- 1 What is cerebral palsy?
- 2 Causes
- 3 Brain development
- 4 Risk factors
- 4.1 Medical conditions
- 4.2 Weight, size and premature birth
- 4.3 Presence of twins
- 4.4 Infections
- 4.5 Exposure to radiation
- 4.6 Substance use
- 4.7 Fator rh
- 4.8 Respiratory distress syndrome
- 4.9 Hypoglycemia
- 4.10 Complicated deliveries and cesarean section
- 4.11 Baby’s position at the time of birth
- 4.12 Low Apgar Score
- 4.13 Jaundice
- 4.14 Convulsions
- 5 Types of cerebral palsy
- 6 Symptoms
- 7 How is the diagnosis of cerebral palsy made?
- 8 Is cerebral palsy curable?
- 9 How to deal with?
- 10 Medicines for cerebral palsy
- 11 Living together
- 12 Prognosis
- 13 Cerebral palsy of the eye?
- 14 Complications
- 15 How to prevent cerebral palsy?
What is cerebral palsy?
Cerebral palsy (CP) is a group of symptoms characterized by a difficulty in controlling posture and movement, caused by some brain anomaly or injury between the fetal stage and 2 years of age. Symptoms appear when the child begins to develop motor skills.
Also known as Chronic Non-Progressive Encephalopathy, cerebral palsy is a neurological condition that does not cause a degenerative disease and, therefore, its symptoms do not worsen over time.
CP causes motor difficulties, especially in the limbs. However, which affected limbs vary widely: it may be just one arm, or two, one or two legs, or all limbs. Sometimes it even affects the face.
This condition forces the muscles to contract too much or too little, sometimes both at the same time. Thus, it is common for these children to suffer from difficulties in maintaining a posture, since motor limitation causes them to be in painful and unhealthy positions.
Not only is the functioning of the muscles affected: these children may also suffer from intellectual disabilities, seizures , visual and hearing problems, among others.
It usually affects 2 out of every 1000 children, being more common in premature babies, weighing less than a pound and a half at birth, due to abnormalities in the blood flow of the placenta or uterus. Therefore, in most cases, the problem still originates during pregnancy.
It is worth remembering that, despite being limiting, cerebral palsy is not a risky condition . While, depending on the severity, some complications can occur, most children with CP manage to reach adulthood.
In ICD-10 (International Classification of Diseases, 10th edition), cerebral palsy is found by code G80.
Cerebral palsy is caused by some change in the structure of the brain, usually the result of some malformation or brain injury . This change occurs in the prenatal, perinatal or postnatal period, and can have the most diverse causes depending on when it occurs.
The types of anomaly that result in cerebral palsy are:
White matter injury to the brain (periventricular leukomalacia)
In the brain, there is a mass called “white matter”, which is responsible for transmitting signals from inside the brain to the rest of the body. In general, between the 26th and 34th weeks of gestation, this part of the brain is more sensitive.
If something interferes with the normal development of the fetus, it can be easily damaged, resulting in “holes” in this mass. These spacing interferes with signal transmission, which can lead to cerebral palsy.
Abnormal brain development
Any situation that interferes with the baby’s brain development process can cause malformations that interfere with signal transmission. Some conditions capable of altering this process are infections, fevers, traumas, among others that cause unhealthy conditions in the uterus.
Another problem that can lead to abnormal brain development is a possible mutation in the genes that coordinate this process.
Bleeding inside the brain can damage the tissue around it. This hemorrhage may be the result of a thrombus from the placenta that ends up blocking blood flow in the brain, or malformations and weakening of the blood vessels in the brain, which can easily rupture.
These conditions are more common when the mother has gestational hypertension. Infections also increase the chances of an intracranial hemorrhage in the baby, especially those that occur in the mother’s pelvis.
Lack of oxygen (choking)
Characterized as a lack of oxygen in the brain, asphyxiation can occur both by the absence of breathing and by the poor supply of oxygen to the baby’s brain. In fact, this condition is normal during childbirth, but it should not last for long.
In very long deliveries, this condition is extended and, thus, can cause a brain injury known as hypoxic-ischemic encephalopathy. In these cases, there is impairment of the motor cortex (responsible for movements), as well as other areas of the brain.
Some situations that lead to this condition are: low blood pressure of the mother ( hypotension ), rupture of the uterus, premature detachment of the placenta, problems with the umbilical cord or severe head trauma during childbirth.
Trauma and postnatal damage
Accidents, falls, physical abuse and infections are just some of the conditions that can cause postnatal damage to the brain. Because of a lack of protection of the brain during these first years of life, trauma has far worse consequences for babies than for adults. In this way, the brain is filled with “scars” that compromise its typical development, leading to cerebral palsy.
