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| + | '''Cerebral palsy (CP)is an umbrella term encompassing a group of non-[[Non-progressive illness|progressive]],<ref>"''Cerebral Palsy.''" (National Center on Birth Defects and Developmental Disabilities, October 3, 2002), [http://www.cdc.gov/ncbddd/dd/ddcp.htm www.cdc.gov]</ref> non-[[Infectious diseases|contagious]] condition that cause [[physical disability]] in [[human development]]. |
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| − | {{DiseaseDisorder infobox | |
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| − | Name = Cerebral palsy| |
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| − | ICD10 = G80 | |
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| − | ICD9 = {{ICD9|343}} | |
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| − | }} |
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| − | '''Cerebral palsy (CP)''' is an [[umbrella term]] encompassing a group of non-progressive [[neurological]] [[physical disability|physical disabilities]] in the development of human movement and posture. CP arises from disturbances in the developing fetal or infant [[brain]]; motor disorders are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behavior, and/or by a [[seizure]] disorder” (Rosenbaum et al, 2005). |
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| + | ''Cerebral'' refers to the affected area of the brain, the [[cerebrum]] (however the centers have not been perfectly localized and the disease most likely involves connections between the cortex and other parts of the brain such as the [[cerebellum]]) and ''[[palsy]]'' refers to disorder of movement. CP is caused by damage to the motor control centers of the young developing brain and can occur during [[pregnancy]] (about 75 percent), during [[childbirth]] (about 5 percent) or after birth (about 15 percent) up to about age three.<ref>{{cite web |url=http://children.webmd.com/tc/cerebral-palsy-topic-overview |title=Cerebral Palsy - Topic Overview |accessdate=2008-02-06 |format= |work=}}</ref>. <ref>{{cite journal |author= |title= |journal= WebMD Medical Reference from Healthwise |volume= |issue= |pages= |year= |pmid= |doi=}}</ref> |
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| − | The incidence in developed countries is approximately 2-2.5 per 1000 live births. Incidence has not declined over the last 60 years despite medical advances like electro-fetal monitoring. Cerebral palsy is a non-progressive disorder, however secondary orthopaedic deformities are common, for example hip dislocation and [[scoliosis]] of the spine. There is no known cure; medical intervention is limited to the treatment and prevention of complications possible from their disabilities. Allied health is employed to maximise their function and ease of care. Severity varies widely, and cerebral palsy ranks among the most costly congenital conditions to manage. |
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| + | It is a non-progressive disorder, meaning the brain damage does not worsen, but secondary orthopedic difficulties are common. There is no known cure for CP. Medical intervention is limited to the treatment and prevention of complications possible from CP's consequences. |
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| − | Cerebral palsy is divided into four major classifications to describe the different movement impairments. These classifications reflect the area of brain damaged. Cerebral palsy can occur during pregnancy (~75%), at birth (~5%) or after birth (~15%). 80% of causes are unknown. For the small number where cause is known this can include infections, malnutrition, and significant head injury in very early childhood. |
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| + | Onset of arthritis and osteoporosis can occur much sooner in adults with CP. Further research is needed on adults with CP, as the current literature body is highly focused on the pediatric patient. CP's resultant motor disorder(s) are sometimes, though not always, accompanied by "disturbances of sensation, cognition, communication, perception, and/or behavior, and/or by a [[seizure]] disorder".<ref>{{cite web |url=http://www.ucpresearch.org/cerebral-palsy-research/proposed-definition.php |title=United Cerebral Palsy Research and Educational Foundation |accessdate=2007-07-29 |format= |work=}}</ref><ref>{{cite journal |author=Bax M, Goldstein M, Rosenbaum P, ''et al'' |title=Proposed definition and classification of cerebral palsy, April 2005 |journal=Developmental medicine and child neurology |volume=47 |issue=8 |pages=571-6 |year=2005 |pmid=16108461 |doi=}}</ref> |
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| − | The four major classifications are: |
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| + | CP is the second-most expensive [[developmental disability]] to manage over the course of a person's lifetime (second to mental disabilities), with an average lifetime cost per person of USD$921,000 (in 2003 dollars).<ref name="pmid14749614">{{cite journal |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5303a4.htm |title=Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment--United States, 2003 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=53 |issue=3 |pages=57-9 |year=2004 |pmid=14749614 |doi= |accessdate=2007-08-12}}</ref> The incidence in the six countries surveyed is approximately an average of 2.12–2.45 per 1000 live births;<ref>{{cite web |url=http://www.ucpresearch.org/fact-sheets/epidemiology-cerebral-palsy.php |title=Summary of "The Epidemiology of cerebral palsy: incidence, impairments and risk factors" |publisher=United Cerebral Palsy Research and Education Foundation (U.S.) |accessdaymonth=5 July | accessyear=2007}}</ref> there has been a slight increase in recent years. Although improvements in [[neonatal nursing]] help reduce the number of babies who develop cerebral palsy, they also mean that babies with very low birth weights survive, and these babies are more likely to have cerebral palsy.<ref>{{cite web |
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| − | *Spastic; |
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| + | | title = Information : Scope |
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| − | *Athetoid; |
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| + | | url = http://www.scope.org.uk/information/cp.shtml |
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| − | *Ataxic, and |
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| + | | accessdate = 2007-12-08 }} |
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| − | *Mixed. |
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| + | </ref><ref> |
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| + | {{cite web |
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| + | | last = Groch |
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| + | | first = Judith |
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| + | | authorlink = Judith Groch |
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| + | | title = Medical News: Cerebral Palsy Rates Decline in Very Low Birthweight Children - in Neurology, General Neurology from MedPage Today |
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| + | | publisher = MedPage Today |
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| + | | date = January 5 |
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| + | | url = http://www.medpagetoday.com/Neurology/GeneralNeurology/tb2/4812 |
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| + | | accessdate = 2007-12-08 }}</ref> |
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| − | In 30% of all cases of cerebral palsy, the spastic form is found along with one of the other types. There are a number of other minor types of cerebral palsy, but these are the most common. |
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| − | == |
+ | ==Classification== |
| + | CP is divided into four major classifications to describe the different movement impairments. These classifications reflect the area of brain damaged. The four major classifications are: |
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| − | *'''[[Ataxia]]''' ([[ICD|ICD-10]] G80.4): Persons with ataxia have damage to their [[cerebellum]] which results in problems with balance, especially while walking. It is the most rare type, occurring in at most 10% of all cases. Some of these individuals have hypotonic-like (low-muscle tone). It is common for these individuals to have difficulty with visual or auditory processing of objects and they may have instability in terms of balance or gravity. |
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| + | *Spastic |
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| − | * '''[[Athetoid]]''' or '''[[dyskinetic]]''' ([[ICD|ICD-10]] G80.3): Persons with this type generally have involuntary body movements. The damage occurs to the [[extrapyramidal motor system]] and/or [[pyramidal tract]] and to the [[basal ganglia]]. It occurs in ~20% of all cases. |
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| + | *Athetoid/Dyskinetic |
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| − | *'''[[Spastic]]''' ([[ICD|ICD-10]] G80.0-G80.1): Persons with this type have damage to the [[corticospinal tract]], [[motor cortex]], or pyramidal tract. It occurs in ~70% of all cases. Spastic cerebral palsy is further classified by [[topography]], dependent on the region of the body affected. These typography classifications include: (1) hemiplegia (one side being more affected than the other); (2) diplegia (the lower body being more affected than the upper body); and (3) quadriplegia (All four limbs affected equally). |
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| + | *Ataxic |
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| + | *Mixed |
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| + | In 30 percent of all cases of CP, the spastic form is found along with one of the other types. There are a number of other, less prevalent types of CP, but these are the most common. |
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| − | ==Types of Spastic CP== |
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| − | Based on the group of muscles involved, the below are typically only used to further describe spastic CP. |
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| + | A general classification is as follows: |
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| − | # '''[[Tetraplegia]]''' or '''[[Quadriplegia]]''' : Involvement of the four limbs, the trunk and the head. The great majority of these individuals will not be able to stand up or walk. |
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| − | # '''[[Diplegia]]''': Both lower limbs are affected to a degree, although most people with diplegia have limited use of their legs. Some diplegic individuals are able to walk either fully independently, with Splints or AFO's or with a walking aid such as crutches or a walker. In diplegia, arms are unaffected or there are only slight effects. |
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| − | # '''[[Hemiplegia]]''': Only the right side or the left side of the body is involved. People with hemiplegia are the most likely to walk, even though people with the above two types can often walk without assistance, if severity allows. |
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| + | ===Spastic=== |
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| − | Occasionally, terms such as [[monoplegia]], [[paraplegia]], [[triplegia]] and [[pentaplegia]] may be used. |
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| + | '''[[Spastic]]''' ([[ICD|ICD-10]] G80.0-G80.1) cerebral palsy is by far the most common type, occurring in 70% to 80% of all cases. People with this type are [[hypertonia|hypertonic]] and have a [[neuromuscular]] condition stemming from damage to the [[corticospinal tract]], [[motor cortex]], or [[pyramidal tract]] that affects the nervous system's ability to receive [[gamma amino butyric acid]] in the area(s) affected by the spasticity. Spastic CP is further classified by [[topography]] dependent on the region of the body affected; these include: |
