segunda-feira, 25 de abril de 2011

Cerebral Palsy - Part I

What is it

CP is the result of an injury to the developing brain at any time during pregnancy, birth, or until the age of three. This will interfere with messages from the brain to the body affecting body movement and muscle coordination, maintaining intact the child’s muscles or nerves. Depending on how much of the brain was affected, the effects of CP vary widely from individual to individual: at its mildest, CP may result in a slight awkwardness of movement or hand control, and at its most severe, CP may result in virtually no muscle control, profoundly affecting movement and speech. There also could be secondary conditions and disabilities, like growth problems (failure to thrive), seizures or epilepsy, learning disabilities, hearing impairments, and vision problems. [1]
Although having CP does present some additional challenges, it does not need to be a barrier to leading an enjoyable and productive life.
  


Causes

There are some risk factors that can predispose to the occurrence of CP, mainly during pregnancy, labour, and post-natal (0-3 years).
During pregnancy anything which tends to produce a low birth weight baby, will increase the likelihood of CP, such as multiple births (twins or triplets), a damaged placenta which may interfere with fetal growth, infection (e.g. rubella), poor nutrition, exposure to toxic substances, including nicotine and alcohol, maternal diabetes, hyperthyroidism or high blood pressure, premature dilation of the cervix leading to premature delivery, biochemical genetic disorders, malformations of the developing brain, blood type incompatibility between mother and enfant, sexual transmitted diseases (e.g. gonorrhea, herpes,…). [1]
During labour, a premature delivery, an abnormal positioning of the baby (such as breech or transverse lie) which makes delivery difficult, a small pelvic structures, a rupture of the amniotic membranes leading to fetal infection, a prolonged loss of oxygen during the birthing process, effects of anesthetics or analgesics, a severe jaundice shortly after birth, or a low Apgar score, are factors that could predispose to CP. [1]
In the post-natal period, CP can occur if a child suffers from an injury to the brain due to infections such as meningitis, brain hemorrhages, nervous system malformations, head injuries following falls, car accidents or abuse, a lack of oxygen (asphyxia) due to accidents such as drowning, poisoning, and seizures. [1]     
In many cases there could be misdiagnosis because a delay in development that occurs early in the child’s life can later disappear (e.g. the child’s “catches-up”). That’s why normally the diagnosis is often made when the child reaches 18-24 months. A child with CP will probably be delayed in reaching her “milestones”, such as rolling over, sitting and standing, and may feel unusually stiff or floppy. [1]
Physical therapy plays a central role in managing the condition; it focuses on function, movement, and optimal use of the child’s potential. Physical therapy uses physical approaches to promote, maintain and restore physical, psychological and social well-being. Physiotherapists also teach parents how to handle their child at home for feeding, bathing, dressing and other activities, and give advice on mobility devices.
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[1] A Guide to Cerebral Palsy (2006). Cerebral Palsy Association of British Columbia: The Hamber Foundation

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