Cerebral palsy is a group of diseases of the central nervous system with a leading non-progressive lesion of the motor zones and motor pathways of the brain. Cerebral palsy occurs as a result of damage to the immature brain, which is in a state of maturation in the prenatal period or at an early age. The basis for establishing the diagnosis of cerebral palsy after six months of a child’s life is that movement disorders are etiopathogenetically associated with brain damage in the perinatal and early postnatal periods, and their development passed into the residual (stationary) period.
The causes of cerebral palsy. Among the causes of cerebral palsy, harmful effects on the brain in the prenatal period predominate, up to 95%, in second place are antenatal (during childbirth) harmfulness, followed by postnatal (early postpartum) factors. Damage to the conditions cerebral of the child during childbirth due to asphyxia and intracranial hemorrhage is superimposed on the existing phenomena. Traumatic brain injury in the postnatal period can also worsen the condition of the child. Also, among the reasons for development, it should be noted:
- deep prematurity and hydrocephalus
- malformations of the brain
- traumatic or hypoxic-ischemic damage to the brain and spinal cord
- intrauterine infection of the fetus (toxoplasmosis, chlamydia, herpes virus, rubella, etc.)
- incompatibility of the Rh factor of the mother and the fetus “Rh-conflict”
- autoimmune process
- toxicosis of pregnancy
- infectious, endocrine
- chronic somatic diseases of the mother.
Symptoms of cerebral palsy may not be noticed until the baby is 1 to 3 years old, when peculiarities of the child’s growth become noticeable. Neither doctors nor parents can pay attention to the child’s motor sphere disorders until these disorders become evident. Children may retain reflex movements of newborns without age-appropriate development of movement skills. And sometimes, the first to pay attention to the child’s underdevelopment are nannies. If cerebral palsy is severe, then the symptoms of this disease are already found in the newborn. But the appearance of symptoms depends on the type of cerebral palsy.
The most common symptoms of severe cerebral palsy are:
- Swallowing and sucking problems
- Faint cry
- Unusual child poses. The body can be very relaxed or have very strong hyperextension with arms and legs. These positions are significantly different from those that occur with colic in newborns.
Some problems become more apparent over time or develop as the child grows. They can include:
- Muscle hypotrophy in injured arms or legs. Nervous system problems interfere with movement in injured arms and legs, and muscle stiffness affects muscle growth.
- Pathological sensations and perception. Some patients with cerebral palsy are very sensitive to pain. Even ordinary daily activities such as brushing your teeth can be painful. Pathological sensations can also affect the ability to identify objects by touch.
- Skin irritation. Drooling, which is often common, can irritate the skin around the mouth, chin, and chest.
- Dental problems. Children who have difficulty brushing their teeth are at risk of gum disease and tooth decay. Drugs used to prevent seizures can also contribute to the development of gum disease.
- Accidents. Falls, seizures, and other accidents are risks.
- Infections and somatic diseases. Adults with this disease are at a high risk of heart and lung diseases. For example, in severe cerebral palsy, there are problems with swallowing, and when choking, part of the food enters the trachea, which contributes to lung disease.
All patients with cerebral palsy have certain problems with body movement and posture. Still, many babies show no signs at birth. Sometimes, only the nannies or caregivers are the first to pay attention to the deviation in the child’s movements that contradict the age criteria. The signs of this disease may become more apparent as the child grows. Some developmental disorders may not show up until the end of the baby’s first year. The brain injury that causes of this disease does not appear for a long time, but the consequences can appear, change, or become more severe as the child grows older.
Certain effects of cerebral palsy depend on its type and severity, the level of mental development, and the presence of other complications and diseases.
Cerebral palsy Treatment
Cerebral palsy is an incurable disease. Conditions cerebral trauma or other factors leading to cerebral palsy do not progress, but new symptoms may appear or progress as the child grows and develops. But a variety of treatments help patients minimize movement and other impairments and thus improve their quality of life.
Initial treatment. Exercise therapy is an essential part of treatment that begins shortly after a child is diagnosed and often continues throughout their life. This type of treatment may also be prescribed before diagnosis, depending on the child’s symptoms.
Medication can help treat some of the symptoms and prevent complications. For example, antispasmodics and muscle relaxants help relax tight muscles and increase range of motion. Anticholinergics help improve limb movement or reduce drooling. Other medications can be used as symptomatic treatment (e.g., using anticonvulsants if seizures are present)
Permanent cerebral palsy treatment focuses on continuing and adjusting existing treatments and adding new treatments as needed. Permanent treatment may include:
- Exercise therapy can help a child become as mobile as possible. It can also help prevent the need for surgery. If the child underwent surgical treatment, intensive exercise therapy may be necessary for six or more months. Medication should be monitored constantly to avoid possible side effects of medications.
- Orthopedic surgery (for muscles, tendons, and joints) or dorsal rhizotomy (excision of the nerves of injured limbs) if there are significant problems with bones and muscles, ligaments, and tendons.
- Special orthopedic devices (braces, splints, orthoses).
- Behavioral therapy, in which a psychologist helps a child find ways to communicate with peers, is also part of the treatment.
- Massage, manual therapy can also be used to treat both basic symptoms and complications associated with impaired biomechanics of movement.
- Social adaptation. Modern technologies (computers) have made it possible to employ many patients with the consequences of cerebral palsy.
What treatment methods are currently being used? There are many different directions in the treatment of cerebral palsy. They can be roughly divided into several groups:
- various types of massage and physiotherapy exercises:
- Bobath techniques
- Blum’s imperative corrective gymnastics
- massage with inflatable Polish objects
- hippotherapy and other techniques.
- surgical methods of treatment, clipping of tendons, stage-by-stage plastering
- administration of botulinum toxin and stem cell preparations
- chipping with various pharmacological preparations
- use of orthopedic devices
- various physiotherapeutic procedures: barotherapy, cryotherapy, kinesiotherapy, electrical muscle stimulation, manual therapy, acupuncture, oxygen therapy, etc.
- speech therapy and psychological correction, music therapy, color therapy, educational impact, occupational therapy.
How effective are these techniques? Undoubtedly, all practically existing methods make a certain contribution to the treatment of cerebral palsy, but it must be borne in mind that all of them are not radical but symptomatic. Most of the available therapeutic methods affect one or more symptoms (decreased muscle tone, correction of pathological attitudes of the limbs, correction of pseudobulbar disorders) without affecting the cause of the disease. Thus, they are not pathogenic, and this leads to their low clinical efficacy.