Another name of hope !

Introduction:

          Cerebral palsy is the term used to describe a form of brain damage that results in significant impairments to motor skills, cognition, perception, speech, coordination and mobility. The syndrome is caused by non-progressive brain damage occurring before birth or within 1 month after birth. The damage is to the brains motor control centers, inhibiting the development of movement and causes abnormal posture and their clinical expression may change over time as the brain matures. Our rehabilitation sector is aimed at improving the debilitating physical, mental and emotional impairments patients with this neurological condition experience. To ensure that each aspect of a condition is treated, a number of different medical professionals, including the following, will likely be involved in a CP patient's treatment process for years, if not a patient's entire life:

• physicians and surgeons
• physical therapists
• occupational therapists
• Special trainers

          The precise details of an individual's cerebral palsy rehabilitation program will vary according to the nature and severity of the condition, as well as other factors. Treatment programs are designed to help patients:

• realize improved balance, mobility and dexterity
• appropriately perceive, interpret and respond to their environment
• live as independently as possible
• achieve the best possible quality of life

          A recent CDC study shows that the average prevalence of CP is 3.3 per 1,000 or 1 in 303 children.   These three sites reported higher prevalence among boys compared with girls and the most common type of CP across all three sites was spastic CP ranging from 85%.    The latest overall prevalence estimate was notably different from that of the previous surveillance year with CP prevalence as 10.3 per 1,000 or 1 in 100 children.� This statistics as per registration of birth / death of children only but in remote villages is unclear about this registration.� Prevalence of CP may be higher than this statistics.

Note: If there is an early intervention through with regular and proper therapy, 90% to 99% cure is possible that differs to the type and severity of the individuals with cerebral palsy.

Definition:

Cerebral palsy is a physical disorder that impairs the brain's ability to properly control muscle movement and motor skills

          Cerebral palsy causes different types of motor impairment in each child. A child may simply be a little clumsy or awkward, or unable to walk at all.

What Are Some of the Signs of Cerebral Palsy?

           The signs of cerebral palsy vary greatly because there are many different types and levels of disability. The main sign that your child might have cerebral palsy is a delay reaching the motor or movement milestones. If you see any of these signs, call your child's doctor or nurse.

A child over 2 months with cerebral palsy might:

• Have difficulty controlling head when picked up
• Have stiff legs that cross or "scissor" when picked up

A child over 6 months with cerebral palsy might:

• Continue to have a hard time controlling head when picked up
• Reach with only one hand while keeping the other in a fist

A child over 10 months with cerebral palsy might:

• Crawl by pushing off with one hand and leg while dragging the opposite hand and leg
• Not sit by himself or herself

A child over 12 months with cerebral palsy might:

• Not crawl
• Not be able to stand with support

A child over 24 months with cerebral palsy might:

• Not be able to walk
• Not be able to push a toy with wheels

Causes of Cerebral Palsy

In general, however, there are two problems that can cause cerebral palsy:

1. Failure of the brain to develop properly (developmental brain malformation)
2. Neurological damage to the child's developing brain

Primary high-risk factors for cerebral paralysis:

• Unknown Etiology
• Suffocation
• �premature birth, bleeding into the brain (intraventricular hemorrhage)
• �nuclear jaundice
• Such as infection (like meningitis), bleeding into the brain, and damage caused by lack of oxygen.

Problems in intrauterine development (e.g. exposure to radiation, infection),

• Asphyxia before birth, hypoxia of the brain, and birth trauma during labor and delivery
• Complications in the perinatal period or during childhood.
• �CP is also more common in multiple births.
• After birth toxins, severe jaundice, lead poisoning, physical brain injury, shaken baby syndrome, incidents involving hypoxia to the brain (such as near drowning), and encephalitis or meningitis.

Cerebral palsy complications:

Mental handicap, barrier to cognitive development, epilepsy, sensory impairments.