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| + | *'''[[spastic hemiplegia]]''' (one side being affected). Generally, injury to the left side of the brain will cause a right sided deficit, and vice versa. |
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| − | == Presentation (signs and symptoms) == |
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| + | *'''[[spastic diplegia]]''' ( the lower extremities are affected more than the upper extremities). Most people with spastic diplegia do eventually walk. The gait of a person with spastic diplegia is typically characterised by a crouched gait. Toe walking and flexed knees are common. Hip problems, dislocations, and side effects like [[strabismus]] (crossed eyes) are common. Strabismus affects three quarters of people with spastic diplegia. This is due to weakness of the muscles that control eye movement. In addition, these individuals are often nearsighted. In many cases the IQ of a person with spastic diplegia is unaffected by the condition. |
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| − | All types of cerebral palsy are characterized by abnormal muscle tone, posture, reflexes, or motor development and coordination. The classical symptoms are [[spasticity]], unsteady gait, and [[dysarthria]]. CP symptomatology is as diverse as the individuals who have it. Secondary symptoms can include speech or communication disorders, [[seizures]], [[hearing impairment|hearing]] or [[vision impairment]], [[cognitive disabilities]], [[learning disabilities]], and/or behavioral disorders. [[Soft tissue]] findings consist largely of decreased muscle mass. |
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| + | *'''[[spastic quadriplegia]]''' (Whole body affected; all four limbs affected equally). Some children with quadriplegia also have hemiparetic tremors; an uncontrollable shaking that affects the limbs on one side of the body and impairs normal movement. A common problem for children with quadriplegia is fluid buildup. Diuretics and steroids are medications administered to decrease any buildup of fluid in the spine that is caused by leakage from dead cells. Hardened feces in a quadriplegia patient are important to monitor because it can cause high blood pressure. Autonomic dysreflexia can be caused by hardened feces, urinary infections, and other problems, resulting in the overreaction of the nervous system and can result in high blood pressure, heart attacks, and strokes. Blockage of tubes inserted into the body to drain or enter fluids also needs to be monitored to prevent autonomic dysreflexia in quadriplegia. The proper functioning of the digestive system needs to be monitored as well. |
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| − | === Bones === |
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| − | In order for bones to attain their normal shape and size, they require the stresses from normal musculature. The osseous findings will therefore mirror the specific muscular deficits in a given patient. The shafts of the bones are often thin (gracile). When compared to these thin shafts (diaphyses) the metaphyses often appear quite enlarged (ballooning). With lack of use, articular cartilage may atrophy, leading to narrowed joint spaces. |
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| + | Occasionally, terms such as [[monoplegia]], [[paraplegia]], [[triplegia]], and pentaplegia may also be used to refer to specific manifestations of the spasticity. |
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| − | Depending on the degree of spasticity in a given patient, they may exhibit a variety of angular deformities about their joints. Vertebral bodies also need vertical gravitational loading forces to develop properly. If a patient with cerebral palsy spends a great deal of time horizontal (in bed) during skeletal maturation, their adults vertebral bodies may be somewhat vertically elongated. Since the horizontal spines of quadrupeds normally appear this way, this finding in humans is sometimes referred to as "caninization". It is suggested to make the patient accustomed to sitting during skeletal maturation (childhood)because it is the easiest way of feeding and also the patient will not have difficulty with sleeping. |
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| − | == |
+ | ===Ataxic=== |
| + | '''[[Ataxia]]''' ([[ICD|ICD-10]] G80.4) type symptoms can be caused by damage to the [[cerebellum]]. Forms of ataxia are less common types of Cerebral Palsy, occurring in at most 10% of all cases. Some of these individuals have [[hypotonia]] and [[tremor]]s. Motor skills like writing, typing, or using scissors might be difficult, as well as problems with balance, especially while walking. It is common for individuals to have difficulty with visual and/or auditory processing of objects. |
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| − | Cerebral palsy, then known as "Cerebral Paralysis", was first identified by [[United Kingdom|British]] surgeon [[William Little (English surgeon)|William Little]] in [[1860]]. Little raised the possibility of [[asphyxia]] during birth as a chief cause of the disorder. It was not until [[1897]] that [[Sigmund Freud]], then a neurologist, suggested that a difficult birth was not the cause but rather only a symptom of other effects on fetal development. Research conducted during the 1980's by the National Institute of Neurological Disorders and Stroke (NINDS) suggested that only a small number of cases of CP are caused by lack of oxygen during birth. |
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| + | ===Athetoid/dyskinetic=== |
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| − | Thomas Galton believed that there was consistency between physical disability and aptitude. This attitude remained prevalent until the 1970's when cerebral palsy was itself, an overdiagnosed disorder. Various subtypes, such as hypotonic CP were utilized and when these individuals are taken out of the CP pool, the number drops to 1 in 2,000 individuals. So the number of people with CP depends on its definition. Most scholars acknowledge that ataxic, atheoid, spastic, and mixed are the relevant forms of CP; however, various conditions and subtypes may exist. A common misnomer is that CP causes mental retardation. In fact, only CP individuals with brain damage in the hippocampus or the frontal cerebral cortex suffer from mental retardation. While learning difficulties and CP may co-occur, it is common for individuals with CP to lead normal lives if their lives are managed coherently and effectively. Individuals with CP fare better when they can focus on scholastic achievement or on improving social skills, rather than on when they will get their next treatment. Assistive technology helps give them such focus. |
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| + | '''[[Athetoid]]''' or '''[[dyskinetic]]''' ([[ICD|ICD-10]] G80.3) is mixed [[muscle tone]] - sometimes [[hypertonia]] and sometimes [[hypotonia]]. People with athetoid CP have trouble holding themselves in an upright, steady position for sitting or walking, and often show [[involuntary motion]]s. For some people with athetoid CP, it takes a lot of work and concentration to get their hand to a certain spot (like scratching their nose or reaching for a cup). Because of their mixed tone and trouble keeping a position, they may not be able to hold onto objects (such as a toothbrush or pencil). About one-fourth of all people with CP have athetoid CP. The damage occurs to the [[extrapyramidal motor system]] and/or [[pyramidal tract]] and to the [[basal ganglia]]. It occurs in 40% of all cases. |
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| + | == Incidence and prevalence == |
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| − | Motor difficulties are common in individuals with CP. This can vary from paralysis of movement to minor levels of clumsiness. The brain's plasticity at a young age is probably one of the main reasons for the differences between individuals with CP. |
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| + | In the industrialised world, the [[incidence (epidemiology)|incidence]] of cerebral palsy is about 2 per 1000 live births.<ref>{{cite web |url=http://www.tvcc.on.ca/gateway.php?id=167&cid=2 |title=Thames Valley Children's Centre - Cerebral Palsy - Causes and Prevalence |accessdate=2007-06-11 |format= |work=}}</ref> The incidence is higher in males than in females; the Surveillance of Cerebral Palsy in Europe (SCPE) reports a M:F ratio of 1.33:1.<ref>{{cite journal |author=Johnson, Ann |title=Prevalence and characteristics of children with cerebral palsy in Europe |journal=Developmental medicine and child neurology |volume=44 |issue=9 |pages=633-40 |year=2002 |pmid=12227618 |url=http://journals.cambridge.org/production/action/cjoGetFulltext?fulltextid=120612}}</ref> Variances in reported rates of incidence across different geographical areas in industrialised countries are thought to be caused primarily by discrepancies in the criteria used for inclusion and exclusion. When such discrepancies are taken into account in comparing two or more registers of patients with cerebral palsy (for example, the extent to which children with mild cerebral palsy are included), the incidence rates converge toward the average rate of 2:1000. |
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| + | In the [[United States]], approximately 10,000 infants and babies are diagnosed with CP each year, and 1200-1500 are diagnosed at preschool age.<ref>{{cite web |
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| − | == Cause == |
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| + | | author=United Cerebral Palsy Research and Education Foundation (U.S.) |
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| − | Since cerebral palsy refers to a group of disorders, there is no exact known cause. Some major causes are [[asphyxia]], [[Hypoxia (medical)|hypoxia]] of the brain, birth trauma or [[premature birth]], [[genetics|genetic]] susceptibility, certain [[infection]]s in the mother during and before birth, central nervous system infections, [[Physical trauma|trauma]], and consecutive [[hematoma]]s. After birth, the condition may be caused by toxins, physical brain injury, incidents involving hypoxia to the brain (such as [[drowning]]), and [[encephalitis]] or [[meningitis]]. However the cause of most individual cases of cerebral palsy is unknown. |
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| + | | title=Cerebral Palsy Fact Sheet |
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| + | | url=http://www.ucp.org/uploads/cp_fact_sheet.pdf |
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| + | | accessdaymonth = [[12 August]] | accessyear=2007 |
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| + | }}</ref> |
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| + | Overall, advances in care of pregnant mothers and their babies has not resulted in a noticeable decrease in CP. This is generally attributed to medical advances in areas related to the care of premature babies (which results in a greater survival rate). Only the introduction of quality medical care to locations with less-than-adequate medical care has shown any decreases. The incidence of CP increases with premature or very low-weight babies regardless of the quality of care.{{Fact|date=February 2007}} |
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| − | Recent research has demonstrated that intrapartum asphyxia is not the most important cause as it was once considered to be, though it still plays a role, probably accounting for no more than 10 percent of all cases. The research has shown that infections in the mother, even infections that are not easily detected, may triple the risk of the child developing the disorder, mainly as the result of the toxicity to the fetal brain of [[cytokine]]s that are produced as part of the inflammatory response. |
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| + | [[Prevalence]] of cerebral palsy is best calculated around the school entry age of about six years, the prevalence in the U.S. is estimated to be 2.3 out of 1000 children<ref name="pmid17261678">{{cite journal |author=Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R |title=How common are the "common" neurologic disorders? |journal=Neurology |volume=68 |issue=5 |pages=326-37 |year=2007 |pmid=17261678 |doi=10.1212/01.wnl.0000252807.38124.a3}}</ref> |
