Cerebral Palsy (CP)

Cerebral Palsy (CP)

CP encompasses a range of conditions that result from an incident to the child’s developing brain. In about 20% of the time it is due to a problem around the birth of the child (perinatal), but in most cases it is not known why children develop CP. The current evidence supports it being caused by an environmental trigger in those who are genetically predisposed. Babies with low birth weight, preterm babies and those who experienced trauma, infections, the effects of drugs and alcohol around the time of birth may be at a slightly higher risk of CP. Maternal diabetes may also be a contributing factor, though the evidence of this is currently weak. The effect of this damage to the brain manifests in cognitive, communicative, perceptive and behavioural problems, and issues with the bones and joints. These children also often have epilepsy as well as nutritional and breathing problems. The condition has a wide spectrum of presentations. The severity and eventual functioning of the child is often not apparent until the 4th birthday, and at this stage the child can be classified using certain scores. This grading system helps guide parents on how much function can be expected in the coming years and assists with the planning of future care.

Regarding the musculoskeletal manifestations of cerebral palsy, muscle tightness or spasticity is most commonly encountered. Some muscle groups are more affected than others leading to imbalance of forces around joints. In the upper limb this may lead to wrist and elbow flexion. It is important that regular physiotherapy augmented with splinting is utilised to prevent fixed deformities. With regards to the spine, scoliosis (curve of the spine) is frequently seen which may lead to heart and lung issues and should be monitored.

Subluxing hips Subluxing hips

In the lower limbs, there is increased risk of hip dislocation and it is important that carers learn good hip health measures to ensure the hips remain in joint. The principle is to keep the hips wide spread (abducted), so the wheel chair should have a pommel and out of the wheelchair an abduction brace may be required until the hips are well developed. Hips which are already subluxing or dislocating require a surgical procedure to put them back in place. Failure to do so could lead to restricted movement, problems with perineal hygiene, pain and discomfort even on sitting, and eventually, in extreme cases, ulceration of the hip from the inside out.

Dislocated left hip Dislocated left hip

The knees may assume a flexed position and flat foot is often present. This is controlled by physiotherapy and splints in the first instance, but in resistant cases surgery may be considered. Cerebral palsy is a complex disorder for which there is no cure, but some of the effects of the condition on the body can be lessened with targeted treatment. This is usually instituted after consultation with the multidisciplinary team including physiotherapists, counsellors, orthotists, paediatricians, neurosurgeons and orthopaedic surgeons. These measures, together with daily attentive care, will enable these children to have the happy and pain free childhood they deserve.

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