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Congenital Cerebral Palsy, (Interventions since there is no true treatment…
Congenital Cerebral Palsy
Pathogenesis
Caused by trauma to the brain or abnormal development of the brain before or during birth
The trauma or disruption in development of the brain impairs the child's motor function
The specific causes of CP are generally unknown
Factors that can lead to CP
Gene mutation
Fetal stroke
Traumatic head injury
Lack of oxygen to the fetal brain
CP effects the cerebral cortex of the brain in the motor area, the part that directs the person's movement
CP is a disorder that is
non-progressive
-- it does not get worse over time
One of the most common contributing factors to CP is damage to the periventricular white matter of the brain
Death of the white matter in the brain's fluid-filled ventricles
This area of the brain contains sensory neurons that send signals to the body's muscle cells for movement
When the white matter in that area of the brain gets damaged, it cannot send those messages to the muscles, resulting in CP
Resources
Boston Children's Hospital. (n.d.).
Cerebral palsy diagnosis and treatments.
https://www.childrenshospital.org/conditions-and-treatments/conditions/c/cerebral-palsy/diagnosis-and-treatment
Centers for Disease Control and Prevention. (2019, September 23).
Causes and risk factors of cerebral palsy.
https://www.cdc.gov/ncbddd/cp/causes.html
Centers for Disease Control and Prevention. (2019, April 30).
Screening and diagnosis of cerebral palsy.
https://www.cdc.gov/ncbddd/cp/diagnosis.html
Centers for Disease Control and Prevention. (2017, February 3).
Birth prevalence of cerebral palsy.
https://www.cdc.gov/ncbddd/cp/features/birth-prevalence.html
Cerebral Palsy Alliance Research Foundation. (n.d.).
Facts about cerebral palsy.
https://cparf.org/what-is-cerebral-palsy/facts-about-cerebral-palsy/
Cerebral palsy facts and statistics.
(2020, March 21). Cerebral Palsy Guidance. Retrieved October 29, 2020, from
https://www.cerebralpalsyguidance.com/cerebral-palsy/research/facts-and-statistics/
Mayo Clinic. (2019, August 17).
Cerebral palsy: Diagnosis and treatment.
https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/diagnosis-treatment/drc-20354005
Mayo Clinic. (2019, August 17).
Cerebral palsy: Symptoms and causes.
https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999
National Institute of Neurological Disorders and Stroke. (2013).
Cerebral palsy: Hope through research.
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Cerebral-Palsy-Hope-Through-Research#:~:text=Cerebral%20palsy%20affects%20the%20motor,developed%20normally%20during%20fetal%20growth
Risk Factors
70-80% of risk factors for CP are antenatal
Genetic risk factors
CP is not a hereditary condition
However, CP can run in the family due to multifactorial inheritance, meaning that certain genetic influences can form interactions when exposed to an environmental factor as well, making specific family members more susceptible to being born with CP
Environmental risk factors
Infants with low birthweight or born prematurely are at a much higher risk for CP than normal gestational, heavier weighing infants
Having multiple births at one time increases the risk of CP for each of the infants
Death of one or more infants conceived in multiples further increases the risk of CP for the remaining infants
Maternal exposure to toxic chemicals during pregnancy, such as mercury
Breech positioning
Complicated labor and delivery
Jaundice
Intrauterine infections
Birth asphyxia
Incidence/Prevalence
CP is the most common motor disability in children
About 10,000 babies are born each year with CP
Males are more often diagnosed with CP than females
About 41% of children in United States with CP also have a cognitive disability
1 in 3 people with CP cannot walk
1 in 4 people with CP also have epilepsy
1 in 5 people with CP is tube fed
About 17 million people worldwide have CP
Diagnostics
Developmental Monitoring
At each wellness check, the development of the child will be reassessed, along with any concerns the physician or parent may have, especially pertaining to the child's muscle tone or movement
Developmental Screening
A short "test" given to the child by the physician or parent to assess their development to see if any motor or muscle movement delays are present
The American Academy of Pediatrics suggests that all children be screened for developmental delays during wellness visits at the ages of 9 months, 18 months, and 24 or 30 months
Most developmental delays are found by 30 months of age
Development and Medical Evaluations
These evaluations will look at the child's motor skills, muscle tone, reflexes, and posture and will use this information to rule out, as well as come up with potential developmental disorders
This is necessary because many children with CP also tend to have other developmental disabilities such as impaired vision, hearing, seizures, and speech problems, so it is important to cover all bases with evaluations
Brain Scans
MRI is used to take images of the brain to discover any lesions or abnormalities that may be relevant to CP
Cranial ultrasound is used in infants to get quick, inexpensive images of the brain for initial assessment for congenital conditions
Electroencephalogram scans are done to further investigate symptoms of seizures that can be associated with CP
Laboratory Tests
(CPK) creatine phosphokinase isoenzymes tests can detect muscle injury, or stress, which can help to diagnose CP
Urine mass spectrometry tests can be used to indicate CP through assessing amino acid and other chemical levels in the urine
Clinical Manifestations
Symptoms of CP typically include those of movement and coordination problems
Muscle tone that is either too stiff or too relaxed
Tremors or other involuntary movements
Delays in reaching milestones in motor movement development such as sitting up unassisted, pushing or pulling against something, and smooth gait while walking
Favoring or lack thereof on one side of the body
Difficulty with sucking, eating, or swallowing
Excessive drooling
Delays in speech development
Seizures
Sensory impairment
Treatments
Medications
Anticonvulsants for children who experience seizures with CP
Gabapentin (Neurontin)
Lamotrigine (Lamictal)
Topiramate (Topamax)
Zonisamide (Zonegran)
Muscle or nerve injections such as onabotulinumtoxinA (Botox) to ease spasticity of certain muscles
Oral muscle relaxants
Diazepam (Valium)
Dantrolene (Dantrium)
Baclofen (Gablofen, Lioresal)
Tizanidine (Zanaflex)
Anticholinergics for children who have excessive drooling and rigidity
Benztropine mesylate
Carbidopa-levodopa (Sinemet)
Glycopyrrolate (Robinul)
Procyclidine hydrochloride (Kemadrin)
Trihexyphenidyl hydrochloride
Therapy
Physical therapy through taking part in stretches, exercises, and play activities to help improve flexibility and mobility, and preventing muscle contracture
Speech therapy for those who have difficulty speaking, chewing, and swallowing through speech exercises to enhance skills
Occupational therapy to develop independence and essential life skills through exercises and games used to master basic life skills such as dressing, feeding, and bathing
Surgical Procedures
Orthopedic surgery can be used to reset joints and bones that have deformities or contracture to make it easier for the patient to be mobile either by foot or with an assistive device
In those with severe pain due to spastic muscles, sometimes a procedure called selective dorsal rhizotomy is performed in which a surgeon will cut the nerves serving those spastic muscles to relieve pain, but can also cause numbness
(Interventions since there is no true treatment for CP)