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| − | Premature babies have a higher risk because their organs are not yet fully developed. This increases the risk of asphyxia and other injury to the brain, which in turn increases the incidence of cerebral palsy. [[Periventricular leukomalacia]] is an important cause of cerebral palsy. |
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| + | The SCPE reported the following incidence of comorbidities in children with CP (the data are from 1980-1990 and included over 4,500 children over age 4 whose CP was acquired during the prenatal or neonatal period): |
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| − | Also, some structural brain anomalies such as [[lissencephaly]] cause symptoms of CP, although whether that could be considered CP is a matter of opinion (some people say CP must be due to brain damage, whereas these people never had a normal brain). Often this goes along with rare [[chromosome disorder]]s. |
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| + | * Mental retardation (IQ < 50): 31% |
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| − | == Incidence and prevalence == |
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| + | * Active seizures: 21% |
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| − | Prevalence is best calculated around the school entry age of about six years. In the industrialized world, the [[incidence]] is about 2 per 1000 live births[http://www.tvcc.on.ca/gateway.php?id=167&cid=2]. In the [[United States]], the rate is thought to vary from between 1.5 to 4 per 1000 live births. This amounts to approximately 5,000-10,000 babies born with cerebral palsy each year in the United States. Each year, around 1,500 preschoolers are diagnosed with the disorder in the USA. There is mental retardation in 60% of the cases, due to brain damage outside the parietal, occipital, temporal or Basal Ganglia. Mental retardation can occur if the child is not given the opportunities to learn; it does not solely occur from brain damage, but from an individual(s)'s ability to 1) communicate with the child and 2) be able to have the child effectively communicate through speech or other means. For example, a child that had CP who suffers from blindness/deafness due to damage that occurred in the occipital and temporal lobes during birth could use tactile sign-language or [[tulonoma]] to communicate. Tulonoma is a type of technique where the user puts his/her hands on the speakers mouth and is able to interpret what they say solely based on the lip movement patterns associated with particular word(s). Other disorders paired with CP include disorders of hearing, eyesight, epilepsy, perception of obstacles (such as judging how far away things are when driving a car), speech difficulties, and eating and drinking difficulties. These esimates include individuals who did not have access to an equal opportunity education prior to the Americans with Disabilities Act of 1990. |
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| + | * Mental retardation (IQ < 50) and not walking: 20% |
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| + | * Blindness: 11%<ref>{{cite journal |author=Johnson, Ann |title=Prevalence and characteristics of children with cerebral palsy in Europe |journal=Developmental medicine and child neurology |volume=44 |issue=9 |pages=633-40 |year=2002 |pmid=12227618 |url=http://journals.cambridge.org/production/action/cjoGetFulltext?fulltextid=120612}}</ref> |
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| + | |||
| + | The SCPE noted that the incidence of comorbidities is difficult to measure accurately, particularly across centers. For example, the actual rate of mental retardation may be difficult to determine, as the physical and communicational limitations of people with CP would likely lower their scores on an IQ test if they were not given a correctly modified version. |
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| + | [[Apgar scores]] have sometimes been used as one factor to predict whether or not an individual will develop CP.<ref name="pmid17138786">{{cite journal |author=Thorngren-Jerneck K, Herbst A |title=Perinatal factors associated with cerebral palsy in children born in Sweden |journal=Obstetrics and gynecology |volume=108 |issue=6 |pages=1499-505 |year=2006 |pmid=17138786 |doi=10.1097/01.AOG.0000247174.27979.6b}}</ref> |
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| − | Overall, advances in care of pregnant mothers and their babies has not resulted in a noticeable decrease in cerebral palsy. Only the introduction of quality medical care to locations with less than adequate medical care has shown any decreases. The incidence increases with premature or very low-weight babies regardless of the quality of care. |
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| + | == Signs and symptoms == |
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| − | Most recently, Apgar scores have been indicated to not be a reliable method of determining whether or not an individual has CP; it really depends on how quickly oxygen reaches the brain and the body's vital organs that matter, instead. |
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| + | All types of CP are characterised by abnormal muscle tone, posture (i.e. slouching over while sitting), reflexes, or motor development and coordination. There can be joint and bone deformities and contractures (permanently fixed, tight muscles and joints). The classical symptoms are spasticity, spasms, other involuntary movements (e.g. facial gestures), unsteady gait, problems with balance, and/or soft tissue findings consisting largely of decreased muscle mass. Scissor walking (where the knees come in and cross) and toe walking are common among people with CP who are able to walk, but taken on the whole, CP symptomatology is very diverse. The effects of cerebral palsy fall on a continuum of motor dysfunction which may range from virtually unnoticeable to"clumsy" and awkward movements on one end of the spectrum to such severe impairments that coordinated movements are almost impossible on the other end of the spectrum. |
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| − | Despite medical advances, the incidence and severity of cerebral palsy has actually increased over time. This may be attributed to medical advances in areas related to premature babies (which results in a greater survival rate).{{fact}} |
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| + | |||
| + | Babies born with severe CP often have an irregular posture; their bodies may be either very floppy or very stiff. Birth defects, such as spinal curvature, a small jawbone, or a small head sometimes occur along with CP. Symptoms may appear, change, or become more severe as a child gets older. Some babies born with CP do not show obvious signs right away. |
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| + | |||
| + | Secondary conditions can include [[seizures]], [[epilepsy]], speech or communication disorders, eating problems, sensory impairments, [[mental retardation]], [[learning disabilities]], and/or behavioral disorders. |
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| + | |||
| + | == History == |
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| + | CP, then known as "Cerebral Paralysis", was first identified by [[England|English]] surgeon [[William Little (English surgeon)|William Little]] in [[1860]]. Little raised the possibility of [[asphyxia]] during birth as a chief cause of the disorder. It was not until [[1897]] that [[Sigmund Freud]], then a neurologist, suggested that a difficult birth was not the cause but rather only a symptom of other effects on fetal development.<ref>{{cite web |
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| + | |url= http://www.ucp.org/ucp_generaldoc.cfm/1/9/37/37-37/447#history |
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| + | |title= Cerebral Palsy - Facts & Figures: History |
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| + | |accessdate=2007-07-06 |
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| + | |publisher=United Cerebral Palsy Research and Education Foundation (U.S.) |
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| + | }}</ref> Research conducted during the 1980s by the National Institute of Neurological Disorders and Stroke (NINDS) suggested that only a small number of cases of CP are caused by lack of oxygen during birth.<ref>{{cite web |
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| + | |url= http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#88033104 |
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| + | |title= Cerebral Palsy: Hope Through Research |
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| + | |year = 2006 |
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| + | |month = July |
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| + | |accessdate=2007-07-06 |
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| + | |publisher=National Institute of Neurological Disorders and Stroke (U.S.). NIH Publication No. 06-159 |
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| + | }}</ref> |
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| + | |||
| + | == Causes == |
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| + | Despite years of debate, the exact cause of CP remains unclear. |
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| + | |||
| + | Some contributing causes of CP are [[asphyxia]], [[Hypoxia (medical)|hypoxia]] of the brain, birth trauma, [[premature birth]], and certain [[infection]]s in the mother during and before birth such as strep infections, central nervous system infections, [[Physical trauma|trauma]], consecutive [[hematoma]]s, [[placenta abruptio]] and [[multiple birth]]. |
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| + | |||
| + | Between 40% and 50% of all children who develop cerebral palsy were born prematurely. Premature infants are at higher risk in part because their organs are not yet fully developed, increasing the risk of asphyxia and other injury to the brain, which in turn increases the incidence of CP. [[Periventricular leukomalacia]] is an important cause of CP. About 10% of cases with CP are caused by malformation of the CNS. |
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| + | |||
| + | Recent research has demonstrated that intrapartum asphyxia is not the most important cause, probably accounting for no more than 10 percent of all cases; rather, infections in the mother, even infections that are not easily detected, may triple the risk of the child developing the disorder, mainly as the result of the toxicity to the fetal brain of [[cytokine]]s that are produced as part of the inflammatory response.<ref>{{cite web |
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| + | |url=http://www.ucpresearch.org/fact-sheets/infection-newborn.php |
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| + | |title=Infection in the Newborn as a Cause of Cerebral Palsy, 12/2004 |
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| + | |accessdate=2007-07-05 |
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| + | |publisher=United Cerebral Palsy Research and Education Foundation (U.S.) |
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| + | }}</ref> |
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| + | Low birthweight is a risk factor for CP--and premature infants usually have low birth weights, less than 2.0kg, but full-term infants can also have low birth weights. Multiple-birth infants are also more likely than single-birth infants to be born early or with a low birth weight. |
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| + | |||
| + | After birth, other causes include toxins, severe [[jaundice]], [[lead poisoning]], physical brain injury, [[shaken baby syndrome]], incidents involving hypoxia to the brain (such as [[near drowning]]), and [[encephalitis]] or [[meningitis]]. The three most common causes of asphyxia in the young child are: choking on foreign objects such as toys and pieces of food; poisoning; and near drowning. |
