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3 Major causes of cerebral palsy and useful ways it can be identified

Dr. Tomi

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CEREBRAL PALSY.

This is a brain damage caused by injury \insult to the brain while a child’s brain is still developing—before birth, during birth or immediately after birth.
It can be defined as a disorder of posture and movement which is caused by a permanent and non-progressive injury to the developing brain.
It results from abnormality in or injury to the cerebrum(the largest area of the brain which controls sensation and voluntary motor function) .The underlying problem originates in the brain not in the muscles themselves.
Cerebral palsy affects body movement, muscle control, posture and balance. Muscles can contract too much, too little, or all at the same time. Limbs can be stiff and forced into painful, awkward positions. Fluctuating muscle contraction can make limbs tremble, shake or writhe. It can affect other brain functions apart from the motor area resulting in speech (talking), auditory (hearing), and visual (seeing) and mental (thinking) deficits.
Every case of cerebral palsy is unique to the individual. One person may have total paralysis and require constant care, while another with partial paralysis might have slight movement tremors but require little assistance. This is due in part by the type of injury and the timing of injury to the developing brain.

CAUSES.
The brain is subject to severe injury whilst its still developing, hence the causes are divided into prenatal, perinatal and post natal causes. The following are just some of the commom causes.

1.PRENATAL (before birth)
Intrauterine infection– resulting from maternal infection during pregnancy. Especially the TORCH INFECTION…(Toxoplasmosis, rubella, cytomegalovirus, herpes infection and others)
Antepartum hemorrhage-bleeding during pregnancy.
.Irradiation.
.Congenital cerebral malformation.
2.PERINATAL.(during delivery)
.Asphyxia. A condition where low or no oxygen gets to the brain constituting an insult to the brain.
.Prematurity.
.Cord prolapse. When the umbilical cord preceeds the baby during delivery..
.Hypoglyceamia. Low blood sugar in the new born.
.Neonatal seizure.
.Intracranial hemorrhage.
3.POSTNATAL (after delivery)
Meningitis. Inflammation of the brain coverings
Encephalitis. Inflammation of the brain
-Head trauma
-Prolonged seizure.
-Hypertonic dehydration.
-Lead toxicity
.

SIGNS AND SYMPTOMS.
. The cardinal features;
-Delay in motor developmental milestones.
-Abnormality of muscle tone I.e. firmness of muscle.
-Reduction in normal movement i.e. rigidity of muscle.
-Presence of abnormal movements.
. Clues to early diagnosis;.
-Floppiness.
-Stiffness.
-Scissoring of the limbs.
-Persistent fisting of the hands.
-Violent startle reactions.
-Sialorrhoea (excessive production of saliva).
-Paucity of movements.
-Strong hand preference in the first year of life.

Associated problems;
-Mental retardation.
-Seizure disorder.
-Deafness.
-Blindness, squints, refractive disorder.
-Orthopedic problems (hip dislocation, contractures like toe-walking and scoliosis)
-Behavioral disorders (incontinence, constipation)
-Attention deficit and hyperactivity disorder.

DIAGNOSIS.
This is guided by the symptoms the child exhibits.
. Through the history (prenatal, perinatal and postnatal.)
. Physical examination (motor and sensory organs).
. investigations such as; CT scan and MRI of the brain. Baseline EEG.
Others…..audiometry, ophthalmologic examination etc.

MANAGEMENT
Early diagnosis and institution of treatment is desired.
It requires multi-disciplinary approach (pediatric neurologist, pediatric nurse, physiotherapist, speech therapist, orthopedic surgeon, social worker, and educator).

Parents should be taught to address the peculiarities of daily activities such as feeding, dressing, bathing and playing in ways that limits the effects of abnormal muscle tone.
Use of adaptive equipment\ assistive technology like walkers, poles and standing frames, motorized wheelchairs, special feeding devices and customized seating arrangements.
-Hearing and visual aids.
-Orthotics like braces and splints.
-Drugs like muscle relaxant.
-Surgical procedures like release of contracture.
-Enrolment in special schools.

PROGNOSIS.
Cerebral palsy is a non-life threatening, non-progressive, incurable, non-contagious, chronic but manageable condition.
Admittedly, their care may involve more visits to the doctor; require therapy and medications and perhaps surgery, most children with Cerebral Palsy can live long, happy, good quality lives.

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Dr Tomi Sofela (MBChB) is a graduate of Olabisi Onabanjo University in Ogun State registered with the Medical and Dental Council of Nigeria. She is on a mission to pursue fulfillment and enjoys watching movies, reading novels and organizing friends and family get-together.