Another possible cause for cerebral palsy is genetics: in some cases, there is evidence – albeit little – that an enzyme called “glutamate decarboxylase-1” has a significant role in the development of CP. About 2% of cases are inherited.
We know that cerebral palsy is the result of some change during the development of the central nervous system, caused by both abnormalities and injuries in some part of the brain. Therefore, it is important to understand how this training process takes place.
Although much research shows that brain development and maturation lasts until at least the end of adolescence, several doctors consider that the organ is fully formed at 2 years of age. This is because, in fact, most of the training takes place during those first years of life and, after that time, the pace of development slows dramatically. But how did this development take place from the beginning?
About 3 or 4 weeks after conception, the embryo consists of 3 layers that give rise to different organs: brain, lungs, bones, skin, among others. The nervous system comes from the ectoderm, one of these layers, which receives signals for the formation of a flattened area called “neural plaque”.
Over time, this plaque forms wrinkles and folds, until its two ends come together giving rise to the “neural tube”. At the top of this tube, there is a growth of three protuberances that give rise to some parts of the brain.
At this point, the ectoderm receives more signals to continue the formation of the central nervous system, but this time, it focuses on forming neurons. These cells are responsible for conducting nerve impulses which, in turn, are what keep our bodies functioning, propagating these impulses to all organs and tissues.
Neurons are formed inside the neural tube, but they must be conducted to the part of the brain where they will perform their functions. Therefore, they migrate, with the help of nutritive cells called neuroglia, and form connections during this movement.
Some brain abnormalities are the result of when an error occurs in this process and neurons are unable to reach their correct destination. Several conditions affect this migration, such as the use of drugs, alcohol, radiation exposure, among others.
Furthermore, the connections between neurons are made through a kind of “tail” that they create, called an axon. These extensions can travel long distances – to a tiny cell like a neuron – to connect to other neurons.
After birth, a process called myelination occurs, which is when the axons are surrounded by an insulating substance called myelin. Thus, protection of these cells is guaranteed and improvement in the conduction of nerve impulses. This phase ends about 2 years after birth, which is why injuries to the brain before that age have such disastrous consequences and can cause cerebral palsy.
There are several conditions that can increase the chances of a baby suffering cerebral palsy. These conditions can be related to either the health of the mother, the child at birth or pregnancy and childbirth. Some examples are:
Diabetes , high blood pressure and other chronic diseases that influence a woman’s metabolism affect pregnancy. Other conditions linked to increased chances of CP are thyroid problems, intellectual deficiency, excess protein in the urine and seizures ( epilepsy ).
Weight, size and premature birth
The risks of developing CP are greater in babies who are born before reaching 40 weeks of gestation, who weigh less than 1.5 kg at the time of birth or who are too small for gestational age.
Presence of twins
The gestation of more than one baby (twins, triplets, etc.) is related to an increased chance of cerebral palsy, especially in cases where one of the babies dies while still in the womb.
Infections with viruses such as rubella , cytomegalovirus, herpes and toxoplasmosis can be passed on to the baby through the blood flow to the placenta. These viruses are able to reach the brain of the fetus, causing injuries.
The chorioamnionitis is a bacterial infection in fetal membranes and is related to prolonged and complicated deliveries.
In addition, if the baby suffers an infection soon after birth, it can quickly reach the brain and damage its tissues. Examples of extremely dangerous infections at this stage are meningitis and encephalitis .
Exposure to radiation
Although low amounts of ionizing rays ( X-rays ) are not harmful to the baby, prolonged exposure can harm the tissues of the fetus, including the brain. Therefore, tests that use radiation should be used on pregnant women only in cases where there is no other option.
The use of substances such as alcohol, tobacco and other drugs directly interferes with the formation of the fetus, which can result in brain malformations.
The Rh factor is an antigen present in the bloodstream and, when the mother’s Rh is incompatible with that of the baby, the mother’s immune system starts to attack the fetus’ blood cells, believing it to be a possibly dangerous foreign body.
Respiratory distress syndrome
When the baby has problems with the functioning of the lung right after birth, the blood is not properly oxygenated and the brain suffers sequelae for this. This can happen both due to infections and phenomena such as meconium aspiration syndrome.
Meconium is the name given to a baby’s first stools, very different from normal stools. It is stored in the baby’s intestines until the moment of birth. However, sometimes, the baby releases meconium in the amniotic fluid during labor and, at that moment, aspirates the substances into his lung, affecting its functioning.
The lack of glucose in the bloodstream affects the functioning of the brain, which leads to seizures that, in the case of the newborn, end up being even more harmful, and there may be brain damage.
