| |
Cerebral palsy (CP) is a group of conditions affecting control of
movement and posture. The characteristics of CP may vary widely between
individuals depending on the degree and location of brain damage. Symptoms may
range from mild to severe, and diagnostic techniques can help determine the
extent of the condition.
Risk Factors
Symptoms
Diagnosis
Risk Factors
Risk factors are variables that have been observed to have an effect on the
diagnosis of medical conditions. Risk factors do not, by themselves, indicate
that a condition will occur, nor does the lack of a risk factor mean that a
condition will not occur. The presence of risk factors may simply point to an
increased likelihood, not a certainty, for the development of cerebral palsy.
The following risk factors in parents, may increase the risk of cerebral palsy
(CP) in their child:
- If the Mother is over 40 years old, or
younger than 20 years old;
- If the Father is younger than 20 years
old;
- African-American ethnicity - cerebral
palsy has a higher rate of incidence within the African-American community;
The following risk factors related to
pregnancy or the delivery, may increase the risk of CP:
- If the pregnancy is the first, or
is the fifth or later in the family;
- Twinning, or multiple child pregnancy,
can lead to lower birth weights and/or prematurity - increasing the risk for CP;
- Vaginal bleeding in the third
trimester;
- Low birth weight - under 5.7 pounds;
- Premature birth, less than 37 weeks;
- Breech birth;
- Fetal Distress, respiratory or vascular
problems during delivery;
- Low Apgar score - infant heart rate,
breathing, muscle tone, reflexes, and skin color are each scored as 0 (low), 1
(intermediate), or 2 (normal) after delivery. A total score of 7-10 at 5 minutes
is considered normal; 4-6, intermediate; and 0-3, low. Scores that remain low
10-20 minutes after delivery indicate increased risk for CP.
Additional risk factors for cerebral
palsy include:
- Rh or ABO blood type incompatibility
between mother and child;
- Serious viral infections (ex., German
Measles) during early pregnancy;
Symptoms
CP syndromes are grouped into four main categories: spastic, athetoid, ataxic,
and mixed forms. Each type is characterized by different symptoms:
Spastic Cerebral Palsy - occurs
in about 70% of cases. The spasticity is due to upper motor neuron involvement
and may mildly or severely affect motor function. The syndrome may produce
hemiplegia, paraplegia, quadriplegia,
or diplegia.
Affected limbs usually are underdeveloped and show increased deep tendon
reflexes, weakness, and a tendency toward contractures. A scissors gait and toe
walking are characteristic. In mildly affected children, impairment may occur
only during certain activities (eg, running). With quadriplegia, an associated
impairment of oral, lingual, and palatal movement, with consequent
dysarthria, is common.
Athetoid Cerebral Palsy - occurs in about 20% of cases. Slow, writhing,
involuntary movements may affect the extremities (athetoid) or the proximal
parts of the limbs and the trunk (dystonia);
abrupt, jerky, distal movements (choreiform)
also may occur. The movements increase with emotional tension and disappear
during sleep. Dysarthria occurs and is
often severe.
Ataxic Cerebral Palsy - occurs in about 10% of cases. Weakness,
incoordination, and intention tremor produce unsteadiness, a wide-based gait,
and difficulty with rapid or fine movements.
Mixed CP - is not uncommon, and is a combination of the above types but
is most often a mixture of spasticity and athetoid movements, with tight muscle
tone and involuntary reflex.
Symptoms of cerebral palsy may be evident immediately after birth, or may take
months or years (1,200 - 1,500 preschool children are diagnosed each year), to
become noticeable. Parents may notice that their child is slow to reach
developmental milestones or displays abnormal behavior.
- At 3 months there may be a lack
of facial expressions, the baby may not respond to some sounds, or is unable to
follow movement with their eyes.
- The child may not be able to bring
their hands together at 4 months.
- A child with cerebral palsy may not
display the coordination to lift their head, or rollover at 6 months.
- At 8 months the baby may not be
able to sit up by themselves, or without support. There may be a head lag when
the child is placed in a sitting position.
- By 12 months the child may not
be able to crawl.
- Drooling is a common problem because of
the lack of facial and muscle control.
- Muscle tremor or
spasticity may be evident, with a
tendency of infants to tuck their arms in toward their sides, scissors movements
of the legs, or other abnormal movements.
- Feeding may be a continuous effort and
problematic.
- Excessive stiffness when dressing,
changing diapers, or bathing.
It is important to realize that the
presence of any of these symptoms does not necessarily indicate your child has
cerebral palsy. Children develop on different timeframes, and symptoms are often
outgrown. Only your doctor can make an accurate diagnosis and provide you with
the information you need to care for your child.
Diagnosis
The diagnosis of cerebral palsy includes the consideration and monitoring of
many factors, and may not be made until after the first or second years of
development. A child's brain and central nervous system have an amazing ability
to recover completely, or partially, following injury - this sometimes leads to
a delay in diagnosis. In addition, children develop at different rates, and
motor skill difficulties can frequently be signs of other problems -
misdirecting diagnosis. In most cases, an interdisciplinary team of medical
professionals will be gathered to review the child's strengths and weaknesses,
test results, risk factors and medical history. Based on these numerous
criteria, a diagnosis of cerebral palsy may be made.
Several tests can be used to assist in the diagnosis, and determine the severity
of cerebral palsy:
- Intelligence tests often are
administered to a child with CP to evaluate mental impairment;
- An electroencephalogram (EEG) traces
electrical activity in the brain and can reveal patterns that suggest a seizure
disorder;
- Imaging tests are helpful in diagnosing
hydrocephalus, structural abnormalities, and tumors. This information can help
the physician assess the child's long-term prognosis;
- Magnetic resonance imaging (MRI) uses a
magnetic field and radio waves to create pictures of the internal structures of
the brain. This study is performed on older children. It defines abnormalities
of white matter and motor cortex more clearly than other methods;
Cerebral palsy diagnosis depends on
many factors, a team of medical professionals can make an accurate diagnosis,
and assist in determining a long-term prognosis for the child. While a medical
diagnosis can be determined, often what caused the cerebral palsy cannot be,
click here to learn more about the
possible causes of CP.
| |
