Cerebral Palsy… Parent’s Experiance

Every parents try all their effort so that their child should get maximal functional improvement to nearly normal level but functional improvement based on many factor like level of physical disability, age of presentation, quality of care given to them, type of surgical and therapeutic intervention and cooperation of child. children with cerebral palsy can get lots if they have been managed by integrated approach including SEMLOSSS, Tendon transfer and supervised therapy programme. visit http://www.samvednatrust.com for more detail.

 

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Manifestations of cerebral palsy

Cerebral palsy is the umbrella term used to describe a form of brain damage that results in significant impairments to motor skills, cognition, perception, speech, coordination and mobility.  It is caused by non-progressive damage to the brain before, during, or shortly after birth.As a result of injury to the brain, these children have motor and sensory defects which will affect them for their entire lifetime.CP is a name given to a wide variety of static neuromotor impairment syndromes occurring secondary to a lesion in the developing brain. The damage to the brain is permanent and cannot be cured but the consequences can be minimized. The child faces various types of multiple problems which can be musculoskeletal, neurological and some associated problems.

  1. Musculoskeletal problems

The child with CP has abnormalities of muscle tone and reflexes, shows delay in developmental milestones, and presents with posture and movement problems. When he tries to move, muscle contractions cannot be effectively controlled. The distal biarticular muscles are more affected because selective motor control is worse distally and the biarticular muscles are more abnormal

than are the monoarticular muscles. Slowly the contractures develops in muscles and can result in deformities in various joints.

Contractures and deformities www.samvednatrust.com

Common sites for contracture in Upper extremity are pronator, wrist and finger flexor, thumb adductor and in Lower extremity Hip adductor-flexor, Knee flexor, Ankle plantar flexor are affected.

Common sites for deformity in spine are scoliosis, kyphosis. The hip deformities are subluxation, dislocation, femer and tibia internal or external or external torsion and in  foot equinus, valgus, varus deformities are present.

 

  1. Neurological Associated problems

The child may suffer from muscle weakness specially in major group of muscles, abnormal muscle tone which can be hypertonic or hypotonic, balance and coordination problems, loss of selective control pathological reflexes,  loss of sensation.

 

  1. Associated problems in cerebral palsy

 

Intellectual impairment

Cognition refers to specific aspects of higher cortical function; namely, attention, memory, problem solving and language. Cognitive disturbance leads to mental retardation and learning disability. It is most common in spastic quadriplegia. Children with intellectual impairment need special education and resources to stimulate the senses for optimal mental function.

Epileptic seizures

Seizures affect about 30 to 50% of patients. They are most common in the total body involved and hemiplegics, in patients with mental retardation and in postnatally acquired CP. Seizures most resistant to drug therapy occur in hemiplegics. Seizure frequency increases in the preschool period. Seizures can be controlled by medication and full body and mental relaxation.

Vision problems

Approximately 40 % of all patients have some abnormality of vision or oculomotor control. If there is damage to the visual cortex, the child will be functionally blind because he will be unable to interpret impulses from the retinas. In severe cases, the optic nerves may also be damaged. Loss of coordination of the muscles controlling eye movements is very common. The child cannot fix his gaze on an object. In half of the cases, binocular vision does not develop. Myopia is a concomitant problem. Screen for visual deficits because some are preventable and they contribute to the movement problem. www.samvednatrust.com

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TOILETING TRAINING FOR THE CHILD WITH CEREBRAL PALSY

Toilet training can be an extremely stressful time for the child with cerebral palsy. Parents can feel pressurized into getting their child out of nappies in time for the start of playgroup or school. It is important to begin toilet training only when the child is developmentally ready, and then there should be a coordinated approach between all parties involved with the child. Children with developmental delay will generally take longer to learn the toileting routine. The child must be able to:

• understand the sensations in his bladder;

• be able to communicate his needs to a parent/caregiver.

And, as the child develops his new skills further and moves towards independence, he will need to:

• move to and transfer onto the toilet/potty;

• manage clothing;

Due to the intimacy of toileting tasks, the aim is to encourage and enable children to be independent so that as they get older they can have as much privacy as possible. Consider the following difficulties:

• non – verbal children will need an easily recognizable way to communicate their need to use the

toilet;

• extra time is needed to remove a child from his supportive equipment, perhaps a standing frame

or seat – remove his/her clothing and then transfer him/her onto the toilet equipment;

• if the only toilet is upstairs it may be more practical to have alternative facilities downstairs for

ready access and use.