Cerebral palsy classifications:

      
There are three main types of cerebral palsy:

• Spastic Cerebral Palsy
  (stiff and difficult movement)


• Athetoid Cerebral Palsy
  (involuntary athletic type and uncontrolled movement)


• Ataxic Cerebral Palsy
  (disturbed sense of balance and depth perception)


• Mixed Cerebral Palsy
  (There may be a combination of these types of cerebral palsy for any one person)


• Atonic type

          Spastic cerebral palsy is by far the most common type, occurring in 70% to 80% of all cases. Moreover, spastic CP accompanies one of the other types in 30% of all cases. Spastic CP is further classified by dependent on the region of the body affected; these include:

• Spastic hemiplegia (one side being affected).
• Spastic diplegia (the lower extremities are affected with little to no upper-body spasticity).


• Spastic quadriplegia (all four limbs affected equally).

          Ataxia� type symptoms can be caused by damage to the cerebellum.
Some of these individuals have hypotonia and tremors. Motor skills such as writing, typing, or using scissors might be affected, as well as balance, especially while walking. It is common for individuals to have difficulty with visual and/or auditory processing.

Athetoid/dyskinetic

          Athetoid or dyskinetic is mixed muscle tone � People with athetoid CP have trouble holding themselves in an upright, steady position for sitting or walking, and often show involuntary motions. The damage occurs to the extrapyramidal motor system and/or pyramidal tract and to the basal ganglia.

Hypotonic

• People with hypotonic CP appear limp and can move only a little or can't move at all.


• Secondary conditions can include seizures, epilepsy, apraxia, dysarthria or other communication disorders, eating problems, sensory impairments, mental retardation, learning disabilities, and/or behavioral disorders.



• Speech and language disorders are common in people with Cerebral Palsy.
• The most common combination of mixed cerebral palsy involves both spasticity and athetoid movements, but other combinations are also possible. The least common mix is athetoid and ataxic cerebral palsy, however any mix of types may occur. It is possible to have a mix of all three types of cerebral palsy: spastic, athetoid and ataxic.

During daily treatment vidial groups should pay special attention to:

• Training time
• Child's �general health (preventive and productive from cough, cold, diarrhea, wheezing and epileptic through parental councelling)


• Helping to correct the posture while the patient is seated
• Making sure there is plenty of opportunity to practice standing and walking
• Focusing on oral cavity mastication, question movement difficulties as soon as possible


• Raise the infants level of intelligence

Treatment

          Various forms of therapy can help a person with the disorder to function and live more effectively. In general, the earlier treatment begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them. Treatment may include one or more of the following: physical therapy; occupational therapy; speech communication methods, drugs to control seizures, braces and other orthotic devices; rolling walkers;

          Interventions for CP should be directed at maximizing the quality of life by improvement in daily function and reduction of the extent of disability. Initially, the parents and other caregivers should learn how to seat, dress, feed, and communicate with, transfer, transport, and toilet the child. With growth and development, the child should achieve maximal independence in these activities.

Interpersonal therapy

          Physiotherapy (PT) programs are designed to encourage the patient to build a strength base for improved gait and volitional movement, together with stretching programs to limit contractures. Many experts believe that physiotherapy is crucial to maintain muscle tone, bone structure, and prevent dislocation of the joints.

Occupational Therapy

          ;Occupational Therapy (OT) helps adults and children maximise their function, adapt to their limitations and live as independently as possible and enables individuals with CP to participate in activities of daily living that are meaningful to them. Occupational therapists work closely with families in order to address their concerns and priorities for their child. Occupational therapists may address issues relating to sensory, cognitive, or motor impairments resulting from CP that affect the child's participation in self-care, productivity, or leisure. Parent counselling is also an important aspect of occupational therapy treatment with regard to optimizing the parent's skills in caring for and playing with their child to support improvement of their child's abilities to do things. The occupational therapist typically assesses the child to identify abilities and difficulties, and environmental conditions, such as physical and cultural influences, that affect participation in daily activities. Occupational therapists may also recommend changes to the play space, changes to the structure of the room or building, and seating and positioning techniques to allow the child to play and learn effectively.