Complicated deliveries and cesarean section
Childbirths that require the use of instruments are linked to the development of PC. In addition, complicated deliveries usually take longer, which increases the chances of suffocation.
Baby’s position at the time of birth
Although there is no right position for the baby at the time of delivery, it is preferable that the baby is upside down (towards the vaginal canal, not towards the bottom of the uterus), as this greatly facilitates delivery. Fortunately, this is the position that a large proportion of babies take in the womb when they are about to be born.
Babies who have their feet turned to the vaginal canal instead of the head are more likely to suffer from cerebral palsy. In such cases, it is common for doctors to reposition the baby in the womb before actually delivering the baby, but this is not a guarantee that everything will be okay.
Low Apgar Score
The Apgar score is a scale that assesses the baby’s physical health as soon as it is born. The evaluated criteria are heart rate, breathing, muscle tone, reflexes and skin color.
CP is more common in babies who have low Apgar scores.
Some babies suffer from jaundice (yellowish coloration of the skin and eyes) at birth, a sign that bilirubin (a substance commonly found in bile) is over-concentrated before the liver is able to metabolize it.
This is harmful because the excess bilirubin traveling through the bloodstream can reach the brain and kill nerve cells.
Babies who experience seizures soon after delivery are more likely to be diagnosed with cerebral palsy.
Paralysis manifests itself in several ways, depending on the part of the brain affected. In some types, total loss of movement is the greatest characteristic, while in others, the child may even be able to walk, albeit awkwardly.
The types of cerebral palsy are:
Spastic CP is characterized by muscle stiffness and weakness. This stiffness can affect all members of the body – arms and legs -, giving rise to the condition called quadriplegia (quadriplegia), or just in the lower part of the body (paraplegia). When both sides of the body are affected, it is a diplegia. In cases where paralysis occurs on only one side of the body, hemiplegia is referred to .
These children tend not to be able to walk, but when they do, their way of walking is characterized by “dragging” from one leg to the front of the other, crossing them. This type of gait is called a “scissor gait”.
This type of paralysis, especially in cases of quadriplegia, is usually accompanied by intellectual limitations (often severe), convulsions and dysphagia (difficulty in swallowing).
Athetoid or dyskinetic
In the athetoid type – also called dyskinetic or extra-pyramidal – there are involuntary movements that, even if slow, are spontaneous. They can be contorted, abrupt and spasmodic, but they tend to cease during sleep. These children usually have normal intelligence, but difficulties with the production and understanding of language.
When it comes to the ataxic type, we see children with poor motor coordination and weak muscles, but who are still able to move. In general, they have tremors, difficulty making quick movements and problems with fine coordination, necessary for making precise movements.
The gait of these children is usually staggering, with legs wide open.
Some children may have symptoms of two types of CP, the most common being the combination of spastic paralysis and athetoid. In general, these children also have severe intellectual limitations.
The symptoms and clinical manifestations of cerebral palsy vary widely from case to case, the only factor in common being changes in motor function, that is, in the ability to move the body.
CP works as a spectrum in which, on the one hand, one may have a simple difficulty in fine motor skills (ability to perform precise movements) and, on the other, a child with extremely impaired motor function, without the ability to walk and even swallow.
Some symptoms that may be present in children with CP are:
- Variation in muscle tone: The child’s muscles are too soft or too hard;
- Generalized muscle weakness: The muscles are unable to work properly, and this weakness may be mild or extreme;
- Difficulty breathing: Due to the difficulty in moving the diaphragm muscle, responsible for the lung’s ability to “suck” air;
- Dysfunctions and delays in motor development: In general, around 6 or 9 months of age, children begin to develop their gross motor skills – they are able to make broader movements, even if abrupt and inaccurate. Children with cerebral palsy have difficulties in this development;
- Poor motor coordination: On the other hand, some children are able to perform these broader movements, but they are unable to develop this ability to the point of being able to make more precise movements (fine motor skills);
- Use one more side of the body: The child can try to pick things up with just one hand or crawl by dragging a leg, signs that there is difficulty in moving on the other side of the body;
- Difficulties in walking: The gait of children with CP is impaired. Not infrequently, a “scissor march” develops, in which the child crosses one leg in front of the other to be able to walk. Another common manifestation, especially when only one side is affected, is lame walking;
- Excessive salivation (drooling): Difficulties in the movement of the muscles of the oral region can prevent salivation from being contained within the mouth;
- Difficulty swallowing: Problems in the throat muscles impair when swallowing. This problem can also worsen the drool, since the child is unable to swallow his own saliva;
- Difficulty sucking while breastfeeding: When the mouth muscles are affected, the suction movement prevents the baby from being able to “suck” the mother’s nipple, which can lead to difficulties in breastfeeding;
- Urination difficulties: Although urination is involuntary to some extent, there are several voluntary muscles related to the process. Therefore, problems in these muscles can cause difficulties when peeing, such as urinary retention or difficulty in emptying the bladder completely (the abdominal muscles need to compress it so that the last drops come out).
