Cerebral Palsy (CP) is a disorder of movement and posture that appears during infancy or early childhood resulting from damage to the brain. The damage to the brain is permanent and cannot be cured but the earlier we start with intervention the more improvement can be made.Any non-progressive central nervous system (CNS) injury occurring during the first 2 (some say 5) years of life is considered to be CP. There are several definitions of Cerebral Palsy within the literature, although these may all vary slightly in the way they are worded they are all similar and can be summarised to:
Cerebral Palsy is a group of permanent, but not unchanging, disorders of movement and/or posture and of motor function, which are due to a non-progressive interference, lesion, or abnormality of the developing/immature brain
The type of cerebral palsy has also changed:
- In the 60’s Athetoid / Dyskinetic Cerebral Palsy accounted for approximately 20% of children with Cerebral Palsy.
- Today only 5 to 10% have this type, with Spastic Cerebral Palsy now accounting for 80-90% of children with Cerebral Palsy.
- This decrease is mainly due to advances in the treatment of hyperbilirubinemia (Bilirubin is toxic to cells of the brain. If a baby has severe jaundice, there’s a risk of bilirubin passing into the brain ie. acute bilirubin encephalopathy. Prompt treatment may prevent significant lasting damage).
- The increase of Spastic Cerebral Palsy is predominantly a result of higher survival rates for (very small premature) babies.
- The most common cause of Cerebral Palsy is idiopathic which means that the cause of damage to the brain during pregnancy is not known.
There are different risk factors for each stage at which a child might develop Cerebral Palsy. These can be broken down into Prenatal, Perinatal and Postnatal.
- Prematurity (Gestational age less than 36 weeks)
- Low Birth Weight (less than 2500 g), which could be due to poor nutritional status of the mother
- Maternal epilepsy
Infections (TORCH = Toxoplasmosis, Other (Syphilis, Varicella-Zoster, Parvovirus B19,) Rubella, Cytomegalovirus (CMV), Herpes Simplex Virus)
- Severe Toxemia, Eclampsia
- Drug Abuse
- Multiple Pregnancies
- Placental Insufficiency
- Premature Rupture of Membranes
- Prolonged and Difficult Labour
- Vaginal Bleeding at the time of admission for labour
Postnatal (0-2 years)
- Central Nervous System infection (encephalitis,meningitis)
- Neonatal Hyperbilirubinemia
- Head Trauma
Anatomical classification are as follows:
- Unilateral: One side of the body is affected
- Bilateral: Both sides of the body are affected
Spastic Cerebral Palsy: are used to distinguish between quadriplegia, diplegia and hemiplegia. Spastic Cerebral Palsy is either bilateral or unilateral.
Dyskinetic Cerebral Palsy and Ataxic Cerebral Palsy: always involve the whole body (bilateral).
Neurodevelopmental Treatment (NDT)
One of the more popular approaches utilised in the management of cerebral palsy, the NDT Approach also know as Bobath Approach
It is a manual application for spastic muscles to relieve soft tissue tightness. Manual stretching may increase range of movements, reduce spasticity, or improve walking efficiency in children with spasticity.  Stretch may be applied in a number of ways during neurological rehabilitation to achieve different effects. The types of stretching used include;
- Fast / Quick
Static Weight-bearing Exercises
Stimulation of antigravity muscle strength, prevention of hip dislocation, reduction in spasticity and improvements in bone mineral density, self-confidence and motor function have all been achieved through the use of Static Weight-Bearing exercises such as Tilt-Table and Standing Frame.
Muscle Strengthening Exercises
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