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Frequently Asked Questions about Cerebral Palsy

Is cerebral palsy a disease?

Cerebral palsy is not a disease. The term cerebral palsy refers a disorder based in the brain which affects movement. Cerebral refers to the brain, while palsy refers to the interference with movement. The movement difficulties experienced by cerebral palsy patients are due to damage or malformations within in the brain, not by problems in the muscles themselves.

Are there different types of cerebral palsy?

There are several different types of cerebral palsy: spastic diplegia, spastic hemiplegia, spastic quadriplegia, athetoid dyskinetic cerebral palsy, choreoathetoid dyskinetic cerebral palsy, dystonic dyskinetic cerebral palsy, ataxic cerebral palsy, hypotonic cerebral palsy, and mixed cerebral palsy.

The spastic forms of CP are characterized by stiff muscles and muscle spasms. The dyskinetic forms of CP are characterized by involuntary, writhing movements. Ataxic CP, the least disabling of all the forms, is characterized by balance and depth perception problems which make walking difficult. Hypotonic CP is characterized by overly relaxed, “floppy” muscles. As the name implies, mixed CP is characterized by symptoms of two or more forms of the disorder.

How severely will my child be affected by cerebral palsy?

The answer depends on the type of CP and the extent of the brain damage or brain malformation which caused it. Impairment from CP ranges from mild to severe. Many people with cerebral palsylead nearly normal lives, while some CP patients require constant care from others throughout their lives.

What causes cerebral palsy?

Cerebral palsy is caused by brain damage or brain malformations. Occasionally genetic abnormalities cause the brain to develop abnormally, but most cases of brain malformation are due to other factors.

Exposure to toxins can interfere with the proper development of the unborn baby’s brain. Damage to the white matter of the brain is particularly likely to lead to CP. Between 26 and 34 weeks gestation, the unborn baby’s brain is especially vulnerable to injury to the white matter, but damage can occur at any point in the pregnancy.

Infections in the mother or in the unborn baby can lead to brain damage. The inflammation produced as a normal part of the infection fighting process can cause damage to the baby’s developing brain cells. Infections can also trigger strokes in the fetus, leading to oxygen deprivation; prolonged oxygen deprivation can cause brain damage which leads to CP.

Uncontrolled high blood pressure in the mother during pregnancy puts the fetus at higher risk for a stroke. Extremely low maternal blood pressure can also put the unborn baby at risk for a stroke. Monitoring and controlling the blood pressure is a vital part of good prenatal care.

Rh incompatibility, a condition in which the fetus’ Rh blood type conflicts with the mother’s Rh blood type, can also cause cerebral palsy. Rh incompatibility leads to severe jaundice—a buildup of bilirubin in the blood which can cause deafness and CP. a Fortunately, Rh incompatibility can be treated if caught in time. In the United States, testing for Rh incompatibility is regular part of prenatal care, but this is not the situation in many other countries. If you are pregnant, make sure your doctor checks for Rh incompatibility as early as possible in the pregnancy.

Severe jaundice caused by problems other than Rh incompatibility can also lead to CP. Jaundice is common in newborns, but it can be treated.

Is cerebral palsy hereditary?

Some cases of brain malformation are due to gene abnormalities which prevent the brain from developing normally, but this is rare. Most cases of CP are not in anyway hereditary, but are due to factors which occurred during the course of the pregnancy.

What is congenital CP?

The term congenital means present at birth. Between 90 to 95 percent of CP cases are congenital. Congenital CP includes those cases which were caused by oxygen deprivation during birth. Doctors used to believe that most cases of CP were caused by a lack of oxygen during a difficult labor and delivery, but it is now known that fewer than 10 percent of congenital cerebral palsy cases stem from asphyxia or other problems during birth. The majority of problems that cause CP occur during development in the womb.

Brain trauma, infections, strokes, and other problems after birth can occasionally cause acquired CP. As the name implies, acquired CP means that the condition was acquired after birth.

Can alcohol consumption during pregnancy cause cerebral palsy?

Alcohol consumption during pregnancy raises the risk of complications which can cause cerebral palsy, and many other birth defects. There is no established safe-level of alcohol consumption during pregnancy, so pregnant women should avoid alcohol entirely.

Are premature babies at greater risk for cerebral palsy?

Babies born prematurely are at a higher risk for cerebral palsy. Modern medical techniques save a higher percentage of premature babies, but these babies are more prone to developing disabilities than full term babies are.

Babies with a low birthweight are also more at risk for cerebral palsy, even if they are full-term.

Are women with certain medical conditions more likely to have a baby with CP?

Women with mental retardation, a seizure disorder, or a thyroid disorder are slightly more likely to have a baby with CP, than women who do not have these conditions.

What percentage of cerebral palsy patients have mental retardation?

According to the National Institute of Neurological Disorders and Stroke, approximately two-thirds of patients with CP have some mental impairment. Mental retardation can range from mild to severe. People with the spastic quadriplegia are more likely to have mental disabilities than those with other forms of CP. CP patients with epilepsy are also more likely to have mental retardation. Because of communication difficulties it is sometimes difficult to accurately assess the IQs of CP patients.