||
| + | |||
| + | Some structural brain anomalies such as [[lissencephaly]] cause symptoms of CP, although whether that could be considered CP is a matter of opinion (some people say CP must be due to brain damage, whereas these people never had a normal brain). Often this goes along with rare [[chromosome disorder]]s and CP is not genetic or hereditary. |
||
| + | |||
| + | == Presentation: bones == |
||
| + | In order for bones to attain their normal shape and size, they require the stresses from normal musculature. Osseous findings will therefore mirror the specific muscular deficits in a given person with CP. The shafts of the bones are often thin (gracile). When compared to these thin shafts (diaphyses) the metaphyses often appear quite enlarged (ballooning). With lack of use, articular cartilage may atrophy, leading to narrowed joint spaces. Depending on the degree of spasticity, a person with CP may exhibit a variety of angular joint deformities. Because vertebral bodies need vertical gravitational loading forces to develop properly, spasticity and an abnormal gait can hinder proper and/or full bone and skeletal development. People with CP tend to be shorter in height than the average person because their bones are not allowed to grow to their full potential. Sometimes bones grow at different lengths, so the person may have one leg longer than the other. |
||
== Prognosis == |
== Prognosis == |
||
| + | CP is not a progressive disorder (meaning the actual brain damage does not worsen), but the symptoms can become worse over time due to 'wear and tear.' A person with the disorder may improve somewhat during childhood if he or she receives extensive care from specialists, but once bones and musculature become more established, orthopedic surgery may be required for fundamental improvement. People who have CP tend to develop arthritis at a younger age than normal because of the pressure placed on joints by excessively toned and stiff muscles. |
||
| − | Cerebral palsy is not a progressive disorder. A person with the disorder may improve somewhat during childhood, if he or she receives extensive care from specialists. While the brain injury is non-progressive, evidence suggests that functional decline occurs in persons with CP in adulthood. Functional decline can encompass decrease in range of motion, decrease or loss of ambulation, and increased pain. In essence, it appears that adults with CP undergo an accelerated aging process compared to their non-disabled peers. Onset of arthritis and osteoporosis can occur much sooner in adults with CP. Further research is needed on adults with CP, as the current literature body is highly focused on the pediatric patient. |
||
| + | The full intellectual potential of a child born with CP will often not be known until the child starts school. People with CP are more likely to have some type of [[learning disability]], but this is unrelated to a person's intellect or IQ level. Intellectual level among people with CP varies from genius to mentally retarded, as it does in the general population, and experts have stated that it is important to not underestimate CP sufferer's capabilities and to give them every opportunity to learn.{{Fact|date=February 2008}} |
||
| − | The ability to live independently with cerebral palsy varies widely depending on severity of the disability. Some individuals with CP will require personal assistant services for all activities of daily living. Others can live semi-independently in the community with support for certain activities. Still others can live with complete independence. The need for personal assistance often changes with increasing age and the associated functional decline. However, in most cases, persons with CP can expect to have a normal life expectancy; survival has been shown to be associated with the ability to ambulate, roll and self-feed. As the condition does not directly affect reproductive function, many persons with CP can have children and parent successfully. |
||
| + | |||
| + | The ability to live independently with CP also varies widely depending on the severity of the disability. Some individuals with CP will require personal assistant services for all activities of daily living. Others can live semi-independently, needing support only for certain activities. Still others can live in complete independence. The need for personal assistance often changes with increasing age and the associated functional decline. However, in most cases persons with CP can expect to have a normal life expectancy; survival has been shown to be associated with the ability to ambulate, roll and self-feed.{{Fact|date=February 2008}} As the condition does not directly affect reproductive function, some persons with CP have children and parent successfully. |
||
| + | |||
| + | According to [[OMIM]], only 2% of cases of CP are inherited (with [[glutamate decarboxylate-1]] as one known enzyme involved.)<ref>{{cite web |url=http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=603513 |title=OMIM - CEREBRAL PALSY, SPASTIC, SYMMETRIC, AUTOSOMAL RECESSIVE |accessdate=2007-07-29 |format= |work=}}</ref> There is no evidence of an increased chance of a person with CP having a child with CP. |
||
== Treatment == |
== Treatment == |
||
| − | There is no cure for |
+ | There is no cure for CP, but various forms of therapy can help a person with the disorder to function and live more effectively. In general, the earlier treatment begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them. Treatment may include one or more of the following: physical therapy; occupational therapy; speech therapy; drugs to control seizures, alleviate pain, or relax muscle spasms (e.g. benzodiazepienes, baclofen and intrathecal phenol/baclofen); hyperbaric oxygen; the use of [[Botox]] to relax contracting muscles; surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; wheelchairs and rolling walkers; and communication aids such as computers with attached voice synthesizers. For instance, the use of a [[standing frame]] can help reduce spasticity and improve [[range of motion]] for people with CP who use wheelchairs. Nevertheless, there is only some benefit from therapy. Treatment is usually symptomatic and focuses on helping the person to develop as many motor skills as possible or to learn how to compensate for the lack of them. Non-speaking people with CP are often successful availing themselves of [[augmentative and alternative communication]] systems such as [[Blissymbols]]. |
| + | '''[[Physical therapy]]''' (PT) programs are designed to encourage the patient to build a strength base for improved gait and volitional movement, together with stretching programs to limit contractures. Many experts believe that life-long physical therapy is crucial to maintain muscle tone, bone structure, and prevent dislocation of the joints. |
||
| − | ==Cultural Dimensions== |
||
| + | '''[[Occupational therapy]]''' helps adults and children maximise their function, adapt to their limitations and live as independently as possible.<ref>{{cite book |author=Hansen, Ruth A.; Atchison, Ben |title=Conditions in occupational therapy: effect on occupational performance |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2000 |pages= |isbn=0-683-30417-8 |oclc= |doi=}}</ref><ref>{{cite book |author=Crepeau, Elizabeth Blesedell; Willard, Helen S.; Spackman, Clare S.; Neistadt, Maureen E. |title=Willard and Spackman's occupational therapy |publisher=Lippincott-Raven Publishers |location=Philadelphia |year=1998 |pages= |isbn=0-397-55192-4 |oclc= |doi=}}</ref> |
||
| − | {{seealso|United Cerebral Palsy)) |
||
| + | '''[[Orthotics|Orthotic devices]]''' such as [[Ankle-foot orthosis|ankle-foot orthoses]] (AFOs) are often prescribed to minimise gait irregularities. AFOs have been found to improve several measures of ambulation, including reducing energy expenditure<ref name="pmid17373095">{{cite journal |author=Balaban B, Yasar E, Dal U, Yazicioglu K, Mohur H, Kalyon TA |title=The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy |journal=Disability and rehabilitation |volume=29 |issue=2 |pages=139-44 |year=2007 |pmid=17373095 |doi= |accessdate=2007-08-12}}</ref> and increasing speed and stride length.<ref name="pmid11995890">{{cite journal |author=White H, Jenkins J, Neace WP, Tylkowski C, Walker J |title=Clinically prescribed orthoses demonstrate an increase in velocity of gait in children with cerebral palsy: a retrospective study |journal=Developmental medicine and child neurology |volume=44 |issue=4 |pages=227-32 |year=2002 |pmid=11995890 |doi= |accessdate=2007-08-12}}</ref> |
||
| − | ===Usage of the term "spastic"=== |
||
| + | '''[[Speech therapy]]''' helps control the muscles of the mouth and jaw, and helps improve communication. Just as CP can affect the way a person moves their arms and legs, it can also affect the way they move their mouth, face and head. This can make it hard for the person to breathe; talk clearly; and bite, chew and swallow food. Speech therapy often starts before a child begins school and continues throughout the school years.<ref name="pmid15106204">{{cite journal |author=Pennington L, Goldbart J, Marshall J |title=Speech and language therapy to improve the communication skills of children with cerebral palsy |journal=Cochrane database of systematic reviews (Online) |volume= |issue=2 |pages=CD003466 |year=2004 |pmid=15106204 |doi=10.1002/14651858.CD003466.pub2}}</ref> |
||
| − | The term "spastic" describes the attribute of [[spasticity]] in types of spastic CP. In [[1952]] a [[United Kingdom|UK]] [[Charitable organization|charity]] called ''The Spastics Society'' was formed. The term "spastic" was used by the charity as a term for people with cerebral palsy. The word has since been used extensively as a general insult to disabled people, which some see as extremely offensive. It is also frequently used to insult able-bodied people when they seem overly anxious or unskilled in sports. The charity changed its name to [[Scope (British charity)|Scope]] in [[1994]]. |
||
| + | '''[[Hyperbaric oxygen therapy]]''' Recent studies have demonstrated a dramatic improvement in CP symptomology when hyperbaric oxygen therapy is used as a treatment. Researchers in Brazil found a significant alleviation in symptomology and other characteristics in a study involving 218 cerebral palsy patients. Significant enhancements were documented showing improved vision, hearing and speech as well as a reduction of spasticity by 50%, which occurred in 94% of study patients.<ref>{{cite web |url=http://www.hbotreatment.com/cp.htm |title=HBO Treatment.com |accessdate=2007-09-03 |format= |work=}}</ref> |
||
| − | === Cerebral Palsy as a Learning Disorder === |
||
| − | {{pov}} |
||
| − | In some circles, motor disorders are perceived as learning problems (Hari and Tillemans, 1984) wherein the condition, even though it is physical, leads to secondary learning difficulties stemming from the initial trauma. In this view, while the original brain damage is non-progressive, its effect upon all areas of development may be constantly changing and can result in, a generalized dysfunction. A motor disordered child, after brain injury, is still actively attempting to solve problems arising from tasks in the environment. At the physical level, it is found that the loss of certain neural tissues does not limit the attempt of the remaining tissues to compensate for the loss. |
||
| + | '''Nutritional counseling''' may help when dietary needs are not met because of problems with eating certain foods. |
||
| − | Experimentation in support of this idea includes Taub’s study (1980) on the deafferentation of a limb in monkeys which started to use the deafferented limb again for functional activities once his intact limb was restrained. This illustrates that non ¬use of the limb does not occur because of the neural deficit but rather because of a learned compensation for the deficit (Tsang,1990).The above can account for the exhibition of various non-functional and stereotyped motor patterns in a child with a motor disorder. Therefore we can not regard dysfunction as a feature of such children, but the product of the interaction between the child and his environment (Hari and Tillemans, 1984). Dysfunction is a change in coordination, which can be viewed separately from any deficiency. Dysfunction is not static or localized and it affects the whole personality of the child with cerebral palsy. |
