Cerebral Palsy: Causes, Symptoms, and Treatment PDF

PEDRIATIC REHABILITATION CEREBRAL PALSY BY: BARTCOBAIN CUATON ELAINE DALE  ANATOMY Cerebral palsy (CP) is a group of neurological disorders that affect movement, muscle tone, and coordination. It is caused by damage to the developing brain, usually before, during, or shortly after birth. The condi...

PEDRIATIC REHABILITATION CEREBRAL PALSY BY: BARTCOBAIN CUATON ELAINE DALE  ANATOMY Cerebral palsy (CP) is a group of neurological disorders that affect movement, muscle tone, and coordination. It is caused by damage to the developing brain, usually before, during, or shortly after birth. The condition is non-progressive, meaning the brain damage does not worsen over time.  ANATOMY Cerebral palsy (CP) is specifically linked to brain lesions and is a neurological disorder that affects movement and motor control. It is not associated with conditions that affect the peripheral nerves or muscles, even if they cause similar early motor issues. For example, diseases like spinal muscular atrophy, muscular dystrophies, and myelomeningocele (a form of spina bifida), which affect the spinal cord, nerves, or muscles, are not considered cerebral palsy, as they do not involve brain injury or abnormal brain development.  ETIOLOGY Cerebral palsy (CP) is caused by brain injury or abnormal brain development that occurs before, during, or shortly after birth. The damage typically affects the areas of the brain that control movement, muscle tone, and coordination. While the exact cause can vary, there are several known factors that contribute to the development of cerebral palsy: PRENATAL (BEFORE BIRTH) CAUSES PERINATAL (DURING BIRTH) CAUSES POSTNATAL (AFTER BIRTH) CAUSES UNKNOWN (IDIOPATHIC) CAUSES Cerebral palsy is primarily caused by brain damage that disrupts normal development. This damage can occur due to a variety of factors, including prenatal infections, lack of oxygen, premature birth, birth trauma, or infections and injuries during early childhood. In many cases, the exact cause remains unknown. PRENATAL (BEFORE BIRTH) CAUSES Genetic Factors: In some cases, CP may be linked to genetic mutations that affect brain development. Infections During Pregnancy: Infections such as rubella (German measles), cytomegalovirus (CMV), toxoplasmosis, or zika virus can cause damage to the developing brain. Lack of Oxygen (Hypoxia): A decrease in oxygen supply to the brain, which can occur for various reasons such as placental problems or umbilical cord accidents, may lead to brain injury. Maternal Health Issues: Conditions like uncontrolled diabetes, high blood pressure, or preeclampsia during pregnancy can increase the risk of CP. Multiple Pregnancies: Premature birth and low birth weight are more common in multiple births (twins, triplets, etc.), increasing the risk of CP. PERINATAL (DURING BIRTH) CAUSES Birth Asphyxia: A lack of oxygen to the baby during the birth process, such as from a prolonged labor, umbilical cord complications, or placental abruption. Premature Birth: Babies born prematurely are more vulnerable to brain injuries, as their nervous system may not be fully developed. Trauma During Delivery: Physical injury during birth, including the use of forceps or vacuum extraction. POSTNATAL (AFTER BIRTH) CAUSES Infections: Infections in early childhood, like meningitis (infection of the brain lining) or encephalitis (brain inflammation), can lead to brain damage and CP. Head Injury: Severe head trauma in infancy or early childhood can damage the brain and result in CP. Stroke: A stroke, which interrupts the blood flow to part of the brain, can occur in newborns or infants, leading to CP. Jaundice: Severe jaundice (yellowing of the skin due to high bilirubin levels) in newborns can cause brain damage if not treated promptly, potentially leading to CP (a condition called kernicterus).  UNKNOWN (IDIOPATHIC) CAUSES In some cases, the exact cause of cerebral palsy cannot be determined. These are referred to as idiopathic cases, where no clear underlying factor can be identified. PATHOPHYSIOLOGY There are different types of cerebral palsy, and the severity and specific symptoms vary widely among individuals. The main types include: Spastic cerebral palsy: Characterized by tight, stiff muscles and exaggerated reflexes, leading to difficulty with movement and posture. Dyskinetic cerebral palsy: Involves involuntary movements, which can be either slow and writhing or rapid and jerky. It affects the ability to control muscle movements. Ataxic cerebral palsy: Affects balance and coordination, causing difficulty with walking and fine motor skills. Mixed cerebral palsy: A combination of two or more types of CP, often spasticity with another movement disorder like ataxia. EPIDEMIOLOGY All races are affected by this disorder. Lower socioeconomic status and male sex may be increased risk factors for cerebral palsy. The insult that gives rise to cerebral palsy occurs during immature brain development. This initiating event can take place anytime between prenatal development and age 3 years. However, children are usually not diagnosed until af ter age 1 year, with the condition becoming identifiable as children fail to meet developmental milestones. Often, children who are older and are diagnosed as having cerebral palsy—as a result of having present ing symptoms or problems that are similar to those of cerebral palsy—should instead be labeled wi th the etiology of their brain injury (ie, t raumatic brain injury secondary to a motor vehicle accident, st roke, metabolic condi tion, etc.).  MEDICATION Treatment focuses on managing symptoms and improving quality of life. It may include physical therapy, occupational therapy, speech therapy, medications, surgery, and assistive devices. Early intervention is key to improving outcomes, and the goal is to help individuals with CP lead as independent and fulfilling a life as possible. MEDICAL PROCEDURE Physical therapy: This involves exercises and stretches to improve muscle tone, flexibility, and range of motion. Occupational therapy: This focuses on improving the ability to perform daily activities and developing fine motor skills. Speech therapy: This involves exercises to improve communication skills and help with swallowing difficulties. Medications: Medications such as muscle relaxants, anticonvulsants, and botulinum toxin injections may be prescribed to manage spast icity, seizures, and other symptoms. DIFFERENTIAL DIAGNOSIS Global Developmental Delay Similarities: GDD is an umbrella term for symptoms not yet considered as CP or other syndromes. GDD patients present with delayed motor funct ion, which is similar from CP patients. Spina Bifida-Similarities: Both cases present with learning disabilities, deformities such as talipes equinus foot, abnormal reflexes and spasticity. Differences: Symptoms of spina bifida depend on the level of the spinal cord, and these patients would seldom present with behavior problems. Autism-Similarities: Both cases would present wi th delayed motor development. Differences: Patients wi th autism would present more with behavior problem, while CP patients would present more with motor problems.