Learning disabilities without mental retardation are also associated with cerebral palsy. The speech, hearing, and vision problems which sometimes accompany CP can make learning difficult.

Many CP patients have normal IQs and no learning disabilities. A few CP patients are intellectually gifted.

Is cerebral palsy a life-threatening condition?

Cerebral palsy is not a terminal condition, but before the advent of newer medical techniques in the mid-twentieth century most children with CP did not live into adulthood; complications from the disorder claimed their lives. Today, between 65 and 90 percent of children with cerebral palsy reach adulthood. CP is stressful for the entire body and can cause premature aging, particularly of the heart, blood vessels, muscles, joints, and bones.

The complications stemming from CP can be life-threatening. Cerebral palsy can lead to respiratory and swallowing difficulties. Difficulty swallowing can lead to malnutrition and/or aspiration pneumonia—in which food is inhaled into the lungs causing an infection. Malnutrition causes weakness and muscle deterioration; it weakens the immune system making the patient more vulnerable to infections and less able to fully recover if an infection occurs.

CP patients whose mobility is extremely restricted may have to sit or lay down for extended periods of time, running the risk of pressure sores. Untreated pressure sores can develop life-threatening infections.

The bowel and bladder problems frequently associated with CP can lead to more serious complications when not properly managed.

Can cerebral palsy be cured?

Cerebral palsy cannot be cured. The brain damage or brain abnormalities from which it stems are irreversible. Fortunately, today much can be done to improve the quality of life for CP patients.

Can cerebral palsy be prevented?

Good prenatal care can help lower the risk of fetal strokes from maternal high blood pressure and infections. Appropriate prenatal care can also prevent complications from Rh incompatibility.

Preventative measures before pregnancy can also reduce the risk of birth defects; women with inflammatory pelvic disease should have the condition treated before becoming pregnant. Women planning on becoming pregnant should vaccinated against Rubella (German measles), which can cause birth defects and should consult their doctor on other measures they can take to assure a trouble-free pregnancy and a healthy baby.

However, some factors which can cause cerebral palsy and other birth defects cannot be prevented. There is no guarantee that the mother or the baby will not develop an infection; infections in the unborn baby are difficult to treat.

What type of research is being done on cerebral palsy treatments and prevention?

Extensive research is being done on cerebral palsy treatment and prevention. Much of this research is funded by the National Institute of Child Health and Human Development, the National Institute of Neurological Disorders and Stroke, and private organizations such as the United Cerebral Palsy Research and Educational Foundation.

Research is being done on brain development in hopes of learning what can be done to prevent brain abnormalities from developing. Scientists are also studying the role uterine infections play in the development of CP. Other research centers on finding new ways to diagnosis CP earlier, so that treatment can be begun as quickly as possible; early treatment leads to better outcomes for CP patients.

In addition, research is being conducted on the various methods of physical therapy used for CP to determine which methods are most effective and to develop better technology to utilize with these methods. For example, functional electrical stimulation of the muscles can help strengthen spastic muscles, but the technique uses bulky implanted devices; research is being done on using a hypodermic needle to inject small devices at the necessary sites, thus making this therapy more practical and affordable.

How is cerebral palsy treated?

Physical therapy, occupational therapy, and speech therapy can help improve the quality of life for CP patients. There are many methods of physical therapy, including conductive education, and hippotherapy. Conductive education is a complete educational program given in a group setting for five days a week, several hours a day; some experts dispute whether this is any more effective than traditional physical therapy, but many children who enjoy the stimulation of being in a group seem to benefit from conductive therapy.

Hippotherapy (hippo–Greek for horse) can help balance and motivation in CP children; the therapy involves riding on a gentle, well-trained horse. Using the leg muscles to keep their balance while riding a horse is therapeutic for cerebral palsy patients. Hippotherapy is psychologically beneficial because it involves the CP child in an activity other children without CP enjoy.

Medication such as muscle relaxants can benefit patients with spastic cerebral palsy. An implantable pump which delivers the muscle relaxant baclofen has helped some patients with chronic stiff muscles or involuntary movements; this therapy is called intrathecal baclofen therapy.

Some CP patients have benefited from BT-A (botullinum toxin) injections. This treatment helps relax spastic muscles for approximately three months and is most beneficial when combined with physical therapy, especially stretching. Parents or caregivers considering BT-A injections should make sure the doctor giving them has experience in using this treatment on children; BT-A injections are approved by the FDA for treatment of other conditions, but they have not yet been formally approved for the treatment of CP.

Surgery to correct or relieve complications from CP such as foot drop, ankle equinus, contractures, or spinal deformities is sometimes needed. Other treatments for CP involve treating other conditions sometimes associated with the disorder, such as hearing and vision problems.

Sources
“Cerebral Palsy: Hope Through Research” National Institute of Neurological Disorders and Stroke. Retrieved March 27, 2009 from the World Wide Web:http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy….

“Cerebral Palsy” March of Dimes. Retrieved March 28, 2009 from the World Wide Web:http://www.marchofdimes.com/pnhec/4439_1208.asp#types

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