain are the basal ganglia and/or the cerebellum.
Basal ganglia: The basal ganglia are a group of nuclei in the brain responsible for coordinating voluntary movement. The basal ganglia are located within the cerebral cortex, a part of the brain that helps control motor function. The basal ganglia also help regulate thinking and learning. Damage to the basal ganglia affects motor function development and causes involuntary movements.
Cerebellum : The cerebellum is responsible for regulating coordination and precision of movements, both of which are essential to fine motor skills and balance. When the cerebellum is damaged, balance and coordination become a struggle. The cerebellum is also an important part of cognitive functions, such as communication and attention. A damaged cerebellum can cause co-occurring disorders, such as intellectual disabilities.
Types of Athetoid CP
Athetoid cerebral palsy may be given other distinctions to further classify the condition based on the specific type of involuntary movement.
      These classifications include:
  àDystonia – This is distinguished by slow, rotational movement of the torso, arm or leg, causing poor posture.
  àChorea – Sudden involuntary movements, especially in fingers and toes, are known as chorea.
  à Athetosis – The condition “athetoid” is derived from athetosis and is described by sluggish, writhing movements, mainly in fingers and face.
àChoreoathetoid – This is a combination of chorea and athetosis.
 àAtaxia – A rare type of cerebral palsy, ataxia is   represented by loss of balance and coordination.
 àRigidity – High muscle tone due to hypertonia causes restricted movement.
 à Dyskinesia – This is a general term to describe involuntary movements. Athetoid cerebral palsy is often interchangeably referred to as dyskinetic cerebral palsy for this reason. 
Symptoms of athetoid cp
The signs and symptoms of athetoid cerebral palsy vary with each child based on the severity of the condition and location of movement issues.
The most common symptoms of athetoid cerebral palsy are:
Involuntary movement
Tremors
Poor posture
Unsteadiness
Twisting of the torso
Slow, writhing movements
Abrupt movements
The symptoms experienced depend on whether the damage was solely to the basal ganglia or both the cerebellum and basal ganglia were damaged. If the cerebellum is also damaged, the child will also have problems with balance and coordination.
The symptoms of athetoid cerebral palsy are a result of problems with both high and low muscle tone, which can vary on a daily basis. High muscle tone causes stiffness and jerky movement. Low muscle tone causes floppiness in the muscles, characterized by issues such as trouble sitting up
Signs of athetoid cp
Parents usually begin noticing signs of athetoid cerebral palsy when their children are around 9 months or older. In younger children, involuntary or jerky movements may be signs of slower development but do not indicate a deeper problem.
Athetoid cerebral palsy may be present in a child who:
     -> Doesn’t kick legs
     -> Seems stiff or rigid
     -> Seems limp
     -> Doesn’t hold up head at three months old
     -> Doesn’t reach for objects
     -> Doesn’t smile by three months old
     -> Doesn’t roll over
Ataxic cp
Ataxic cerebral palsy is characterized by problems with balance and coordination.
These issues are caused by damage to the developing brain’s motor control centers.
Children with ataxic cerebral palsy have a hard time controlling their movements. 
They are shaky and struggle with precise movements, such as writing and grasping small objects. Ataxic CP can affect the hands, arms, legs, feet, eyes and even speech.
Causes
Ataxic cerebral palsy is caused by a brain injury to the cerebellum before, during or shortly after birth.
Cerebellum Injuries :The cerebellum is essential for uninhibited motor function. It is central to regulating balance and coordination commands from other parts of the brain, such as the motor cortex, and translating these signals to the central nervous system. It also helps regulate posture, motor learning and communication
Symptoms
The primary symptoms of ataxic cerebral palsy are problems with balance and coordination of motor skills. 
The damage to the cerebellum that caused the palsy may also cause secondary symptoms, such as trouble hearing or seeing.
The most common symptoms of ataxic cerebral palsy are:
      à Imprecise motor skills
      à Trouble walking and balancing
      à Issues with depth perception
      à Tremors and shakiness
Just because a child has these symptoms doesn’t mean they will be diagnosed with cerebral palsy. Doctors usually hesitate to make a diagnosis until the child is around 18 months of age to ensure they make an accurate diagnosis. 
Signs
Signs of ataxic cerebral palsy in a child include:
Walking with feet spread far apart
Trouble bringing hands together
Unsteady gait
Trouble grasping objects
Over-correcting movements
Trouble with repetitious movements
Struggling with speech
Slow eye movements
Mixed cp
Mixed cerebral palsy is a developmental disorder with a combination of movement problems. It has traits of spastic, athetoid and ataxic cerebral palsy.
Children with mixed CP have damage to the motor control centers in several parts of their brain.
Children with this condition may have issues with movement, including: spasticity (abrupt, convulsive movements), involuntary movements, imbalance and lack of coordination. 
Spastic – High muscle tone, causing stiffness and jerky movement
Athetoid – Variations in high and low tone, causing rigidity and floppiness
Ataxic – Issues with balance and coordination affect normal movement
Children who exhibit movement problems that fall into two or more of these categories are classified as having mixed cerebral palsy. 
The most common variation of mixed CP is a combination of spastic and athetoid.
Mixed CP varies based on the location of movement problems. 
These movement problems can occur in the legs (diplegia), one half of the body (hemiplegia) or all four limbs (quadriplegia). 
Causes 
In mixed CP, multiple parts of the motor control centers may be damaged, causing movement problems seen in various types of cerebral palsy.
Motor cortex
Pyramidal tracts
Basal ganglia
Cerebellum
Symptoms
Every case of cerebral palsy is unique because of the different levels of severity and specific locations of movement problems. 
Children with mixed cerebral palsy, however, tend to have an even wider variety in symptoms since each child may have different types of brain damage. 
The symptoms of any type of cerebral palsy may apply to a child with mixed cerebral palsy. 
Some of the most common are:
      > Exaggerated, jerky movements
      > Abnormal reflexes
      > Poor posture
      > Tremors or shakiness
      > Issues with coordination
Signs
The typical signs of mixed CP in a child include:
Inability to hold up their head
Unnaturally stiff muscles
Crossed legs or abnormal gait
Inability to roll over
Favoring one arm when reaching for objects

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