Cerebral Palsy

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Cerebral Palsy also known as CP is an umbrella term which refers to a group of physical disorders which affects an individuals ability to move;


  • Cerebral means “of the brain” and palsy refers to the lack of muscle control

  • CP is non progressive disorder however without therapeutic treatment impairments may progress

  • People who have cerebral palsy may also have visual, learning, hearing, speech and intellectual impairments.


The main types of cerebral palsy are:


  • Quadriplegia affects both arms and legs, the trunk, face and mouth may also be affected

  • Diplegia affects both legs, in some cases arms may also be affected but to a lesser extent

  • Hemiplegia affects one side of the body

  • An individuals Cerebral palsy can also be described by the way it affects their movement

  • Spastic where muscles feel stiff and tight, this is due to damage of the motor cortex

  • Dyskinetic is involuntary movements caused by damage to the Basal Ganglia

  • Ataxic where muscles produces a shaky movement which also affects balance, this is due to cerebellum damage

  • An individual with CP may also have a combination of damage to the brain resulting in a variety of movement patterns

Causes

CP is caused by damage to the developing brain during pregnancy or shortly after birth and is a life long condition


There are a variety of causes, some of which are;


  • Lack of oxygen to the brain during labor and delivery

  • Maternal infections

  • Brain infections

  • Bleeding into the brain

  • Head injuries

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Signs & Symptoms

Most signs are picked up as the baby develops and is not reaching age appropriate mile stones, these may include;


  • low muscle tone or feeling “floppy” when picked up

  • feeling stiff or experiencing muscle spasms

  • poor muscle control/posture

  • feeding or swallowing difficulties

  • favouring one side of their body

  • not walking by 18 months

Differential Diagnosis

CP may take a long time to diagnose due to the doctor ruling out other disorders, in particular any progressive disorders which may require different care, a differential diagnosis may include;


  • Progressive hereditary neurological disorders

  • Progressive cerebellar degenerative disorder

  • Athetosis, self-mutilation, and hyperuricemia in boys indicate Lesch-Nyhan syndrome.

  • Cutaneous or ocular abnormalities may indicate tuberous sclerosis complex, neurofibromatosis, ataxia-telangiectasia, von Hippel–Lindau disease, or Sturge-Weber syndrome.

  • Infantile spinal muscular atrophy, muscular dystrophies, and neuromuscular junction disorders associated with hypotonia and hyporeflexia usually lack signs of cerebral disease.

  • Leukodystrophies begin earlier and may be mistaken for CP at first.

PROmotion Assessment and outcome measures

  • Initial diagnosis will be through an early childhood nurse, practitioner or Peadiatrician and include observation of child’s movements and posture followed by a possible CT or MRI if required

  • If there are any medical concerns at birth a health professional may send a newborn for a general movement assessment

  • Once diagnosed Childen and adults with CP may come into PROmotion for an initial assessment with an Exercise Physiologist

  • An assessment with Exercise Physiologist will include a medical PAR-Q, medical history, current signs and symptoms, current physical activity levels, short and long term goals and blood pressure

  • Based on individual goals further assessment may include Body composition (height, weight, body girths), Cardiovascular fitness test, muscular strength & endurance, flexibility, balance and range of movement

  • Re-test and a visit of goals will occur every 6-8 weeks

How to Manage

  • An individual exercise program designed around specific goals and possible barriers

  • Options of Group, individual or home exercise setting

  • Management may also include referral to other relevant allied health professionals for a holistic approach

References

  1. Verschuren O, Peterson MD, Balemans AC, Hurvitz EA. Exercise and physical activity recommendations for people with cerebral palsy. Dev Med Child Neurol. 2016;58(8):798-808. doi:10.1111/dmcn.13053

  2. Hsu CW, Kang YN, Tseng SH. Effects of Therapeutic Exercise Intensity on Cerebral Palsy Outcomes: A Systematic Review With Meta-Regression of Randomized Clinical Trials. Front Neurol. 2019;10:657. Published 2019 Jun 21. doi:10.3389/fneur.2019.00657

  3. Booth ATC, Buizer AI, Meyns P, Oude Lansink ILB, Steenbrink F, van der Krogt MM. The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2018;60(9):866-883. doi:10.1111/dmcn.13708