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.
- 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.
- 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.
- Associated problems in cerebral palsy
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.
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.
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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Dr. Jitendra Kumar Jain
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