||
| + | Both '''[[massage therapy]]'''<ref name="pmid17355474">{{cite journal |author=Macgregor R, Campbell R, Gladden MH, Tennant N, Young D |title=Effects of massage on the mechanical behaviour of muscles in adolescents with spastic diplegia: a pilot study |journal=Developmental medicine and child neurology |volume=49 |issue=3 |pages=187-91 |year=2007 |pmid=17355474 |doi=10.1111/j.1469-8749.2007.00187.x}}</ref> and '''[[hatha yoga]]'''{{Fact|date=July 2007}} are designed to help relax tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises are sometimes used to try to prevent lung infections. More research is needed to determine the health benefits of these therapies for people with CP. |
||
| − | The dysfunction of the child is not the maladaptive movement pattern itself, but the result of an interrupted learning process. The difficulties inherent in adapting to the requirements of an activity leave the child unmotivated to continue the problem-solving skill process. The child then learns to be dependent. One can see that the effect of a lack of motivation is not limited to the physical level, but extends to the psychosocial level, impeding the child’s development as a whole (Kwan 1990). In other words, as individuals, we face greater and greater challenges that require more and more skills. Motor disorder can have a devastating effect upon the ability to meet these challenges and to learn the necessary skills. Dysfunction is a certain organizational characteristic of an individual. It is not a well defined malfunction or symptom or condition. Its manifestation is that the individual wants or should do something but he is unable to do it, not because he is incapable of doing it but because he does not know how to do it (Hari, 1990). While the origin of Cerebral Palsy is medical, the consequences interrupt the general learning ability of the individual. It can be concluded that instead of thinking in therapy and adaptation, by applying an appropriate educational approach the individual may learn to overcome the consequences of the motor disorder. |
||
| + | '''Surgery''' for people with CP usually involves one or a combination of: |
||
| − | === Pop Culture References === |
||
| − | *In the film [[The Usual Suspects]], [[Kevin Spacey]] plays Verbal Kint, a criminal who appears to have cerebral palsy. |
||
| − | *Although [[Tom Hanks]]'s title character in "[[Forrest Gump]]" is never explicitly diagnosed, he exhibits symptoms consistent with cerebral palsy. |
||
| − | *The film [[Inside I%27m Dancing]] focuses on a quadraplegic youth in Dublin who befriends someone who has cerebral palsy and acts as his translator. |
||
| + | *Loosening tight muscles and releasing fixed joints, most often performed on the hips, knees, hamstrings, and ankles. In rare cases, this surgery may be used for people with stiffness of their elbows, wrists, hands, and fingers. |
||
| − | ===People with cerebral palsy=== |
||
| + | *Straightening abnormal twists of the leg bones, i.e. femur (termed femoral anteversion or antetorsion) and tibia (tibial torsion). This is a secondary complication caused by the spastic muscles generating abnormal forces on the bones, and often results in intoeing (pigeon-toed gait). The surgery is called derotation osteotomy, in which the bone is broken (cut) and then set in the correct alignment.<ref name="pmid17140515">{{cite journal |author=Schejbalová A |title=[Derotational subtrochanteric osteotomy of the femur in celebral palsy patients] |language=Czech |journal=Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca |volume=73 |issue=5 |pages=334-9 |year=2006 |pmid=17140515 |doi=}}</ref> |
||
| − | *[[Christy Brown]], the famous writer and painter who wrote [[My Left Foot (book)|My Left Foot]], which was later adapted into an Oscar winning [[My Left Foot (movie)|movie of the same name]] starring [[Daniel Day Lewis]] |
||
| − | *[[Bruce Perens]]<ref>{{cite web |
||
| − | | author=Perens, Bruce |
||
| − | | title=My use of "brain-damage" as a metaphor |
||
| − | | year=1996 |
||
| − | | work=Mailing list archive of debian-user |
||
| − | | url=http://lists.debian.org/debian-user/1996/04/msg00454.html |
||
| − | | accessyear=2006 |
||
| − | | accessdate=March 16}}</ref>, an [[open source]] developer |
||
| − | *[[Eric S. Raymond]], an [[open source]] evangelist |
||
| − | *Kaine (Rapper), One half of The [[Ying Yang Twins]] |
||
| − | * Christopher Widdows aka Steady Eddy, Australian Comedian |
||
| − | *[[Josh Blue]], comedian and winner of the fourth season of [[Last Comic Standing]], who often jokes about his condition. |
||
| − | *[[Gianna Jessen]], singer-songwriter and pro-life activist |
||
| − | *[[Stephen Hopkins (politician)|Stephen Hopkins]], signer of Declaration of Independence, reputed to have stated, "My hand trembles, but my heart does not." {{citation needed}} |
||
| − | *[[Bill Porter (salesman)|Bill Porter]], a salesman for [[Watkins Incorporated]] whose life story was told in the TV movie [[Door to Door (film)|Door to Door]]. |
||
| + | *Cutting nerves on the limbs most affected by movements and spasms. This procedure, called a [[rhizotomy]], "rhizo" meaning root and "tomy" meaning "a cutting of" from the Greek suffix 'tomia' reduces spasms and allows more flexibility and control of the affected limbs and joints.<ref name="pmid17643249">{{cite journal |author=Farmer JP, Sabbagh AJ |title=Selective dorsal rhizotomies in the treatment of spasticity related to cerebral palsy |journal= |volume= |issue= |pages= |year=2007 |pmid=17643249 |doi=10.1007/s00381-007-0398-2}}</ref> |
||
| − | ==Notes== |
||
| + | *Botulinum Toxin A ([[Botox]]) injections into muscles that are either spastic or have contractures, the aim being to relieve the disability and pain produced by the inappropriately contracting muscle.<ref name="pmid17268388">{{cite journal |author=Hawamdeh ZM, Ibrahim AI, Al-Qudah AA |title=Long-term effect of botulinum toxin (A) in the management of calf spasticity in children with diplegic cerebral palsy |journal= |volume= |issue= |pages= |year=2007 |pmid=17268388 |doi=}}</ref> |
||
| − | <references/> |
||
| + | Another way is that a new study has found that '''cooling''' the bodies and blood of high-risk full-term babies shortly after birth may significantly reduce disability or death.<ref name="pmid16221780">{{cite journal |author=Shankaran S, Laptook AR, Ehrenkranz RA, ''et al'' |title=Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy |journal=N. Engl. J. Med. |volume=353 |issue=15 |pages=1574-84 |year=2005 |pmid=16221780 |doi=10.1056/NEJMcps050929}}</ref> |
||
| − | == References == |
||
| + | |||
| − | * "''Conditions in Occupational Therapy: effect on occupational performance.''" ed. Ruth A. Hansen and Ben Atchison (Baltimore: Lippincott Williams & Williams, 2000), 8-21. ISBN 0-683-30417-8 |
||
| + | '''[[Conductive education]]''' (CE) was developed in Hungary from 1945 based on the work of [[András Pető]]. It is a unified system of rehabilitation for people with neurological disorders including cerebral palsy, Parkinson's disease and multiple sclerosis, amongst other conditions. It is theorised to improve mobility, self-esteem, stamina and independence as well as daily living skills and social skills. The conductor is the professional who delivers CE in partnership with parents and children. Skills learned during CE should be applied to everyday life and can help to develop age-appropriate cognitive, social and emotional skills. It is available at specialised centres. |
||
| − | * "''Cerebral Palsy.''" (National Center on Birth Defects and Developmental Disabilities, October 3, 2002), [http://www.cdc.gov/ncbddd/dd/ddcp.htm www.cdc.gov] |
||
| + | |||
| − | * "''William and Spackman's Occupational Therapy 9th Edition.''" ed. Maureen E. Neistadt and Elizabeth Blesedell Crepeau (Lippincott-Raven Publishers, 1998), 233, 589-598. ISBN 0-397-55192-4 |
||
| + | '''[[Biofeedback]]''' is an [[alternative medicine|alternative therapy]] in which people with CP learn how to control their affected muscles. Some people learn ways to reduce muscle tension with this technique. Biofeedback does not help everyone with CP. |
||
| − | * Bax, M., Goldstein, M., Rosenbaum, P., Leviton, A., Paneth, N., Dan, B., Jacobsson, B., & Damiano, D. (Executive Committee for the Definition of Cerebral Palsy), 2005. Developmental Medicine and Child Neurology, 47(8), 571-6 |
||
| + | |||
| + | ==Cultural aspects== |
||
| + | === Use of terms when referring to people with CP === |
||
| + | Many people would rather be referred to as a person with a disability instead of handicapped. "Cerebral Palsy: A Guide for Care" at the [[University of Delaware]] offers the following guidelines:<ref>{{cite web |url=http://gait.aidi.udel.edu/res695/homepage/pd_ortho/clinics/c_palsy/cpweb.htm |title=Cerebral Palsy: a Guide for Care |accessdate=2007-07-29 |format= |work=}}</ref> |
||
| + | |||
| + | <blockquote> |
||
| + | Impairment is the correct term to use to define a deviation from normal, such as not being able to make a muscle move or not being able to control an unwanted movement. Disability is the term used to define a restriction in the ability to perform a normal activity of daily living which someone of the same age is able to perform. For example, a three year old child who is not able to walk has a disability because normal three year old can walk independently. Handicap is the term used to describe a child or adult who, because of the disability, is unable to achieve the normal role in society commensurate with his age and socio-cultural milieu. As an example, a sixteen-year- old who is unable to prepare his own meal or care for his own toileting or hygiene needs is handicapped. On the other hand, a sixteen-year- old who can walk only with the assistance of crutches but who attends a regular school and is fully independent in activities of daily living is disabled but not handicapped. All disabled people are impaired, and all handicapped people are disabled, but a person can be impaired and not necessarily be disabled, and a person can be disabled without being handicapped. |
||
| + | </blockquote> |
||
| + | |||
| + | The term "[[spastic]]" describes the attribute of spasticity in types of spastic CP. In 1952 a UK charity called The Spastics Society was formed.<ref name="Guardian20020522">{{cite web |url=http://society.guardian.co.uk/charitymanagement/story/0,8150,719600,00.html |title=A very telling tale | Society | SocietyGuardian.co.uk |accessdate=2007-07-29 |format= |work=}}</ref> The term "spastics" was used by the charity as a term for people with CP. The word "spaz" has since been used extensively as a general insult to disabled people, which some see as extremely offensive. It is also frequently used to insult able-bodied people when they seem overly anxious or unskilled in sports. The charity changed its name to [[Scope (British charity)|Scope]] in 1994.<ref name="Guardian20020522"> </ref> In the United States the word spaz has the same usage as an insult, but is not generally associated with CP.<ref>{{cite web |url=http://itre.cis.upenn.edu/~myl/languagelog/archives/003020.html |title=Language Log: A brief history of "spaz" |accessdate=2007-07-29 |format= |work=}}</ref> |
||
| + | |||
| + | ===Misconceptions=== |
||
| + | A common misconception about those born with Cerebral Palsy is that they are less intelligent than those born without it. Cerebral Palsy is defined as damage to the part of the brain that controls movement; areas of the brain which define a persons intelligence are not affected by CP. |
||
| + | |||
| + | Spastic Cerebral Palsy, the most common form of CP, causes the muscles to be tense, rigid and movements are slow and difficult. This can be misinterpreted as cognitive delay due to difficulty of communication. Individuals with cerebral palsy can have learning difficulties, but sometimes it is the sheer magnitude of problems caused by the underlying brain injury which prevents the individual from expressing what cognitive abilities they do possess. |