 

EQUIPMENT TO REDUCE BACK STRAIN FOR PARENTS/CARERS

There are many different tasks and activities associated with toileting. These include:

• removing and adjusting clothing;

• changing nappies/pads;

• transferring the child on and off the potty or toilet;

• supporting the child during bottom wiping.

The twisting and bending involved in these actions can increase the risk of back injury and this should be reduced where possible. This could be done in the following ways:

• by careful choice of clothing, e.g. elasticized waist bands, Velcro fastenings, stretchy fabrics;

• by using a changing bench set a height to meet the requirements of the caregiver, or by   adjusting the height to make it possible for the child to get him/herself onto the bench;

• by using a hoist to assist with transfers;

• by installing a bidet/drying facility.

 

FOR YOUNG CHILDREN WHO NEED ADDITIONAL SUPPORT ON A TOILET

 

Some potties available from stores and shops have an integral backrest for additional support and are more like a chair as they are higher from the floor. These may provide adequate support for a child with mild difficulties.

• Potties with oval apertures provide a more comfortable and supportive seat than a round aperture, in which children with narrow hips tend to get their bottom stuck. A wide ledge each side for support under the bottom is also more comfortable with the result that the child performs more easily.

• Some potties have a pommel moulded into the front of them which will keep the legs apart and in a more relaxed position. This will also provide a splashguard for boys.

 

FOR OLDER CHILDREN WHO NEED ADDITIONAL SUPPORT ON A STANDARD ADULT TOILET

 

Trainer seats –

Trainer seats are secured either by positioning them under the standard toilet seat, or they snugly fit into the toilet seat aperture from above. Older children will need one that will take their extra weight. Those with a front splashguard are useful for keeping the legs apart. Consider the following:

• the child will find it easier to keep stable on the seat and will manage toileting tasks better if

feet are supported on a box step;

• a front pommel/splash guard will make it more difficult for the child to get on and off the toilet.

A box step should help with transfers;

• a child may also need wall rails or a toilet frame for additional support during transfers and

while sitting on the toilet.

Toilet support seats and frames –

These comprise a more supportive seat unit (usually incorporating a backrest, side support, lap strap or harness) that either clamps to the WC bowl or is freestanding.  Any additional equipment used with a standard WC can be inconvenient for bowel evacuation is to have the feet supported, with the knees slightly higher than the hips – i.e. mimicking a squatting position;

• for children who find it difficult to sit up straight, check the level of support provided given by the straps and harnesses.26-4-14

 

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Need more information on how to organize your efforts to manage your child’s care?
Call 945-303-9213.
Dr. Jitendra Kumar Jain
jjain999@gmail.com
www.samvednatrust.com

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Understanding Cerebral Palsy

What is Cerebral Palsy?
Cerebral palsy (CP) is a term used to describe a spectrum of problem related to movement and posture that interfere with normal functioning of individual. Simply stated, “Cerebral” refers to the brain, and “Palsy” refers to muscular weakness/poor control. These problems are present not because of weakness or damage in muscles or the peripheral nervous system but rather because of problems in the brain.
This is might be due to an injury to the brain or improper development of the brain. These problems can affect the way the brain controls movement and posture. The brain injury itself does not change overtime and currently there is no “cure” for cerebral palsy.

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CP
Who Does Cerebral Palsy Affect?
It is estimated that every 500th newborn develops cerebral palsy. According to a US report published in 2006:
•The average prevalence of CP was approximately 3.3 per 1,000 or 1 in every 303 8-year-old.
• CP prevalence varied by site, ranging from 2.9 per 1,000 8-year-olds to 3.8 per 1,000 8-year-olds.
• CP, on average, occurred 1.2 times more frequently among boys than among girls;
• Spastic CP was the most common type of CP, found among approximately 80% of children with CP
• While 56% of children with CP were able to walk independently, 33% had limited or no walking ability.
• And nearly 40% of those born with cerebral palsy have a severe case.

