Gilbert Ekezie
Cerebral palsy stems from ‘cerebral’ referring to the brain and ‘palsy’ to poor muscle control or muscle weakness. It is a disorder of movement, muscle tone or posture caused by damage that occurs to the immature, developing brain, most often before birth. Signs and symptoms appear during infancy or preschool years.
According to Dr. Gabriel Omonaiye, “In general, cerebral palsy causes impaired movement associated with abnormal reflexes, floppiness or rigidity of the limbs and trunk, abnormal posture, involuntary movements, unsteady walking, or some combination of these.” Cerebral palsy is also the collective name used to describe a spectrum of chronic movement disorders that affect muscle and body coordination, caused by damage to one or more areas of the brain.
The parts of the body that provide movement, such as the muscles, nerves, and the spinal cord are normal. The brain, which is responsible for sending messages to those parts of the body that coordinate movement, cannot execute these movements like a non-disabled person. Degrees of mobility issues can vary from slight to severe.
Meanwhile, the disorder is not inherited, and as of now, there is no way to predict which child would be afflicted. And, no two people with cerebral palsy are the same rather it is as individual as the people themselves.
Also, cerebral palsy is a condition, not a disease, and is not communicable. It usually occurs during foetal development, before, during, shortly after birth, or during infancy.
Early signs of Cerebral Palsy
Dr. Gabriel Omonaiye said that infants under six months of age displaying unusual stiffness or difficulty maintaining steady posture may be at risk of developing the disorder.
Additionally, when the child is picked up, and the head lags or legs stiffen into cross or scissor positions, parents and caregivers should monitor the child for potential physical impairments. Also, infants between six to ten months of age with higher chances of developing the neurological disorder may fail to roll successfully themselves, show limited mobility in the hands and arms and favours one hand over the other.
“At-risk infants over ten months of age might crawl in an uneven fashion, drag one arm or leg and fail to stand without physical support stated Omonaiye.”
Diagnosis of Celebral Palsy
Parents are often disheartened to learn that there is no singular test that will accurately diagnose a child with Cerebral Palsy. Once a round of medical evaluations are initiated in order to form a diagnosis, parents prepare for a long and sometimes frustrating process that will, in time, provide answers about a child’s condition.
According to Dr. Ifeyinwa Onuoha, diagnosing Cerebral Palsy takes time. There is no test that confirms or rules out Cerebral Palsy.
She said: “In severe cases, the child may be diagnosed soon after birth, but for the majority, diagnosis can be made in the first two years.”
For those with milder symptoms, a diagnosis may not be rendered until the brain is fully developed at three to five years of age. Onuoha noted that the average age of diagnosis for a child with spastic diplegia, a very common form of Cerebral Palsy, is 18 months. This can be a difficult time for parents who suspect something might be different about their child. Often, parents are first to notice their child has missed one of the age-appropriate developmental milestones.
If a growth factor is delayed, parents may hope their child is just a slow starter who will “catch up.” While this may be the case, parents should inform the child’s doctor of concerns, nonetheless.
Confirming Cerebral Palsy can involve many steps. The first is monitoring for key indicators such as: When does the child reach development milestones and growth chart standards for height and weight? How do the child’s reflexes react? Does it seem as if the child is able to focus on and hear his or her caregivers? Does posture and movement seem abnormal? Dr. Onuoha said that doctors will test reflexes, muscle tone, posture, coordination and other factors, all of which can develop over months or even years. Primary care physicians may want to consult medical specialists, or order tests such as MRIs, cranial ultrasounds, or CT scans to obtain an image of the brain. Once a diagnosis of Cerebral Palsy is made, parents may wish to seek a second opinion to rule out misdiagnosis.
A diagnosis is important to understand the child’s health status, to begin early intervention and treatment, to remove doubt and fear of not knowing and to find and secure benefits to offset the cost of raising a child with Cerebral Palsy.
Effects of Cerebral Palsy
Cerebral palsy’s effect on functional abilities varies greatly from one child to another. Some children can walk, while others can’t. Some children show normal or near-normal intellectual capacity, while others may have intellectual disabilities. In some cases, epilepsy, blindness or deafness also may be present.
According to Dr. Onuoha, the disability associated with cerebral palsy may be limited primarily to one limb or one side of the body, or it may affect the whole body. “The brain disorder causing cerebral palsy does not change with time, so the symptoms usually don’t worsen with age. However, muscle shortening and muscle rigidity may worsen, if not treated aggressively, Onuoha revealed.” Brain abnormalities associated with cerebral palsy also may contribute to other neurological problems. Children with the condition may also have difficulty with vision and hearing, intellectual disabilities, seizures, abnormal touch or pain perceptions, oral diseases, mental health conditions and urinary incontinence.
Risk factors
A number of factors are associated with an increased risk of cerebral palsy states Dr. Omonaiye. They include maternal health, infections or health problems during pregnancy. “Infections of particular concern include rubella, a viral infection that can cause serious birth defects. Others are Chickenpox, Cytomegalovirus, a common virus that causes flu-like symptoms and may lead to birth defects if a mother experiences her first active infection during pregnancy.” Onuoha added that herpes infection can be passed from mother to child during pregnancy, affecting the womb and placenta. Inflammation triggered by infection may then damage the unborn baby’s developing nervous system.
Illnesses in a newborn that can greatly increase the risk of cerebral palsy include bacterial meningitis, viral encephalitis and severe or untreated jaundice. Also, pregnancy or birth factors associated with increased cerebral palsy risk include breech births. This means that babies with cerebral palsy are more likely to be in a feet-first position at the beginning of labour rather than headfirst.
Dr. Omonaiye said: “Babies who weigh less than 2.5 kilograms are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.” Cerebral palsy risk also increases with the number of babies sharing the uterus. Another factor is when babies born fewer than 37 weeks into the pregnancy. The earlier a baby is born, the greater the cerebral palsy risk.
Prevention
Some cases of cerebral palsy cannot be prevented but one can lessen the risks. Dr Gab Omonaiye said good antenatal care and standard delivery measures should be taken to prevent and treat birth asphyxia.
“The detection and treatment of Jaundice will help in the prevention of cerebral palsy. Regular visits to the doctor during pregnancy will drastically reduce Cerebral Palsy risks.” Reports have it that out of all diagnoses, 70% of cases of cerebral palsy in children are congenital, or present at birth. An additional 20% are diagnosed with congenital cerebral palsy due to a brain injury during child delivery.
The remaining10% suffer from acquired cerebral palsy, which occurs in the first few months or years of life and is usually preventable with proper delivery and childcare techniques.