Cerebral Palsy
Summary/Definition
Cerebral palsy is a condition in which damage occurs to the immature brain before birth, during childbirth, or shortly after birth, resulting from various causes. Cerebral palsy is not a single disorder disease, and it leads to abnormal motor function and postural deformity. Cerebral palsy can occur due to various causes and lesions. The causes of cerebral palsy include maternal infections, fetal hyperoxia, hypoxia, brain hemorrhage during childbirth, and hydrocephalus, among others. The symptoms of cerebral palsy vary and depend on the area of damage and its severity level. The most common symptoms of cerebral palsy include muscle stiffness, motor disorders, postural dysfunctions, sensory impairments, intellectual disabilities, speech disorders, visual impairments, hearing impairments, urinary tract dysfunction, and defecating disorders difficulties. Cerebral palsy cannot be cured, but appropriate treatment and education can help manage symptoms and improve functionality. Cerebral palsy treatment includes physical therapy, occupational therapy, speech therapy, and special education, among various other therapies. Although cerebral palsy causes disabilities, with proper treatment and education, individuals can have normal lives.
Classification of cerebral palsy is as follows.
Spastic type: The most common type of cerebral palsy, characterized by muscle stiffness due to damage to the brain’s nerve cells.
Dyskinetic type: Characterized by difficulty in controlling movements due to damage to the cerebellum.
Ataxic type: Abnormal movements occur due to damage to the basal ganglia.
Mixed type: When a combination of the above three types is present.
The outcome of cerebral palsy varies from person to person. Some patients may have severe symptoms that make independent living challenging. However, many patients can manage their symptoms and improve their functionality with appropriate treatment and education, allowing them to lead normal lives.
Symptoms
One of the major symptoms observed in cerebral palsy is the insufficient control of the neuromuscular system. When individuals with cerebral palsy move their arms and legs, the movements of each joint may not be smooth. When they sit, their legs may take on a “W” shape. While walking, some individuals with cerebral palsy may walk on tiptoes or their pelvis may tilt backward. There may be an asymmetric appearance of the arms and legs, depending on the position of the head.
Additionally, cerebral palsy can be accompanied by a range of other disabilities, including intellectual disabilities, seizures, visual impairments, hearing impairments, difficulties with oral motor skills and dysphagia, as well as gastrointestinal problems.
Diagnostics
Since cerebral palsy is a functional disorder, diagnosing cerebral palsy on the early stage is difficult when the symptoms are mild. Diagnosing cerebral palsy involves taking a detailed look at a medical history, assessing developmental delays in motor skills, identifying abnormal movement patterns, assessing posture deformity, and determining muscle tension. Additionally, techniques such as brain magnetic resonance imaging (MRI), evoked potential tests (EP), and electroencephalograms (EEG) can provide information about the location and severity of lesions, as well as the underlying causes. Additional tests for metabolic and genetic diseases can also be conducted.
Treatment and course of the disease
It is possible to live a fairly independent life with proactive and appropriate rehabilitation treatment implemented from a young age. The effective treatment of cerebral palsy typically involves a comprehensive approach. The treatment is led by rehabilitation medical team composed of specialists in rehabilitation medicine, physical therapists, occupational therapists, speech therapists, social workers, clinical psychologists, rehabilitation nurses, and educators.
Physical Therapy and Occupational Therapy
In physical therapy, methods focused on stretching muscles are applied to prevent joint contractures caused by muscle stiffness. Physical exercises help to prevent the weakening of unused muscles, slows down joint contracture progression, and can also strengthen muscles. Occupational therapy provides exercises for all upper limb movements necessary for performing daily activities. In cases of severe joint contracture, treatments like heat and cold therapy or deep ultrasound heat therapy can be used concurrently.
Nerve Block and Botox Injection
For muscles exhibiting stiffness, it is possible to block the signals transmitted to the muscles by injecting alcohol or phenol into the motor nerves that control those muscles. In this procedure, the epineurium remains intact, so the nerves typically regain their functionality after about 6-10 months. In contrast to alcohol and phenol, which directly block the nerves, Botulinum toxin (Botox) injections work by reducing muscle tension through the inhibition of nerve signals between the muscles and nerves. This treatment is effective when joint contracture has not progressed significantly in the limb that is being treated.
Neurophysiological Treatment Methods
Two widely used neurophysiological treatment methods in South Korea are the Bobath therapy and the Vojta therapy. The Bobath therapy aims to address abnormal postures and movements caused by central nervous system disorders, allowing individuals to establish normal movement patterns by inhibiting abnormal motor patterns and normalizing muscle tone. The Vojta therapy involves repetitive stimulation of specific body parts to induce movement and establish normal movement patterns in the brain.
Use of Assistive Devices
The use of assistive devices such as walkers enables more comfortable walking and plays a role in preventing joint contractures and deformities. In some cases, assistive devices are also used during the night to prevent the progression of deformities.
Speech Therapy
For children with cerebral palsy and accompanying speech disorders, speech therapy is conducted to stimulate the development of oral muscles and treat dysarthria.
Medication Therapy
The most commonly used medication is Baclofen, which increases the signals that relax muscles within the spinal cord, reducing muscle reflexes and involuntary spasms. This medication has sedative properties and may have side effects such as a decrease in the level of consciousness, drowsiness, and more when administered.
Surgical Treatment
Surgical treatment for cerebral palsy can be broadly categorized into orthopedic surgery and neurological surgery. Orthopedic surgery is typically performed on patients over the age of 5 with severe joint contractures and skeletal deformities. Procedures include tendon release surgery, tendon lengthening surgery, tendon transfer surgery, muscle release surgery, and joint fixation surgery. Neurological surgery includes a procedure called Selective Dorsal Rhizotomy, which surgically cuts overactive spinal nerve roots. This surgery can be performed using open or minimally invasive techniques and may involve selective or complete rhizotomy, depending on the surgical approach and the nerves being targeted. This method is most effective for children with cerebral palsy who are between the ages of 3 and 8, who has significant spasticity-related impairments, no severe musculoskeletal deformities, and good cognitive function.
In cerebral palsy, the most common symptom is motor impairment. However, when there is damage to the central nervous system, it can also result in accompanying impairments in other areas, which can have a negative impact. Therefore, it is crucial to detect and address issues such as intellectual disability, seizure disorders, speech difficulties, and learning disabilities early on in order to provide appropriate care and support.