||
| + | [http://www.snowdrop.cc/info2.cfm?info_id=62106] |
||
| + | |||
| + | ===Public perception=== |
||
| + | Those with CP are sometimes stigmatised and shunned. This has lessened since the 1950s thanks to public education and to [[United Cerebral Palsy]] in the U.S. and similar organisations in other countries. Prior to that time the great majority were often sent to asylums or confined to attics. They were perceived to be the products of incest and partial smotherings. {{Fact|date=February 2007}} Often parents kept their children away from them in the mistaken belief that the condition was the product of disease or poor sanitary habits. |
||
| + | |||
| + | [[Thomas Galton]] believed that there was a correlation between physical disability and [[aptitude]], and this attitude remained prevalent as concerned CP until the 1970s. At this time, CP was an overdiagnosed disorder, and a common misunderstanding then and now is that CP causes mental retardation. In fact, only CP individuals with brain damage in the hippocampus or the frontal cerebral cortex develop mental retardation. While learning difficulties and CP may co-occur, it is common for individuals with CP to lead normal lives. |
||
==See also== |
==See also== |
||
| + | * [[Athetosis]] |
||
| + | * [[Boccia]] |
||
* [[Chorioamnionitis]] |
* [[Chorioamnionitis]] |
||
| + | * [[Rhizotomy]] |
||
| + | * [[United Cerebral Palsy]] |
||
| − | == |
+ | ==External links== |
| + | * {{DMOZ|Health/Conditions_and_Diseases/Neurological_Disorders/Cerebral_Palsy/}}: Includes links to more than a dozen sites with information on CP, as well as support groups and CP organisations. |
||
| − | *[http://society.guardian.co.uk/charitymanagement/story/0,8150,719600,00.html Faults-and-all book marks Scope's 50th anniversary] |
||
| − | *[http://www. |
+ | * [http://www.cp855.com Cerebral Palsy Help in the US] |
| + | * [http://www.scope.org.uk/index.shtml Website of Scope], the disability organisation in England and Wales focussing on people with cerebral palsy. |
||
| − | *[http://www.ucp.org United Cerebral Palsy, including information on physical therapy and exercise] |
||
| − | *[http://www.cpalberta.com/ Cerebral Palsy Association in Alberta] |
||
| − | *[http://www.cplqld.org.au/ Cerebral Palsy League of Queensland] |
||
| − | *[http://www.thespasticcentre.org.au/ The Spastic Centre] |
||
| − | *[http://www.cpaustralia.com.au/ CP Australia] |
||
| − | *[http://www.cerebralpalsytreating.com/cerebral-palsy-causes.html Disorders that causes cerebral palsy] |
||
| − | *[http://www.baclofen.info Patient Site giving information on Intrathecal Baclofen Treatment for Spasticity as a result of Cerebral Palsy] |
||
| − | *[http://www.dvltrust.org.uk/ Dame Vera Lynn Trust for Children with Cerebral Palsy] |
||
| − | *[http://www.infantcerebralpalsy.com/ Infant Cerebral Palsy Resources] |
||
| − | *[http://www.gillettechildrens.org/ Center for Cerebral Palsy at Gillette Children's Specialty Healthcare] |
||
| − | *[http://www.palsy-help.com/ Help guide to Cerebral and Facial Palsy] |
||
| − | * |
||
| − | [http://www.cnsfoundation.org/goto/Brianna.K Brianna Research Fund] |
||
| + | |||
| + | {{Cerebral palsy and other paralytic syndromes}} |
||
| + | |||
| + | ==References== |
||
| + | {{Reflist|2}} |
||
| + | |||
| + | [[Category:Brain disorders]] |
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| + | [[Category:Congenital disorders]] |
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[[Category:Disability]] |
[[Category:Disability]] |
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[[Category:Neurological disorders]] |
[[Category:Neurological disorders]] |
||
| − | [[Category: |
+ | [[Category:Paralysis]] |
| + | <!-- |
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| + | [[ar:شلل دماغي]] |
||
| + | [[ca:Paràlisi cerebral]] |
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[[de:Infantile Zerebralparese]] |
[[de:Infantile Zerebralparese]] |
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| + | [[da:Cerebral parese]] |
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| + | [[es:Parálisis cerebral]] |
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[[fr:Infirmité motrice cérébrale]] |
[[fr:Infirmité motrice cérébrale]] |
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| + | [[ko:뇌성마비]] |
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| + | [[hr:Cerebralna paraliza]] |
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| + | [[id:Cerebral palsy]] |
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| + | [[it:Paralisi cerebrale infantile]] |
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[[he:שיתוק מוחין]] |
[[he:שיתוק מוחין]] |
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| + | [[nl:Hersenverlamming]] |
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| + | [[ja:脳性麻痺]] |
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[[no:Cerebral parese]] |
[[no:Cerebral parese]] |
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[[pl:Mózgowe porażenie dziecięce]] |
[[pl:Mózgowe porażenie dziecięce]] |
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| + | [[pt:Paralisia cerebral]] |
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| + | [[ru:Детский паралич]] |
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| + | [[sr:Церебрална парализа]] |
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[[fi:CP-vamma]] |
[[fi:CP-vamma]] |
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Cerebral palsy (CP)is an umbrella term encompassing a group of non-progressive,[1] non-contagious condition that cause physical disability in human development.
Cerebral refers to the affected area of the brain, the cerebrum (however the centers have not been perfectly localized and the disease most likely involves connections between the cortex and other parts of the brain such as the cerebellum) and palsy refers to disorder of movement. CP is caused by damage to the motor control centers of the young developing brain and can occur during pregnancy (about 75 percent), during childbirth (about 5 percent) or after birth (about 15 percent) up to about age three.[2]. [3]
It is a non-progressive disorder, meaning the brain damage does not worsen, but secondary orthopedic difficulties are common. There is no known cure for CP. Medical intervention is limited to the treatment and prevention of complications possible from CP's consequences.
Onset of arthritis and osteoporosis can occur much sooner in adults with CP. Further research is needed on adults with CP, as the current literature body is highly focused on the pediatric patient. CP's resultant motor disorder(s) are sometimes, though not always, accompanied by "disturbances of sensation, cognition, communication, perception, and/or behavior, and/or by a seizure disorder".[4][5]
CP is the second-most expensive developmental disability to manage over the course of a person's lifetime (second to mental disabilities), with an average lifetime cost per person of USD$921,000 (in 2003 dollars).[6] The incidence in the six countries surveyed is approximately an average of 2.12–2.45 per 1000 live births;[7] there has been a slight increase in recent years. Although improvements in neonatal nursing help reduce the number of babies who develop cerebral palsy, they also mean that babies with very low birth weights survive, and these babies are more likely to have cerebral palsy.[8][9]
Classification
CP is divided into four major classifications to describe the different movement impairments. These classifications reflect the area of brain damaged. The four major classifications are:
- Spastic
- Athetoid/Dyskinetic
- Ataxic
- Mixed
In 30 percent of all cases of CP, the spastic form is found along with one of the other types. There are a number of other, less prevalent types of CP, but these are the most common.
A general classification is as follows:
Spastic
Spastic (ICD-10 G80.0-G80.1) cerebral palsy is by far the most common type, occurring in 70% to 80% of all cases. People with this type are hypertonic and have a neuromuscular condition stemming from damage to the corticospinal tract, motor cortex, or pyramidal tract that affects the nervous system's ability to receive gamma amino butyric acid in the area(s) affected by the spasticity. Spastic CP is further classified by topography dependent on the region of the body affected; these include:
- spastic hemiplegia (one side being affected). Generally, injury to the left side of the brain will cause a right sided deficit, and vice versa.
- spastic diplegia ( the lower extremities are affected more than the upper extremities). Most people with spastic diplegia do eventually walk. The gait of a person with spastic diplegia is typically characterised by a crouched gait. Toe walking and flexed knees are common. Hip problems, dislocations, and side effects like strabismus (crossed eyes) are common. Strabismus affects three quarters of people with spastic diplegia. This is due to weakness of the muscles that control eye movement. In addition, these individuals are often nearsighted. In many cases the IQ of a person with spastic diplegia is unaffected by the condition.
- spastic quadriplegia (Whole body affected; all four limbs affected equally). Some children with quadriplegia also have hemiparetic tremors; an uncontrollable shaking that affects the limbs on one side of the body and impairs normal movement. A common problem for children with quadriplegia is fluid buildup. Diuretics and steroids are medications administered to decrease any buildup of fluid in the spine that is caused by leakage from dead cells. Hardened feces in a quadriplegia patient are important to monitor because it can cause high blood pressure. Autonomic dysreflexia can be caused by hardened feces, urinary infections, and other problems, resulting in the overreaction of the nervous system and can result in high blood pressure, heart attacks, and strokes. Blockage of tubes inserted into the body to drain or enter fluids also needs to be monitored to prevent autonomic dysreflexia in quadriplegia. The proper functioning of the digestive system needs to be monitored as well.
Occasionally, terms such as monoplegia, paraplegia, triplegia, and pentaplegia may also be used to refer to specific manifestations of the spasticity.
Ataxic
Ataxia (ICD-10 G80.4) type symptoms can be caused by damage to the cerebellum. Forms of ataxia are less common types of Cerebral Palsy, occurring in at most 10% of all cases. Some of these individuals have hypotonia and tremors. Motor skills like writing, typing, or using scissors might be difficult, as well as problems with balance, especially while walking. It is common for individuals to have difficulty with visual and/or auditory processing of objects.
Athetoid/dyskinetic
Athetoid or dyskinetic (ICD-10 G80.3) is mixed muscle tone - sometimes hypertonia and sometimes hypotonia. People with athetoid CP have trouble holding themselves in an upright, steady position for sitting or walking, and often show involuntary motions. For some people with athetoid CP, it takes a lot of work and concentration to get their hand to a certain spot (like scratching their nose or reaching for a cup). Because of their mixed tone and trouble keeping a position, they may not be able to hold onto objects (such as a toothbrush or pencil). About one-fourth of all people with CP have athetoid CP. The damage occurs to the extrapyramidal motor system and/or pyramidal tract and to the basal ganglia. It occurs in 40% of all cases.
Incidence and prevalence
In the industrialised world, the incidence of cerebral palsy is about 2 per 1000 live births.[10] The incidence is higher in males than in females; the Surveillance of Cerebral Palsy in Europe (SCPE) reports a M:F ratio of 1.33:1.[11] Variances in reported rates of incidence across different geographical areas in industrialised countries are thought to be caused primarily by discrepancies in the criteria used for inclusion and exclusion. When such discrepancies are taken into account in comparing two or more registers of patients with cerebral palsy (for example, the extent to which children with mild cerebral palsy are included), the incidence rates converge toward the average rate of 2:1000.