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Unfortunately, such statistical report doesn’t exist for Indian population, due to reluctance and lack of awareness regarding the problem. The estimates for India are expected to be close to those of US or even worse.
Why should a CP patient opt for treatment?
Although, any brain injury is relatively permanent and remains unaltered over time, the patient of CP may improve in condition (by learning to optimally function in society given the disadvantage they have), remain same, or deterate in condition (due to an increase in muscular weakness). Any intervention related to Cerebral Palsy aims at helping the patient adjust best in the normal life.
Different treatment options are available for people who have cerebral palsy. These options include therapy, medications, surgery, education and support. By taking help of one or more of these options, people with cerebral palsy can learn to improve their function and the quality of their lives.
The type of treatment that is suggested depends on the severity of the problem.

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ORTHOSIS MANAGEMENT IN CHILDREN WITH CEREBRAL PALSY

A multidisciplinary team including an orthotist, physical therapist and an orthopedist can advance a child with cerebral palsy along the continuum of care throughout his development. This team, coordinating with a family-centered approach to care, should encourage optimal use of an orthosis within the prescribed treatment plan.

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There are different and evolving schools of thought regarding the use of orthotic intervention. Some practitioners believe less bracing is better and that positive development can come from muscle stretching, training and strengthening exercises. There is a trend toward making below-the-knee only orthoses and using flexible AFOs to maximize gait and performance.

It is important to remember that providing orthotic care to this patient population does not follow a one-size-fits-all approach. An orthosis must fit well, and control the ankle, forefoot and hindfoot. Total contact is important because of the deviations in planes of the foot. A loose brace may cause skin breakdown; an orthosis that is dorsiflexed may cause discomfort and decreased function in a child who doesn’t have adequate dorsiflexion range of motion.

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Patients with spasticity may have inherent body weakness that affects their inability to control their muscles. Strengthening those muscles, once thought to increase spasticity, is now a critical part of a multidisciplinary approach to treatment.

We still have to use AFOs. Neutral alignment reduces the power of over-powerful muscles, and gives underused and underpowered muscles a chance to increase in strength and be more effective.

AFOs that control the foot in stance and swing phase can improve gait efficiency in children with cerebral palsy. The report suggested little evidence supporting the use of orthoses for the hip, spine or upper limb.  The trend toward using less rigid materials to craft AFOs allows the child more motion. Now days Light wt poly propylene materials are being used commonly, that is more comfortable to child.

Traditionally there has been a lot of use of 90· angle of the ankle in the AFO, when that might not always be the optimal alignment of the foot relative to the shank. That may change the bony alignment of the foot, and the child may not be extending their knee fully in gait. They might walk with a flexed knee gait and therefore not be stretching their calf muscles. Owen disagrees with the notion that the foot has to always be supported at 90·and that by failing to do so, the child cannot get good knee extension in gait. We can have lots of modification in articulated AFo,s according to need of child. If child have some residual Equinus Spasticity with Genu Recurvatum then we have to restrict plantification by PF stop, and if we have crouching then we should have dorsiflexion stop by DF Stop. Other medication are medial arch support, toe support, medial or lateral strap to control rotational element in foot. Other modification is SMO, FRO.

These braces should be wear minimum for 18-20 hour in a day. Good braces always help lots in children with cerebral palsy. That always is prescribed with some intervention modality for contracture / Spasticity by botulinum toxin, surgery or therapy.

watch this video

http://www.youtube.com/watch?v=QjYWs1zc_DU

Need more information on how to organize your efforts to manage your child’s care?
Call 945-303-9213.
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Cerebral Palsy treatment: The success rate

Cerebral Palsy is not a disease, but a disorder that hinders the patient’s physical movement along with lots of associated medical problem like epilepsy, speech problem, hearing, recurrent chest infection, and visual problem in some patient. Such specific disorders are noticed in early infancy, which later starts affecting its life from the very first year and also affect the balance of the body and its posture over time. Unfortunately, no permanent cure has still been invented for this disorder, but you can find various cerebral palsy treatment, which when applied could help to improve the functions of the body of the patients, suffering from such disorders.

