Cerebral Palsy

INTRODUCTION:-

 Cerebral palsy is a non progressive disorder, a term used to describe a group of chronic conditions affecting body movements and muscle co-ordination.

TYPES :-

Cerebral palsy (CP) is classified as spastic, athetoid, ataxic, or mixed. These classifications reflect the type of movement disturbance displayed by the patient.

 

  • Spastic CP–stiff, permanently contracted muscles; 50% to 75% of cases
  • Athetoid CP- (also called dyskinetic cerebral palsy)–slow, uncontrolled, writhing movements; 10% to 20% of cases
  • Ataxic CP–poor coordination, balance, and depth perception; 5% to 10% of cases
  • Mixed CP–two or more types present; 10% of cases (percentage may be higher)

FACTORS WHICH INCREASE THE POSSIBILITY OF CEREBRAL PALSY:

Breech presentation. : Infants with cerebral palsy are more likely to present feet first, instead of head first, at the beginning of labor.
Infants with permanent brain damage resulting from vascular or respiratory problems of the baby during labor and delivery are at increased risk of cerebral palsy.

Low Apgar score. : A low Apgar score (determined in the first minutes after birth by a check of the baby’s heart rate, breathing, muscle tone, reflexes, and skin color) is often considered an important sign of potential problems.

Low birthweight and Prematurity. The risk of cerebral palsy is higher among babies who weigh less than 5 lbs., 7 1/2 oz. (2500 grams) at birth. The lower the birth weight the higher the risk of cerebral palsy. The risk of cerebral palsy is also higher among babies who are born less than 37 weeks into pregnancy.

Multiple births. : Twins, triplets, and other multiple births are linked to an increased risk of cerebral palsy.

Nervous system malformations. : Some babies born with cerebral palsy have nervous system malformation, such as an abnormally small head (microcephaly). Problems of this nature occurred in the development of the nervous system while the baby was in the mother’s womb.

Maternal bleeding or severe proteinuria late in pregnancy. : Vaginal bleeding during the last three months of pregnancy and severe proteinuria (the presence of excess proteins in the urine) are linked to a higher risk of having a baby with cerebral palsy.

Maternal hyperthyroidism, mental retardation, or seizures. : Mothers with hyperthyroidism, mental retardation or seizure disorders are slightly more likely to have a child with cerebral palsy.

Seizures in the newborn. : A newborn infant who has seizures is at higher risk of being diagnosed, later in childhood, with cerebral palsy

SIGNS AND SYMPTOMS:

The signs and symptoms of Cerebral Palsy may be mild or subtle or quite obvious:

  • Poor head control
  • Difficulty feeding and sucking
  • Delays in motor development
  • Lying in awkward positions
  • Easily or frequently startled
  • Delay in crawling, walking, pushing up on all fours
  • Favoring of one hand over the other
  • Abnormal crawling
  • Spasticity (abnormal stiffness and contraction of muscles)
  • Motor impairment (difficulty with writing and other coordinated tasks)
  • Involuntary movements
  • Slow overall development
  • Difficulty with speech, hearing, or vision
  • Difficulty with perception or sensation
  • Inability to control bladder
  • Inability to control bowels
  • Breathing difficulties
  • Seizures
  • Behavioral and/or attention deficit disorders
  • Impaired sense of touch or pain
  • Swallowing problems
  • Limited range of motion
  • Progressive joint contractures

CAUSES OF CEREBRAL PALSY:

  • Acquired cerebral palsy : Brain damage in the first few months or years of life, brain infections, such as bacterial meningitis or viral encephalitis, or head injury account for many of the cases of acquired cerebral palsy.
  • Congenital cerebral palsy : Cerebral palsy which occurs at birth is often the result of specific events during pregnancy or around the time of birth. These events result in damage to the motor centers in the developing brain. Often times, however, congenital cerebral palsy may not be detected for months.
    Adequate care during pregnancy, labor and delivery, and immediately after the delivery of the infant is essential. Failure to perform the necessary tests and accurately interpret the results of these tests may cause injury to the developing brain. Improper use of medications, unrecognized fetal distress, untreated infections, excessive use of vacuum extraction, and the failure to perform a timely cesarean section may result in damage to the motor centers in the brain.
  • Infections during pregnancy : Viruses such as German measles, or rubella can infect the developing fetus in a pregnant woman and cause damage to the developing nervous system. Brain injury in the developing fetus may also be caused by other infections such as cytomegalovirus and toxoplasmosis. Infections of the placental may also be associated with cerebral palsy.
  • Jaundice in the infant : If left untreated, severe jaundice can damage brain. With the exception of physiologic jaundice in the newborn (normal newborn jaundice in the first week of life), all other jaundice indicates overload or damage to the liver, or inability to move bilirubin from the liver through the biliary tract to the gut.