In the United States, approximately 10,000 infants and babies are diagnosed with CP each year, and 1200-1500 are diagnosed at preschool age.[12]
Overall, advances in care of pregnant mothers and their babies has not resulted in a noticeable decrease in CP. This is generally attributed to medical advances in areas related to the care of premature babies (which results in a greater survival rate). Only the introduction of quality medical care to locations with less-than-adequate medical care has shown any decreases. The incidence of CP increases with premature or very low-weight babies regardless of the quality of care.[How to reference and link to summary or text]
Prevalence of cerebral palsy is best calculated around the school entry age of about six years, the prevalence in the U.S. is estimated to be 2.3 out of 1000 children[13]
The SCPE reported the following incidence of comorbidities in children with CP (the data are from 1980-1990 and included over 4,500 children over age 4 whose CP was acquired during the prenatal or neonatal period):
- Mental retardation (IQ < 50): 31%
- Active seizures: 21%
- Mental retardation (IQ < 50) and not walking: 20%
- Blindness: 11%[14]
The SCPE noted that the incidence of comorbidities is difficult to measure accurately, particularly across centers. For example, the actual rate of mental retardation may be difficult to determine, as the physical and communicational limitations of people with CP would likely lower their scores on an IQ test if they were not given a correctly modified version.
Apgar scores have sometimes been used as one factor to predict whether or not an individual will develop CP.[15]
Signs and symptoms
All types of CP are characterised by abnormal muscle tone, posture (i.e. slouching over while sitting), reflexes, or motor development and coordination. There can be joint and bone deformities and contractures (permanently fixed, tight muscles and joints). The classical symptoms are spasticity, spasms, other involuntary movements (e.g. facial gestures), unsteady gait, problems with balance, and/or soft tissue findings consisting largely of decreased muscle mass. Scissor walking (where the knees come in and cross) and toe walking are common among people with CP who are able to walk, but taken on the whole, CP symptomatology is very diverse. The effects of cerebral palsy fall on a continuum of motor dysfunction which may range from virtually unnoticeable to"clumsy" and awkward movements on one end of the spectrum to such severe impairments that coordinated movements are almost impossible on the other end of the spectrum.
Babies born with severe CP often have an irregular posture; their bodies may be either very floppy or very stiff. Birth defects, such as spinal curvature, a small jawbone, or a small head sometimes occur along with CP. Symptoms may appear, change, or become more severe as a child gets older. Some babies born with CP do not show obvious signs right away.
Secondary conditions can include seizures, epilepsy, speech or communication disorders, eating problems, sensory impairments, mental retardation, learning disabilities, and/or behavioral disorders.
History
CP, then known as "Cerebral Paralysis", was first identified by English surgeon William Little in 1860. Little raised the possibility of asphyxia during birth as a chief cause of the disorder. It was not until 1897 that Sigmund Freud, then a neurologist, suggested that a difficult birth was not the cause but rather only a symptom of other effects on fetal development.[16] Research conducted during the 1980s by the National Institute of Neurological Disorders and Stroke (NINDS) suggested that only a small number of cases of CP are caused by lack of oxygen during birth.[17]
Causes
Despite years of debate, the exact cause of CP remains unclear.
Some contributing causes of CP are asphyxia, hypoxia of the brain, birth trauma, premature birth, and certain infections in the mother during and before birth such as strep infections, central nervous system infections, trauma, consecutive hematomas, placenta abruptio and multiple birth.
Between 40% and 50% of all children who develop cerebral palsy were born prematurely. Premature infants are at higher risk in part because their organs are not yet fully developed, increasing the risk of asphyxia and other injury to the brain, which in turn increases the incidence of CP. Periventricular leukomalacia is an important cause of CP. About 10% of cases with CP are caused by malformation of the CNS.
Recent research has demonstrated that intrapartum asphyxia is not the most important cause, probably accounting for no more than 10 percent of all cases; rather, infections in the mother, even infections that are not easily detected, may triple the risk of the child developing the disorder, mainly as the result of the toxicity to the fetal brain of cytokines that are produced as part of the inflammatory response.[18] Low birthweight is a risk factor for CP--and premature infants usually have low birth weights, less than 2.0kg, but full-term infants can also have low birth weights. Multiple-birth infants are also more likely than single-birth infants to be born early or with a low birth weight.
After birth, other causes include toxins, severe jaundice, lead poisoning, physical brain injury, shaken baby syndrome, incidents involving hypoxia to the brain (such as near drowning), and encephalitis or meningitis. The three most common causes of asphyxia in the young child are: choking on foreign objects such as toys and pieces of food; poisoning; and near drowning.
Some structural brain anomalies such as lissencephaly cause symptoms of CP, although whether that could be considered CP is a matter of opinion (some people say CP must be due to brain damage, whereas these people never had a normal brain). Often this goes along with rare chromosome disorders and CP is not genetic or hereditary.
Presentation: bones
In order for bones to attain their normal shape and size, they require the stresses from normal musculature. Osseous findings will therefore mirror the specific muscular deficits in a given person with CP. The shafts of the bones are often thin (gracile). When compared to these thin shafts (diaphyses) the metaphyses often appear quite enlarged (ballooning). With lack of use, articular cartilage may atrophy, leading to narrowed joint spaces. Depending on the degree of spasticity, a person with CP may exhibit a variety of angular joint deformities. Because vertebral bodies need vertical gravitational loading forces to develop properly, spasticity and an abnormal gait can hinder proper and/or full bone and skeletal development. People with CP tend to be shorter in height than the average person because their bones are not allowed to grow to their full potential. Sometimes bones grow at different lengths, so the person may have one leg longer than the other.
Prognosis
CP is not a progressive disorder (meaning the actual brain damage does not worsen), but the symptoms can become worse over time due to 'wear and tear.' A person with the disorder may improve somewhat during childhood if he or she receives extensive care from specialists, but once bones and musculature become more established, orthopedic surgery may be required for fundamental improvement. People who have CP tend to develop arthritis at a younger age than normal because of the pressure placed on joints by excessively toned and stiff muscles.
The full intellectual potential of a child born with CP will often not be known until the child starts school. People with CP are more likely to have some type of learning disability, but this is unrelated to a person's intellect or IQ level. Intellectual level among people with CP varies from genius to mentally retarded, as it does in the general population, and experts have stated that it is important to not underestimate CP sufferer's capabilities and to give them every opportunity to learn.[How to reference and link to summary or text]
The ability to live independently with CP also varies widely depending on the severity of the disability. Some individuals with CP will require personal assistant services for all activities of daily living. Others can live semi-independently, needing support only for certain activities. Still others can live in complete independence. The need for personal assistance often changes with increasing age and the associated functional decline. However, in most cases persons with CP can expect to have a normal life expectancy; survival has been shown to be associated with the ability to ambulate, roll and self-feed.[How to reference and link to summary or text] As the condition does not directly affect reproductive function, some persons with CP have children and parent successfully.
According to OMIM, only 2% of cases of CP are inherited (with glutamate decarboxylate-1 as one known enzyme involved.)[19] There is no evidence of an increased chance of a person with CP having a child with CP.
Treatment
There is no cure for CP, but various forms of therapy can help a person with the disorder to function and live more effectively. In general, the earlier treatment begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them. Treatment may include one or more of the following: physical therapy; occupational therapy; speech therapy; drugs to control seizures, alleviate pain, or relax muscle spasms (e.g. benzodiazepienes, baclofen and intrathecal phenol/baclofen); hyperbaric oxygen; the use of Botox to relax contracting muscles; surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; wheelchairs and rolling walkers; and communication aids such as computers with attached voice synthesizers. For instance, the use of a standing frame can help reduce spasticity and improve range of motion for people with CP who use wheelchairs. Nevertheless, there is only some benefit from therapy. Treatment is usually symptomatic and focuses on helping the person to develop as many motor skills as possible or to learn how to compensate for the lack of them. Non-speaking people with CP are often successful availing themselves of augmentative and alternative communication systems such as Blissymbols.
Physical therapy (PT) programs are designed to encourage the patient to build a strength base for improved gait and volitional movement, together with stretching programs to limit contractures. Many experts believe that life-long physical therapy is crucial to maintain muscle tone, bone structure, and prevent dislocation of the joints.
Occupational therapy helps adults and children maximise their function, adapt to their limitations and live as independently as possible.[20][21]
Orthotic devices such as ankle-foot orthoses (AFOs) are often prescribed to minimise gait irregularities. AFOs have been found to improve several measures of ambulation, including reducing energy expenditure[22] and increasing speed and stride length.[23]
Speech therapy helps control the muscles of the mouth and jaw, and helps improve communication. Just as CP can affect the way a person moves their arms and legs, it can also affect the way they move their mouth, face and head. This can make it hard for the person to breathe; talk clearly; and bite, chew and swallow food. Speech therapy often starts before a child begins school and continues throughout the school years.[24]
Hyperbaric oxygen therapy Recent studies have demonstrated a dramatic improvement in CP symptomology when hyperbaric oxygen therapy is used as a treatment. Researchers in Brazil found a significant alleviation in symptomology and other characteristics in a study involving 218 cerebral palsy patients. Significant enhancements were documented showing improved vision, hearing and speech as well as a reduction of spasticity by 50%, which occurred in 94% of study patients.[25]
Nutritional counseling may help when dietary needs are not met because of problems with eating certain foods.
Both massage therapy[26] and hatha yoga[How to reference and link to summary or text] are designed to help relax tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises are sometimes used to try to prevent lung infections. More research is needed to determine the health benefits of these therapies for people with CP.
Surgery for people with CP usually involves one or a combination of:
- Loosening tight muscles and releasing fixed joints, most often performed on the hips, knees, hamstrings, and ankles. In rare cases, this surgery may be used for people with stiffness of their elbows, wrists, hands, and fingers.
