Tuesday, October 13, 2009

Cerebral Palsy

What is Cerebral Palsy?

The term cerebral palsy refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don’t worsen over time. Even though cerebral palsy affects muscle movement, it isn’t caused by problems in the muscles or nerves. It is caused by abnormalities in parts of the brain that control muscle movements. The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later. The early signs of cerebral palsy usually appear before a child reaches 3 years of age. The most common are a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a “scissored” gait; and muscle tone that is either too stiff or too floppy. A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse.

What is the prognosis?

Cerebral palsy doesn’t always cause profound disabilities. While one child with severe cerebral palsy might be unable to walk and need extensive, lifelong care, another with mild cerebral palsy might be only slightly awkward and require no special assistance. Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.

Is there any treatment?

An occupational therapist may work within the community, the hospital, school or a special unit. Within local authority social services departments, occupational therapists are responsible for the assessment and provision of suitable equipment and for major adaptations to an existing or new environment at home, school or work to enable an individual to be as functionally independent as possible.

Occupational therapy plays a large role in the development of a child with Cerebral Palsy. The job of an occupational therapist is to hone the ability of the fine-motor skills and small muscles, which include hands, feet, mouth, fingers and toes. These therapists also teach daily living skills such as dressing, eating, and everyday mobility. It is also one of their jobs to make sure children are properly positioned in wheelchairs, standing frames, etc to maximize benefit and minimize positions that could contribute to more spasms or other uncontrolled movements. They may also teach your child better or easier ways to write, draw, cut with scissors and brush their teeth. Occupational therapists will also help your child find the right special equipment to make everyday jobs a little easier, such as modified spoons and cups for easier feeding, toys that are easily held and that will help the development of motor skills and seats, wheelchairs, pushchairs, standing frames, walking frames and side lying boards that will help improve your child’s mobility, posture, etc. The occupational therapist may try to develop certain physical and learning skills using special play equipment and advise on equipment to help mobility such as tricycles and trolleys.

It is also the job of an occupational therapist to help make your home and community accessible to your child. Many adaptations may needs to be accommodated in order for your child to reach his maximum level of independence. For instance, because children with Cerebral Palsy often have problems with their posture and muscle tension, a chair may need to be adapted with creative use of foam in order for the child to sit comfortably. Things such as the Rifton Corner Seat aid in a child’s ability to sit on the floor while playing, without stressing the leg muscles and while keeping the child’s posture upright.

Occupational therapists will look at the best posture and seating for the child. When you and your occupational therapist are considering your child’s seating needs, it is important to obtain a clear idea of what final outcome you are looking to achieve. “Some seating is very bulky. Many special seats have trays in front of them, which means that the child is unable to join the rest of the family at the dinner table. Many chairs available on the market depend on numerous straps to hold the child in place. I don’t think I would have been very comfortable as a child if several parts of my body were strapped down every time I sat in a chair. On the other hand, chairs that do not rely on straps probably require the child to put in some effort to keep their posture correct. Thus, sitting down becomes an activity rather than an act of relaxation. If your child clearly needs special seating it might be worth considering the option of more than one chair, perhaps one for relaxing and one for active sitting.”

In addition to helping your child find comfortable seating, depending on the degree of disability of the child, the therapist may be interested in the walking pattern or gait of the child. Even if the child can not walk or stand on his or her own, it is important that your child stand for a portion of the day. While movement is necessary to stop muscles from becoming atrophied, for children with Cerebral Palsy standing takes the weight from the hips to the feet, allowing the hip joint to develop more regularly. Hip dislocation is a common problem in children with Cerebral Palsy, and allowing the joint to develop adequate strength will help to avoid such dislocations. If a child is unable to stand on his own, there are many standing frames available. If a child is not able to stand on his own but can manage with an adult’s assistance, purchasing a standing frame may not be necessary. Activities such as holding your child’s hips and supporting him in a standing position while he leans against a sofa or low table can be just as effective in allowing your child’s joints to grow healthfully. Toilet seats can be specialized to help children with Cerebral Palsy develop this independent function without the need of assistance.

In instances where mobility is very limited, special computers that can be used by touching the screen, by speaking the commands, or other modifications make it possible for individuals with Cerebral Palsy to accomplish tasks they would otherwise be unable to do on their own. For example, computers can help people turn on a light switch with the blink of an eye or open a door with a nod of the head.

Occupational Therapists are also trained to evaluate the child’s sensory system to determine whether a primary sensory deficit is present or whether a child has difficulty processing sensory information. Sensory Integration refers to the ability to evaluate the relative importance of all sensory inputs acting on the body, on the basis of a child’s current posture, previous movement experiences and movement expectations. A child with Cerebral Palsy may experience sensory integration dysfunction as a result of central nervous system damage, or sensory integration dysfunction might develop secondary to the limited sensory experiences that these children have as a result of their limited motor abilities.

Occupational therapy will help determine your child’s abilities and will help to form reasonable goals to help your child reach.

What occupational therapists cannot do

Therapists cannot cure cerebral palsy; they can only help reduce disabling effects. Through therapy, disabled people can achieve improvement in communication and movement, and can become more independent. Every person with cerebral palsy is different, however, and not everyone will achieve the same results.

What research is being done?

Researchers are investigating the roles of mishaps early in brain development, including genetic defects, which are sometimes responsible for the brain malformations and abnormalities that result in cerebral palsy. Scientists are also looking at traumatic events in newborn babies’ brains, such as bleeding, epileptic seizures, and breathing and circulation problems, which can cause the abnormal release of chemicals that trigger the kind of damage that causes cerebral palsy. To make sure children are getting the right kinds of therapies, studies are also being done that evaluate both experimental treatments and treatments already in use so that physicians and parents have valid information to help them choose the best therapy

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