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(Cerebral means having to do with the brain; Palsy means weakness or problems with using the muscles)Cerebral Palsy is a condition with abnormalities of movement, posture and tone (tightness or looseness of the muscles) due to damage or injury in a developing brain. The child does not learn to hold his head, sit, stand and walk at appropriate times. Also, the muscles may be loose or tight. There may be abnormal positions and postures of the body. Thus, even when the child learns to do these activities, the way s/he performs these activities is not normal. For instance, instead of crawling, the child may move forward on his bottoms, or may walk on the toes. There may be other associated problems like: • Delayed development or intellectual disability • Seizures • Behavioral problems • Speech, hearing and language disorders • Vision problems • Sensory impairment - either increase or decrease of sensations • Feeding difficulties • Bladder/Bowel disturbances - constipation • Orthopedic problems It is important to understand that clinical picture does not remain same throughout. It changes with time due to ongoing brain developmental maturation/interventions. Disabilities differ in each child, and severity is variable. CEREBRAL PALSY (CP) and PREGNANCY
Cerebral Palsy is a result of an injury of the part of the brain that control movement. Damage to other parts can also occur, which can cause difficulty in seeing, hearing, communicating and learning. Damage occurs in the early stages of brain development that may start during pregnancy itself and up to 5 years of age. Damage to the brain does not get worse, the effects become more noticeable with time.
The damage to the brain can result due to use of certain drugs, irradiation, smoking/alcohol by the mother. Any infection to her or poor fetal growth.
DURING LABOR/DELIVERY/NEWBORN PERIOD
Delayed cry at birth.
Prematurity, neonatal jaundice, low blood sugar or calcium, other serious illness
After birth, in early childhood due to infection of brain, head injury, prolonged seizures, stroke, and others.
HOW DO WE INVESTIGATE CEREBRAL PALSY?A number of investigations are required for the evaluation of Cerebral Palsy
• MRI Brain
A number of investigations are required for the evaluation of Cerebral Palsy • MRI Brain
• BERA / Audiometry - hearing evaluation • VEP - if reduced visual acuity is suspected • EEG for seizures • Biochemical/genetic tests, if any other cause is suspected, as per advice of the Pediatric Neurologist • An Ophthalmologist should examine the eyes in all cases. MANAGEMENT Cerebral Palsy can only be managed by a team. One person cannot do it. The team is made up of: • Pediatrician/Pediatric Neurologist: checks and evaluates for brain injury, seizures, and neurological problems • Developmental Pediatrician: evaluates the developmental status of the child • ENT Specialist / Eye Specialist - checks the visual system and hearing system • Pediatric Orthopedic Surgeon: checks out bone deformities and contractures Various therapists are required for different therapies: • Occupational Therapist/Physiotherapist - helps in achieving milestones • Speech Therapist: helps in improving speech • Child Psychologist: evaluates IQ and developmental status of the child, and behavior problems • Special Educators: if a child has associated autistic features by special management techniques, sensory integration Inputs are required from different members of the team. All team members are required only initially; later consultations are decided based on the needs of the child as s/he develops. Therapists are the ones who will be associated with the child as long it’s required. REMEMBER: Management is required to be started as soon as diagnosis is suspected or made for best results. Management should be continued in various aspects till child reaches adolescence. WHAT THE DOCTOR MAY ADVISE? After the assessment, the doctor will advise necessary investigations. After review of the investigations, they’ll advise various therapies as required depending on the child’s age, and particular problems. Medicines may be advised for seizures, muscle tightness, or abnormal movements. WHAT THE PARENTS CAN DO? Follow doctors’ and therapists' advice carefully. Regular visits are important. Take active interest in the therapy, and be involved even when the therapist is working on the child. Carry out therapies at home as well - incorporate them in your day to day life. Do not hesitate to clear doubts and concerns on any aspect of the treatment or therapy. Maintain your own record of the child's development. The therapies last for long periods - but do not lose heart. Focus on the child's abilities - not on what he does not have.
MS(GENERAL SURGERY),MCH(PEDIATRIC SURGEON),PEDIATRIC UROLOGIST,RENAL TRANSPLANT SURGEON
Rainbow Children's Hospital, Banjara Hills, Hyderabad