- Straightening abnormal twists of the leg bones, i.e. femur (termed femoral anteversion or antetorsion) and tibia (tibial torsion). This is a secondary complication caused by the spastic muscles generating abnormal forces on the bones, and often results in intoeing (pigeon-toed gait). The surgery is called derotation osteotomy, in which the bone is broken (cut) and then set in the correct alignment.[27]
- Cutting nerves on the limbs most affected by movements and spasms. This procedure, called a rhizotomy, "rhizo" meaning root and "tomy" meaning "a cutting of" from the Greek suffix 'tomia' reduces spasms and allows more flexibility and control of the affected limbs and joints.[28]
- Botulinum Toxin A (Botox) injections into muscles that are either spastic or have contractures, the aim being to relieve the disability and pain produced by the inappropriately contracting muscle.[29]
Another way is that a new study has found that cooling the bodies and blood of high-risk full-term babies shortly after birth may significantly reduce disability or death.[30]
Conductive education (CE) was developed in Hungary from 1945 based on the work of András Pető. It is a unified system of rehabilitation for people with neurological disorders including cerebral palsy, Parkinson's disease and multiple sclerosis, amongst other conditions. It is theorised to improve mobility, self-esteem, stamina and independence as well as daily living skills and social skills. The conductor is the professional who delivers CE in partnership with parents and children. Skills learned during CE should be applied to everyday life and can help to develop age-appropriate cognitive, social and emotional skills. It is available at specialised centres.
Biofeedback is an alternative therapy in which people with CP learn how to control their affected muscles. Some people learn ways to reduce muscle tension with this technique. Biofeedback does not help everyone with CP.
Cultural aspects
Use of terms when referring to people with CP
Many people would rather be referred to as a person with a disability instead of handicapped. "Cerebral Palsy: A Guide for Care" at the University of Delaware offers the following guidelines:[31]
Impairment is the correct term to use to define a deviation from normal, such as not being able to make a muscle move or not being able to control an unwanted movement. Disability is the term used to define a restriction in the ability to perform a normal activity of daily living which someone of the same age is able to perform. For example, a three year old child who is not able to walk has a disability because normal three year old can walk independently. Handicap is the term used to describe a child or adult who, because of the disability, is unable to achieve the normal role in society commensurate with his age and socio-cultural milieu. As an example, a sixteen-year- old who is unable to prepare his own meal or care for his own toileting or hygiene needs is handicapped. On the other hand, a sixteen-year- old who can walk only with the assistance of crutches but who attends a regular school and is fully independent in activities of daily living is disabled but not handicapped. All disabled people are impaired, and all handicapped people are disabled, but a person can be impaired and not necessarily be disabled, and a person can be disabled without being handicapped.
The term "spastic" describes the attribute of spasticity in types of spastic CP. In 1952 a UK charity called The Spastics Society was formed.[32] The term "spastics" was used by the charity as a term for people with CP. The word "spaz" has since been used extensively as a general insult to disabled people, which some see as extremely offensive. It is also frequently used to insult able-bodied people when they seem overly anxious or unskilled in sports. The charity changed its name to Scope in 1994.[32] In the United States the word spaz has the same usage as an insult, but is not generally associated with CP.[33]
Misconceptions
A common misconception about those born with Cerebral Palsy is that they are less intelligent than those born without it. Cerebral Palsy is defined as damage to the part of the brain that controls movement; areas of the brain which define a persons intelligence are not affected by CP.
Spastic Cerebral Palsy, the most common form of CP, causes the muscles to be tense, rigid and movements are slow and difficult. This can be misinterpreted as cognitive delay due to difficulty of communication. Individuals with cerebral palsy can have learning difficulties, but sometimes it is the sheer magnitude of problems caused by the underlying brain injury which prevents the individual from expressing what cognitive abilities they do possess. [1]
Public perception
Those with CP are sometimes stigmatised and shunned. This has lessened since the 1950s thanks to public education and to United Cerebral Palsy in the U.S. and similar organisations in other countries. Prior to that time the great majority were often sent to asylums or confined to attics. They were perceived to be the products of incest and partial smotherings. [How to reference and link to summary or text] Often parents kept their children away from them in the mistaken belief that the condition was the product of disease or poor sanitary habits.
Thomas Galton believed that there was a correlation between physical disability and aptitude, and this attitude remained prevalent as concerned CP until the 1970s. At this time, CP was an overdiagnosed disorder, and a common misunderstanding then and now is that CP causes mental retardation. In fact, only CP individuals with brain damage in the hippocampus or the frontal cerebral cortex develop mental retardation. While learning difficulties and CP may co-occur, it is common for individuals with CP to lead normal lives.
See also
External links
- Cerebral palsy at the Open Directory Project: Includes links to more than a dozen sites with information on CP, as well as support groups and CP organisations.
- Cerebral Palsy Help in the US
- Website of Scope, the disability organisation in England and Wales focussing on people with cerebral palsy.
Cerebral palsy and other paralytic syndromes (G80-G83, 342-344) | |
|---|---|
| Paresis and plegia NOS |
Paralysis - Quadriplegia - Triplegia - Hemiplegia/Hemiparesis - Paraplegia/Diplegia - Monoplegia |
| Flaccid vs. spastic | |
| Specific types |
Cerebral palsy - Cauda equina syndrome - Locked-In syndrome |
References
- ↑ "Cerebral Palsy." (National Center on Birth Defects and Developmental Disabilities, October 3, 2002), www.cdc.gov
- ↑ Cerebral Palsy - Topic Overview. URL accessed on 2008-02-06.
- ↑ . WebMD Medical Reference from Healthwise.
- ↑ United Cerebral Palsy Research and Educational Foundation. URL accessed on 2007-07-29.
- ↑ Bax M, Goldstein M, Rosenbaum P, et al (2005). Proposed definition and classification of cerebral palsy, April 2005. Developmental medicine and child neurology 47 (8): 571-6.
- ↑ (2004). Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment--United States, 2003. MMWR Morb. Mortal. Wkly. Rep. 53 (3): 57-9.
- ↑ Summary of "The Epidemiology of cerebral palsy: incidence, impairments and risk factors". United Cerebral Palsy Research and Education Foundation (U.S.).
- ↑ Information : Scope. URL accessed on 2007-12-08.
- ↑ Groch, Judith Medical News: Cerebral Palsy Rates Decline in Very Low Birthweight Children - in Neurology, General Neurology from MedPage Today. MedPage Today. URL accessed on 2007-12-08.
- ↑ Thames Valley Children's Centre - Cerebral Palsy - Causes and Prevalence. URL accessed on 2007-06-11.
- ↑ Johnson, Ann (2002). Prevalence and characteristics of children with cerebral palsy in Europe. Developmental medicine and child neurology 44 (9): 633-40.
- ↑ United Cerebral Palsy Research and Education Foundation (U.S.). Cerebral Palsy Fact Sheet.
- ↑ Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R (2007). How common are the "common" neurologic disorders?. Neurology 68 (5): 326-37.
- ↑ Johnson, Ann (2002). Prevalence and characteristics of children with cerebral palsy in Europe. Developmental medicine and child neurology 44 (9): 633-40.
- ↑ Thorngren-Jerneck K, Herbst A (2006). Perinatal factors associated with cerebral palsy in children born in Sweden. Obstetrics and gynecology 108 (6): 1499-505.
- ↑ Cerebral Palsy - Facts & Figures: History. United Cerebral Palsy Research and Education Foundation (U.S.). URL accessed on 2007-07-06.
- ↑ (2006). Cerebral Palsy: Hope Through Research. National Institute of Neurological Disorders and Stroke (U.S.). NIH Publication No. 06-159. URL accessed on 2007-07-06.
- ↑ Infection in the Newborn as a Cause of Cerebral Palsy, 12/2004. United Cerebral Palsy Research and Education Foundation (U.S.). URL accessed on 2007-07-05.
- ↑ OMIM - CEREBRAL PALSY, SPASTIC, SYMMETRIC, AUTOSOMAL RECESSIVE. URL accessed on 2007-07-29.
- ↑ Hansen, Ruth A.; Atchison, Ben (2000). Conditions in occupational therapy: effect on occupational performance, Hagerstwon, MD: Lippincott Williams & Wilkins.
- ↑ Crepeau, Elizabeth Blesedell; Willard, Helen S.; Spackman, Clare S.; Neistadt, Maureen E. (1998). Willard and Spackman's occupational therapy, Philadelphia: Lippincott-Raven Publishers.
- ↑ Balaban B, Yasar E, Dal U, Yazicioglu K, Mohur H, Kalyon TA (2007). The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy. Disability and rehabilitation 29 (2): 139-44.
- ↑ White H, Jenkins J, Neace WP, Tylkowski C, Walker J (2002). Clinically prescribed orthoses demonstrate an increase in velocity of gait in children with cerebral palsy: a retrospective study. Developmental medicine and child neurology 44 (4): 227-32.
- ↑ Pennington L, Goldbart J, Marshall J (2004). Speech and language therapy to improve the communication skills of children with cerebral palsy. Cochrane database of systematic reviews (Online) (2): CD003466.
- ↑ HBO Treatment.com. URL accessed on 2007-09-03.
- ↑ Macgregor R, Campbell R, Gladden MH, Tennant N, Young D (2007). Effects of massage on the mechanical behaviour of muscles in adolescents with spastic diplegia: a pilot study. Developmental medicine and child neurology 49 (3): 187-91.
- ↑ Schejbalová A (2006). [Derotational subtrochanteric osteotomy of the femur in celebral palsy patients]. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca 73 (5): 334-9.
- ↑ Farmer JP, Sabbagh AJ (2007). Selective dorsal rhizotomies in the treatment of spasticity related to cerebral palsy.
- ↑ Hawamdeh ZM, Ibrahim AI, Al-Qudah AA (2007). Long-term effect of botulinum toxin (A) in the management of calf spasticity in children with diplegic cerebral palsy.
- ↑ Shankaran S, Laptook AR, Ehrenkranz RA, et al (2005). Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N. Engl. J. Med. 353 (15): 1574-84.
- ↑ Cerebral Palsy: a Guide for Care. URL accessed on 2007-07-29.
- ↑ 32.0 32.1 A very telling tale. URL accessed on 2007-07-29.
- ↑ Language Log: A brief history of "spaz". URL accessed on 2007-07-29.
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