Doctor’s Handbook

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Cerebral Palsy (CP)

It is a group of disorders that affect a person’s ability to move. (Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles). Cerebral palsy is caused by a brain injury that occurs during pregnancy or birth of within the first 2 to 3 years of the child’s life. Brain injury results in random or uncontrolled movements, loss of muscle control, impaired strength and locomotor patterns or a combination of these symptoms. 

Brain injury is non-progressive but its symptoms may be. Apart from impaired motor function, there are several comorbidities associated with cerebral palsy in children, including epilepsy, cognitive and learning disabilities, mental retardation, impaired attention, auditory and visual impairments, language-speech disorders, respiratory dysfunction and swallowing problems (dysphagia).
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Prevalence

Cerebral palsy (CP) is the most common motor disability in childhood. Prevalence estimates of CP ranging from 2 to 3 per 1,000 live births or per 1,000 children around the world.

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Aetiology

The cause of the Cerebral Palsy is by brain injury or malformation that occurs while the brain is developing. The cause of this is insufficient oxygen supply (hypoxia) to the central nervous system. Other causes and risk factors of Cerebral Palsy include:

Infections during pregnancy leading to fetal viral infections such as cytomegalovirus (CMV) or rubella (german measles)

hydrocephalus–both congenital and acquired post birth

problems with blood flow to the brain–stroke or bleeding associated with a blood clotting problem, associated with premature birth

brain development disorders in the first trimester

birth complications such as detachment of the placenta, problems with the umbilical cord during birth can disrupt oxygen supply to the baby

infections of the brain–meningitis or encephalitis during infancy

injuries to the brain–craniocerebral trauma, head injuries caused by child abuse or shaken child syndrome

premature birth and low birthweight

There are five major types of Cerebral Palsy with different severity:

diplegia–a form of bilateral cerebral palsy affecting both legs (while the arms may be affected to a lesser extent)

hemiplegia–a form of bilateral cerebral palsy where one side of the body is affected

quadriplegia–a form of bilateral cerebral palsy where both arms and legs are affected

dyskinetic (extrapyramidal)–Characterised by involuntary movements

ataxic–caused by cerebellum damage, characterised by shaky movements

Dear Doctor!

Children affected by cerebral palsy are at risk of neurogenic hip dislocation, significantly affecting quality of life due to pain. The prevention of hip pathology is therefore one of the most important health considerations for a child with CP.

As many as 40 percent

 of children with cerebral palsy are at risk of neurogenic hip dislocation, especially children at GMFCS III–V
If possible, dislocated hip joint are treated with surgery, and if not, palliative interventions are usually indicated. 

Hip dislocation causes:

pain and trauma
reduces the range of movement
prevents children from sitting or standing correctly
can lead to fractures
promotes abnormal spine curvature