          Speech Communication Method (Speech and language therapy) and sensory integration therapy may also be incorporated into a cerebral palsy physiotherapy program. �This enables a cerebral palsy patient to more effectively communicate with others by developing the facial and jaw muscles, improving speech or sign language communication, and providing communication tools (such as computers and other visual tools).

          Conductive Education (CE) It is a unified system of rehabilitation for people with neurological disorders including cerebral palsy.� It is theorised to improve mobility, self-esteem, stamina and independence as well as daily living skills and social skills. The conductor is the professional who delivers CE in partnership with parents and children. Skills learned during CE should be applied to everyday life and can help to develop age-appropriate cognitive, social and emotional skills. We are regularly following this method in our center.

          Neuro-cognitive therapy. It is based upon two proven principles. (i) Neural Plasticity. The brain is capable of altering its own structure and functioning to meet the demands of any particular environment. Consequently if the child is provided with an appropriate neurological environment, he will have the best chance of making progress. (ii) Learning can lead to development.

Adaptive Equipment

          Both physical and occupational therapists can help choose the right type of adaptive equipment that can enhance a patient's motor abilities. Wheelchairs, walkers, special eating utensils and other adaptive equipment can allow a cerebral palsy physiotherapy patient to reap greater benefits from therapy and achieve a greater degree of physical ability.

Note: If in very earlier stages use of adaptive devices may prohibit the promotion rate. For eg;- Knee Ankle Foot Orthosis� is used only for maintenance of knee extension and not used while standing and walking because it inhibits the muscle's voluntary control , muscle's strength and muscles girth.

Prognosis

          Early diagnosis within 3 � 6 months and start proper physiotherapy and occupational therapy will promote as near normal for people with CP. The full intellectual potential of a child born with CP will often not be known until the child starts school. People with CP are more likely to have some type of learning disability, but this is not related to a person's intellect or IQ level. Intellectual level among people with CP varies from genius to mentally retarded, as it does in the general population, and experts have stated that it is important to not underestimate a person with CP capabilities and to give them every opportunity to learn. The ability to live independently with CP varies widely depending on the severity of each case.

Associated Conditions

• Mental disadvantage (IQ < 50): 31%
• Active seizures: 21%
• Mental disadvantage (IQ < 50) and not walking: 20%
• Blindness: 11%

Self-care

          Self-care is any activity children do to care for themselves. For many children with CP, parents are heavily involved in self-care activities. Self-care activities, such as bathing, dressing, grooming and eating, can be difficult for children with CP as self-care depends primarily on use of the upper limbs. �For those living with CP, impaired upper limb function affects almost 50% of children and is considered the main factor contributing to decreased activity and participation. Overall, children with CP may have difficulty in chewing and swallowing food, holding utensils, and preparing food due to sensory and motor impairments.� Early interventions with full rehabilitation CP people will manage their ADL themselves.

Leisure

          Leisure occupations are any activities that are done for enjoyment. Enjoyable activities depend on the child's personality and environment. Leisure activities can have several positive effects on physical health, mental health, life satisfaction and psychological growth for children with physical disabilities like CP. Common benefits identified are stress reduction, development of coping skills, companionship, enjoyment, relaxation and a positive effect on life satisfaction. �In addition, for children with CP, leisure appears to enhance adjustment to living with a disability.

          Leisure can be divided into structured (formal) and unstructured (informal) activities. Studies show that children with disabilities, like CP, participate mainly in informal activities that are carried out in the family environment and are organized by adults. �Typically, children with disabilities carry out leisure activities by themselves or with their parents rather than with friends. Therefore, children may experience limited diversity of activities and social engagements, as well as a more passive lifestyle than their peers. Although leisure is important for children with CP, they may have difficulties carrying out leisure activities due to social and physical barriers.