DIAGNOSIS:

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.
  • 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.

PHYSIOLINE’S MANAGEMENT FOR CEREBRAL PALSY:

Each case of cerebral palsy is as unique as the individual it affects.

  • Physioline’s Specialised Physiotherapy is classified as a non-medicinal treatment of cerebral palsy with the use of exercise, massage, heat, and other external means of treatment, Used to help cerebral palsy patients improve movement and motor skills. Since cerebral palsy is a physical disorder that impairs the brain’s ability to properly control muscle movement, physiotherapy can do wonders in helping cerebral palsy patients gain mobility.
    At Physioline, the Cerebral palsy physiotherapy techniques are determined by the degree of physical limitations of the individual, and what will be most beneficial to the cerebral palsy patient. Physiotherapy can be great for increasing the success of learning to walk, standing without aid, using a wheelchair or other adaptive equipment, and other movement skills. The physical therapists involved in physiotherapy reduce further development of musculoskeletal problems by preventing muscle weakening, deterioration, and contracture through the correct physiotherapy techniques.
    Specialised Physiotherapy is an integral part in the majority of many cerebral palsy patients’ daily lives. It has the ability to develop self-sufficiency in cerebral palsy patients where it was previously absent.
  • Splints, Casts and Calipers: Specially designed shoes, ankle-foot orthoses (AFO) and calipers may be required to provide stability to the joints in a child who is learning to stand and walk. AFOs are particularly useful in children with spastic diplegia who have dynamic spasticity with tendo- achilles (TA) tightening. Lightweight splints may at times be required to maintain normal postures. Dynamic Lycra splints that provide support as well as flexibility are also used.
    However, Splints and Casts should not be used for prolonged periods of time as they may lead to disuse atrophy of the muscles.
  • Surgery: Surgery is useful in some children with spasticity, especially where mainly the lower limbs are involved. It should be done with a predefined functional goal, by an experienced surgeon. Tendon lengthening and transfer and arthrodesis are some of the procedures commonly performed. Generally multilevel surgery is required and is done after 8 years of age. Simultaneous availability of intensive physiotherapy is essential.
  • Parent Counseling: This is one of the most important aspects because parents are pivotal in the management of their child. It is an ongoing process, as the parents need to be counseled periodically at various stages of their child’s development.
    The main objectives are to properly explain the child’s condition and help the parents to accept it, guide them regarding proper treatment, address their concerns about the child, try to alleviate the immense psychosocial stress that they face, remove the feelings of guilt and blame and help build positive attitudes.

DETAILED TREATMENT:- Kindly contact Physioline for the detailed assessment and treatment program which is individualised according to every patient.

Paralysis Patients get Combination Therapy 

Physioline, a specialized physiotherapy and rehabilitation center of international repute in Manish Nagar, Andheri west, Mumbai introduced world’s best treatment protocol for the paralytic patients called Combination therapy. As the name suggests it is a combination of an array of therapies for the paralytic patients. Physioline in India is the first to bring such a intensive and result oriented treatment protocol of global standards right at your door step pioneered by Dr Sanjay Bakhshi, the founder and chief physiotherapist and rehabilitation consultant.

Combination therapy consists of the usage of specialized and sophisticated electronic equipment from Germany namely ‘Mentamove’ in adjunction with all the best approaches and techniques used world wide for the treatment of paralysis, all which are FDA approved German & US Equipment.

Combination therapy works on the principal of ‘Neuro-Plasticity’ i.e. the ability of the brain to reorganize its neuronal networks so that it functions by experience thus helping to relearn and adapt to new conditions. This  therapy can be used in the treatment of most of the causative factors of paralysis, to mention a few paralyses due to stroke,Facial Paralysis post-op for brain tumors, cranio cerebral trauma, spinal cord injuries, multiple sclerosis cerebral palsy etc. This form of therapy promises recovery at a faster pace with success rates scaling as high as 99% and with absolutely no side effects as well as a fair reduction in the cost of illness and medications.

With this innovative concept, the success ratio soars as high upto 99.99% in neurological conditions and 100% pain relief in orthopedic conditions. This has rewarded them with satisfied patients over the years.

The overall goal of treatment or management at Physioline is to cater to the health needs of patients and strive hard to enhance their capacity to function and remain as independent as possible. The endeavor to be the best in the field has prompted Dr Sanjay Bakhshi to constantly look for new ways to improve the results for the patients. With each new patient he and his team try to gain greater knowledge for guiding the successful recovery of future patients with similar impairments and diseases.

E-mail: physioline@gmail.com

Website: www.physioline.in

Contact: 26302176 / 26340779 / 65266092