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9-5-14
Some efficient and dependable cerebral palsy treatment is mentioned here. Few medicines are being used but these are not without side effect so their use is limited and should be for limited period of time if required at all. This type of treatment treats spastic muscles. Spastic muscle is noted to be the common attribute in the patients suffering from such disorders. However, it is a must for every individual suffering from such disorders to consult expert health care professionals to begin the medications. Now days with the new advancement in management these drugs are not being used due lots of side effect.

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Now botulinum toxin is being used very frequently in children of spastic cerebral palsy. Its use should also be limited to ideal indication such as child with sever Spasticity, not improving with good therapy protocol, child is not fully cooperating with therapist due to Spasticity and in some cases where you think that Spasticity is interfering in development of matured gait pattern & interfering in getting function in hands. It is effective only in child with Spasticity and will not be effective when contracture has already settled in child. Ideal age for its use is 2-6 years. Now-a- days at some of the centers this is being used very frequently even at every 4 months duration.
Samvedna is trying its best to provide comprehensive treatment in all these children by providing all useful and required treatment and now most of the children are getting significant functional improvement at Samvedna.

 

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Call 945-303-9213.

Dr. Jitendra Kumar Jain

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Cerebral Palsy: An overview

Cerebral Palsy is commonly referred as paralysis because of a lesion in the brain. Cerebral Palsy in itself is not to be treated as a disease, but actually described as disorders that result from defect to a single or more than one area in the brain, which happen during infancy or during pregnancy to the growing fetus. It is regarded as non-progressive condition due to the result of the damage of the brain being a single occurrence. Although, the affected brain cells can not be repaired, the remaining cells in the brain would continue in development and work.

Cerebral palsy awareness is very much needed in countries India US UAE Europe Pakistan Nepal Bangladesh Sri Lanka

Cerebral palsy awareness is very much needed in countries India US UAE Europe Pakistan Nepal Bangladesh Sri Lanka 

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Cerebral Palsy occurs because of any injury to brain due various factors:

  • Oxygen received by the baby during birth and pregnancy being insufficient.
  • Low birth weight or  premature birth
  • Baby and mother having incompatibility in blood group.
  • Extreme illness or head injury during early childhood.
  • Extreme jaundice just after birth
  • Disorders, genetic in nature.

 Symptoms

The common symptoms noticed in Cerebral Palsy are delayed developmental milestones, excessive docility or irritability, poor eye contact, poor sleep, frequent vomiting, poor sucking, tongue retraction, grimacing, weakness of muscle, stiffness in movement, balancing difficulty, shakiness and slowness. Some patients experience only mild symptom in one of the limbs, whereas the others are disabled severely and the whole body is affected. www.samvednatrust.com

There are 4 types of CP, such as:

Spastic CP-

Spastic CP is one common type which occurs in 70% to 80% of the cases. Patients belonging to this category are said to be hypertonic, that determines that there is an increase in the tension of the muscles with a decreased capability for stretching and relaxing their muscles, the patients might seem stiff or rigid.

Dyskinetic ( Athetoid ) CP-

Patients suffering from this type of category tend to have a various mixture of muscle tone. The patient has great difficulty in his ability to stand or sit along with the posture and also experiences slowness and involuntary movements in hands, arms, legs with drooling and grimaces. The patient might also experience limited eating, difficulty in swallowing, speaking and in motor skills.

Ataxic CP

5% to 10% of patients tend to suffer from this category of CP. The symptoms commonly appears in arms, legs and often in the torso and experiences weak coordination and balance. The patients also tend to have wide based gait, shaky and unsteady gait.

Mixed CP

10% of patients experience this category of CP. Common combination being athetoid and spastic CP; however, other combinations are also possible. In some cases, patients might also be affected with all the 3 CP. types

Treatment for patients suffering from CP

At present, there is no specific cure for Cerebral Palsy. Physical Therapy plays vital role in the treatment for strengthening of the muscle groups and to develop the motor skills. TES or Therapeutic-Electrical Simulation might need to be administered in the patients and patients benefit greatly when TES and physical therapy is given together. Some therapy sessions like horseback riding and hydrotherapy (swimming) benefit the patients. Beside that botulinum toxin & surgical intervention can also be indicated in some patient.

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Need more information on how to organize your efforts to manage your child’s care?
Call 945-303-9213.
Dr. Jitendra Kumar Jain
jjain999@gmail.com
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