Types of Cerebral Palsy
Spastic, Athetoid, and Ataxic.
The most common type of CP is spastic. A child with spastic CP can’t relax his/her muscles or his/her muscles may be stiff. Athetoid CP affects a child’s ability to control his/her muscles. This means that the arms or legs that are affected by athetoid Cerebral Palsy may flutter and move suddenly. A child with ataxic CP has problems with balance and coordination. A child with CP can have a mild case or a more severe case which depends on how much of the body is affected. If both arms and both legs are affected, a child might need to use a wheelchair. If only the legs are affected, a child might have to wear braces or walk with crutches. If the part of the brain that controls speech is affected, a child with CP might have trouble talking. Another child with Cerebral Palsy might not be able to speak at all.
Causes of Cerebral Palsy
No one knows for sure what causes cerebral palsy. For some babies, injuries to the brain can happen during or soon after birth and this sometimes causes CP. Small, premature babies (babies who are born many weeks before completion of 9 months in their mothers’ womb) or babies who need to be on a ventilator (a machine to help with breathing) for several weeks or more are most at risk for developing Cerebral Palsy. But for most children, the problem in the brain occurs before the baby is born, and we don’t know why.
Diagnosis of Cerebral Palsy
There is no actual test to figure out if a child has cerebral palsy. Doctors may order X–rays and blood tests to rule out other diseases of the brain and nervous system, but they must wait to see how a child develops in order to be sure, for proper management. A case of cerebral palsy can usually be diagnosed by the age of 18 months. Some children with CP won’t be able to sit up on their own by the age of 6 to 7 months or walk by 10 to 14 months, the way that most children without Cerebral Palsy can do. If a child has not done these things by a certain age, it can be an indication that he/she might have Cerebral Palsy. Doctors also look closely at problems with muscle tone, movement, and reflexes.
Managing Cerebral Palsy
It is difficult to differentiate between treatment and management, although most experienced physiotherapists in the field of cerebral palsy probably agree that periodic treatment sessions only are inadequate. The therapist must become involved with the parents, care staff and others and train them to physically manage the child appropriately throughout the day and night. However, this is not to say that specific, well–chosen treatment techniques performed by the skilled therapists are not an essential part of treatment as well. The aims of all management and handling techniques are:
- To promote the child’s assets and abilities, and, if possible, to stimulate normal patterns of movement.
- To prevent or reduce deformity.
- To discourage positions, movements and behaviors that make handling difficult, such as extending and thrusting backwards.
Methods of carrying the cerebral palsied child
- For fixed children.
- For extended of thrusting children. The adult’s hands may be under or in front of the child’s knees in either method of carrying.
- For children with tight hip adductors, hemiplegia and more able children. Note the position of the hemiplegic right arm, held by the adult in the extended position. For a left hemiplegia, carry on the left hip.
It is important that a cerebral palsied child experiences a variety of positions throughout the day. Most of the children, regardless of level of ability, will eventually be spending a good deal of the day in sitting. To counteract the detrimental effects of time spent in this flexed position, each child must also spend time in ‘Straight’ positions, either lying or standing, preferably both. Each of the positions discussed below is both posturally and functionally beneficial and detrimental, and it is up to the therapist to determine which ones suitably complement each other and are therefore appropriate.
In supine, many cerebral palsied children are completely unable to function, and in this position they may be most asymmetrical. If the supine position must be used, a pillow placed under the head and shoulders often promotes symmetry and the ability to get the hands together. In prone, the children are often more symmetrical, but they usually need to be raised off the floor, such as on a wedge, in order to use their hands and heads. A sandbag or strap placed across the child’s bottom may be needed to help the child maintain the position. Some children are very difficult to place in the prone position and do not tolerate it well. Others utilize the position to strengthen and improve their ability to extend and thrust, which should be discouraged. Side–lying is a position in which the child can be quite symmetrical, both hands are within his vision and are more likely to be used together. However, care must be taken that he/she does not fall partially into prone or supine lying, and therefore into a windswept deformity. Positions for sleeping can be difficult: children who have windswept hips tend to sleep in this position and often are woken by discomfort. A comfortable, non–detrimental position can only be found by trial and error. It may involve changing from supine to prone or side lying, or tilting the bed/mattress slightly to tip the child’s weight on to his/her relatively unweighted side. Leg gaiters, if tolerated, can help in maintaining a relatively symmetrical position.