Cerebral palsy

Cerebral palsy or CP is a group of disorders associated with developmental brain injuries[?] that occur during fetal development, birth, or shortly after birth. It is characterized by a disruption of motor skills, with symptoms such as spasticity, paralysis, or seizures. Cerebral palsy is also known as static encephalopathy[?] and Little's disease. It is no longer considered a disease, but rather it is a chronic nonprogressive neurological disorder. The incidence is about 1.5 to 4 per 1000 live births. There is no cure, but therapy may be helpful. It has one of the highest lifetime costs of any birth defect.

The disorder is marked by several important signs. All persons with cerebral palsy developed it while the brain was under development. This limits the age at which the disorder can develop to at most 5 years old, however 80% of all cases occur before the baby reaches 1 month old. Secondly, it is a nonprogressive disorder, that is, once the damage to the brain is done no additional damage occurs. Cerebral palsy never worsens, though its symptoms may change with time. The disorder also never improves. It is a permanent disability which stays with a person their entire life. Any temporary problems would suggest a disorder other than cerebral palsy. Additionally, the disorder is characterized by disruption of the motor skills of the person. The severity in the loss of motor skills varies greatly from case to case. Lastly, even though there is a loss of motor skills, the muscles themselves are not defective. The problem lies solely in the brain's ability to control those otherwise healthy muscles.

Table of contents 1 History 2 Cause 3 Incidence and Prevalence 4 Types 5 Presentation (Signs and Symptoms) 6 Prognosis 7 Treatment 8 Usage of the term "spastic" 9 References

History Cerebral palsy, then known as "Cerebral Paralysis", was first identified by a British surgeon named William Little[?] in 1860. Little raised the possibility of asphyxia during birth as a chief cause of the disorder. It was not until 1897 when Sigmund Freud suggested that a difficult birth was not the cause but rather only a symptom of other effects on fetal development. Modern research has shown that asphyxia is not found during birth in 75% of cases. Such research shows that Freud's view was correct, even though during the late 19th century and most of the 20th century Little's view was the traditional explanation. ("Conditions", 9)

Cause Since cerebral palsy refers to a group of disorders, there is no exact known cause. Some major causes are asphyxia or hypoxia of brain, birth trauma or premature birth, genetic susceptibility, certain drugs or infections in the mother during and before birth, central nervous system infections, trauma, and consecutive hematomas. After birth, the condition may be caused by toxins, physical brain injury, incidents involving hypoxia to the brain (such as drowning), and encephalitis or meningitis. Despite all of these causes, the cause of many individual cases of cerebral palsy is unknown.

Recent research has demonstrated that asphyxia is not the most important cause as it was once considered to be, though it still plays a role. The research has shown that infections in the mother, even infections that are not easily detected, may triple the risk of the child developing the disorder.

Premature babies have a higher risk because their organs are not yet fully developed. This increases the risk of asphyxia and other injury to the brain, which in turn increases the incidence of cerebral palsy.

Incidence and Prevalence The incidence is about 1.5 to 4 per 1000 live births. This amounts to approximately 5,000-10,000 babies born with cerebral palsy each year in the United States. Each year, around 1,500 preschoolers are diagnosed with the disorder. In around 70% of all cases, cerebral palsy is found with some other disorder, the most common being mental retardation.

Overall, advances in care of pregnant mothers and their babies has not resulted in a noticeable decrease in cerebral palsy. Only the introduction of quality medical care to locations with less than adequate medical care has shown any decreases. The incidence increases with premature or very low-weight babies regardless of the quality of care. Twins are also four times more likely to develop cerebral palsy than single births.

Despite medical advances, in some cases the incidence of cerebral palsy has actually increased over time. This may be attributed to medical advances in areas related to premature babies or the increased usage of artificial fertilization techniques.

Types

1. Ataxia: Persons with ataxia have damage to their cerebellum which results in problems with balance, especially while walking. It is the most rare type, occurring in at most 10% of all cases.
2. Athetoid or dyskinetic: Persons with this type generally have involuntary body movements. The damage occurs to the extrapyramidal motor system[?] and/or pyramidal tract[?] and to the basal ganglia. It occurs in ~20% of all cases.
3. Spastic: Persons with this type have damage to the corticospinal tract[?], motor cortex[?], or pyramidal tract. It occurs in ~70% of all cases.

These three types may be found together. In 30% of all cases of cerebral palsy, the spastic form is found with the one of the other types. There are a number of other minor types of cerebral palsy, but these are the most common.

Presentation (Signs and Symptoms) All types of cerebral palsy are characterized by abnormal muscle tone, posture, reflexes, or motor development and coordination. The classical symptoms are spasticity, paralysis, seizures, unsteady gait, and dysarthria. While mental retardation and cerebral palsy do not cause each other, the two disorders are found together in approximately 40%-70% of all persons with cerebral palsy.

Prognosis Cerebral Palsy is a static disorder. A person with the disorder will not improve or deteriorate. It will stay with a person for their entire life.

Treatment There is no cure for cerebral palsy, however various forms of therapy can help a person with the disorder to function more effectively. Nevertheless, there is only some benefit from a life-long care. The treatment is usually symptomatic and focuses on helping the person to develop as many motor skills as possible or to learn how to compensate for them. The disorder does not affect the expected length of life so treatment focuses around quality of life issues.

Usage of the term "spastic" The term "spastic" describes the attribute of spasticity in one type of cerebral palsy. In 1952 a UK charity called The Spastics Society was formed. The term "spastic" was used by the charity as a term for people with cerebral palsy. Unfortinately, this rapidly became a playground insult, and the charity changed its name to SCOPE in 1994.

References

• "Conditions in Occupational Therapy: effect on occupational performance." ed. Ruth A. Hansen and Ben Atchison (Baltimore: Lippincott Williams & Williams, 2000), 8-21. ISBN 0-683-30417-8
• "Cerebral Palsy." (National Center on Birth Defects and Developmental Disabilities, October 3, 2002), http://www.cdc.gov/ncbddd/dd/ddcp.htm
• "Cerebral Palsy Explained." October 3, 2002, http://www.cerebralpalsy.cc/cerebral_palsy_explained
• "William and Spackman's Occupational Therapy 9th Edition." ed. Maureen E. Neistadt and Elizabeth Blesedell Crepeau (Lippincott-Raven Publishers, 1998), 233, 589-598. ISBN 0-397-55192-4
• Faults-and-all book marks Scope's 50th anniversary (http://society.guardian.co.uk/charitymanagement/story/0,8150,719600,00)