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Cerebral palsy: motor development disorder

Cerebral palsy (CP) is a disorder in the motor development of chronic and non-progressive, secondary to brain injury, usually produced during intrauterine growth, but that may also occur at the time of delivery (by lack of oxygen during the period of expulsion, for example), or during the first two years of the baby's life, while your brain is still developing (traumainfections...).
It is not a specific disease, but a Group of disorders of varying causes, which may be very mild or very severe symptoms. Lesions of cerebral palsy are translated in a difficulty to control the functions of the motor system, and the affected can present spasms or muscle rigidity, involuntary movements, lack of coordination, or disorders in posture or mobility of the body. Depending on the extent and location of the lesion, there may be other problems such as mental retardation, difficulty speaking or learning, or Visual or hearing impairments.
It is estimated that two of every thousand people suffering from cerebral palsy, a percentage that rises to 10 of every 1,000 when it comes to premature or low birth weight. This prevalence is stable in developed countries, but thanks to advances in treatment and care, the life expectancy of those affected has increased in recent years, so the number of patients has increased.
Causes of cerebral palsy
In the majority of cases the injury occurs during pregnancy because of intrauterine infections, vascular processes, brain malformations, genetic causes, etc.
It has been shown that more than a third of affected children weighing less than 2.5 kg at birth, cerebral anoxia (lack of oxygen), making it the likely cause in these cases is usually complicated by internal bleeding associated with prematurity and low weight. Trauma in childbirth is also a possible cause.
Less than 10% of cases are due to problems arising after the birth of the baby to term, and possible causes include: meningitis, encephalitis, severe infections, trauma, vascular accidents...
In some cases it is not possible to determine the cause of cerebral palsy.

Symptoms of cerebral palsy

The symptoms of cerebral palsy - that vary significantly from one patient to another, so there are not two equal cases-, are usually seen before two years of age. Affected children show delays in their ability to sit, turn, reach an object, crawl, stand... The clinical classification of patients with cerebral palsy is based on observed characteristics in affected children, which are related to the type of motor disorder predominantly and the extent and severity of the same, the presence of other associated disorders (frequently be observed also behavioral, cognitive, sensory disorders, mental retardation, epilepsy...), the causes of injury, etc. Among the most common presentations:
Spastic cerebral palsy
As quadriplegia, diplegia, paraplegia, hemiplegia or Monoplegia, it is the form of more frequent paralysis, and common clinical manifestations include hyperexcitability and the abnormal persistence of neonatal reflexes. These demonstrations make fists remain firmly closed, that there are reflexes tonics of the neck, often maintained constantly, and positions of extension when it is held vertically to the child (back arched, and rigid extension and internal rotation of the legs). Spasticity and stiffness is van showing to grow the patient, and frequently give rise to abnormal postures of limbs and contractures.
  • In the spastic quadriplegia, the most severe form, the four members are affected. The child has mental retardation associated with (more than 90% of cases) and frequent seizures.
  • In spastic diplegia are affected four members, although it is much more intense in the lower extremities. Intelligence is usually normal, but the apraxias (inability to carry out movements of purpose, learned and family) that hinder learning are frequent.
  • Only the lower extremities are affected in spastic paraplegia .
  • Spastic hemiplegia manifests itself in the third part of the diagnosed children and affects one side of the body. Frequently there is a homonymous hemianopsia (vision loss partial or complete of one half of the visual field in both eyes), and hemisensory deficit (lack sensitivity in the affected half of the body). It is limp and posture which adopts arm flexion maintained when is prone forearm (showing the back of the hand) and the wrist is flexed.
  • Monoplegia is limited to limb weakness. It is very rare.
Cerebral palsy/dyskenetic
It is less frequent than the spastic PC, and is characterized by involuntary movements, persistence of archaic reflexes and abnormal postures, movements and hypotonia (decreased muscle tone) in childhood coreoatetosicos and dystonias (movement disorders).
These patients tend to have affected the buco-laryngeal muscles, causing them to speech disorders. Also they can suffer from deafness, which might imply, wrongly, in the existence of profound mental retardation; only intellectual capacity after multiple scans can be assessed.
Ataxic cerebral palsy
Infrequent a form of cerebral palsy (5-10% of cases), which is characterized by hypotonia, lack of coordination of movement and balance deficit. In congenital cerebellar ataxia appear hypotonia and tendon reflexes during lactation. The tremor and ataxic gait are developed from the second year of life. There may be an associated mental deficit, but mild.

Diagnosis of cerebral palsy

There is a specific test to detect if a child suffers from cerebral palsy. To diagnose the disorder, doctors generally observe the development of the child and the clinical manifestations.
The definitive diagnosis, which includes all the factors involved: degree of affectation, causes, type of motor disorder and other associated disorders presenting the patient, requires specific evidence such as brain magnetic resonance imaging, and it takes time.
Severely affected infants may have generalized cerebral atrophy (brain size diminishes because cells missing).
Diagnostic diferencialde cerebral palsy
It is necessary to differentiate the cerebral palsy from other diseases that present with similar symptoms such as the leukodystrophies. In borderline cases, lumbar puncture is used. Check that the cause of the spasm is not Hydrocephalus or a tumor in a cerebral hemisphere.
When the spasms and weakness affect lower neck muscle groups should take account of spinal cord injuries. The spastic diplegia is confounded with muscular dystrophy. The atonic diplegia should differ from neuromuscular diseases of childhood, as Werdnig-Hoffman disease and benign congenital hypotonia. Congenital cerebellar ataxia should be distinguished from a series of progressive cerebellar degenerations.
If there is more than one individual in the family with motor deficit we must think in a disease other than cerebral palsy, there is no family "cerebral palsy".
To determine the diagnosis of cerebral palsy will have to meet three requirements:
  • That disorder is permanent.
  • Be of cerebral origin.
  • It's not progressive.

Treatment and prevention of cerebral palsy

Cerebral palsy has no cure; the treatment is multidisciplinary, and its objective is to achieve the greatest possible degree of physical development and social integration of those affected. It should be focused to three lines of action:
  • The motor disorder treatment: to improve the mobility of the patient and prevent and treat associated deformation and/or the sore. To achieve this techniques of physiotherapy and occupational therapy, orthotic devices, surgery, and drugs are used to reduce seizures or relax the muscles.
  • Prevention or diminution of the effects that has the motor disorder on the overall development of the child: during the first years of life, learning and the relationship of the child with its surroundings are directly related to your ability to move. Their displacement and the manipulation of the objects help you know your environment, and motor limitation deprives you of this knowledge, hence the importance of an early therapeutic care that improves the autonomy of the patient and their possibilities of communication.
  • Treatment of associated disorders: whether sensory deficits (hearing loss, impaired vision...), epilepsy (very frequent in these patients), eating disorders, breathing, sleep, delayed growth, mental retardation, learning disabilities, etc.
In the majority of cases it is not possible to prevent brain injury which causes disorders grouped under the denomination of cerebral palsy, although appropriate prenatal controls partners, can be prevented to some extent risk factors as prematurity. Also improvements in therapeutic control of the newly born premature and multidisciplinary care are very effective to detect and treat early disorder and the problems associated with it.
The life expectancy of a child with cerebral palsy largely depends on the intensity and severity of brain injury presented associated disorders, and age to begin therapeutic intervention. Family response to the situation and the availability of adequate educational and therapeutic services are of vital importance in the evolution of the patient.
Published for educational purposes
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