Children with cerebral palsy tend to have delayed language, especially due to dysarthria : a neurological condition in which it is difficult to articulate words. This is because the muscles involved in the speech process are usually damaged.
In addition, speech-related problems can be linked to breathing difficulties (since the voice is basically the passage of air through the vocal cords), in addition to the result of intellectual disability. In the latter case, children also have difficulties with writing. They can also have deafness.
Bones and Joints
In order for bones to develop properly, they need the impacts of muscle. Due to the lack of movement and exercise, the bones may have small and thin extremities (epiphyses), while the center (diaphysis) remains “chubby”.
Due to lack of use, the cartilages atrophy, causing a narrowing of the joint space, which can lead to loss of function. In addition, problems related to the angulation of these joints can occur.
The bones may also encounter difficulties in development due to changes in the child’s gravitational center, which can be extremely impaired when the child has a different gait.
Adults with cerebral palsy tend to be shorter than healthy adults, as motor limitations do not allow bones to grow to their full potential. These people may also have shorter bones than others, depending on the body part affected.
It is normal for some children to develop scoliosis – a spinal deformation – even before the age of 10, especially those with a lot of difficulty in gross motor skills. It is estimated that 21 to 64% of patients with CP will develop the deformity.
As a result of deformities, children with CP may suffer from chronic pain, often undiagnosed in young children. These pains are usually caused by shortened muscles, abnormal posture, stiff joints, among others.
Not infrequently, children with cerebral palsy have secondary sleep disorders, the result of physical and environmental factors. Babies with very rigid muscles have trouble falling asleep, and cry more often than healthy babies. Those with “soft” muscles, on the other hand, show lethargy.
Because of muscle difficulties, people with CP have limitations when it comes to eating. Damage to fine motor skills prevents the preparation of food and the handling of plates and cutlery. In addition, people with affected facial muscles have difficulty chewing and swallowing.
Even people with only the affected trunk can also have problems, since feeding is not done with the hands alone: we often move the trunk towards the cutlery we are bringing to the mouth.
It is also common for these individuals to have little or a lot of sensitivity around the mouth.
A large proportion of people with cerebral palsy have some degree of intellectual disability: from mild to severe, depending on the area and extent of the brain affected.
Sensory problems such as abnormal perceptions, difficulties in seeing and hearing, in addition to memory and learning disorders are just some signs of intellectual disability.
Brain changes are a risk factor for seizures. Thus, it is not uncommon for children with cerebral palsy to have seizures.
Some other symptoms related to cerebral palsy are:
- Mood and behavior disorders, such as depression and anxiety;
- Urinary and fecal incontinence.
There is no test that can diagnose cerebral palsy. To make matters worse, she will most likely only be diagnosed from the first year of age, when parents notice the delay in developing motor skills such as walking, muscle stiffness and lack of motor coordination.
When taking the baby to the pediatrician, he will analyze the medical history – both of the baby and the mother – in order to detect any abnormalities during pregnancy, birth and the first days of life that may have caused a brain injury.
After a physical evaluation and analysis of the history, the diagnosis of cerebral palsy can be considered. However, the doctor will be watching to see if the symptoms have worsened over time, as this would be a sign that there is possibly another disorder causing the symptoms.
In order to detect brain abnormalities or rule out the possibility of other disorders, the doctor may order the following tests:
Magnetic resonance imaging (MRI)
A magnetic resonance imaging (MRI) is a type of test that uses magnetic fields to create cross-sectional images of the brain (as if it had been cut) and shows change in its structure.
Because it is faster, you can order a cranial ultrasound , an examination that uses sound waves to create a visual representation of the tissues within the body. However, the images taken by this exam are not very reliable.
If the child has seizures, the doctor may order an electroencephalogram to detect the problem. This test consists of monitoring the electrical activity of the brain.
Since the seizures are the result of an electrochemical imbalance in the brain, the wave pattern shown by the EEG can change, which helps in diagnosing the problem.
If the diagnosis is confirmed, the doctor may order other tests to check the child’s abilities. These can be: eye exams, speech therapists, intellectual skills, among others.
To check for the possibility of metabolic or genetic problems, blood tests may also be ordered.
Unfortunately, cerebral palsy is caused by irreversible brain damage. Therefore, it has no cure , but it also does not get worse over time. In addition, there are several treatments that can ensure quality of life for the individual and help him to develop his autonomy as far as possible.
As CP has no cure, the treatment seeks to maximize motor and cognitive abilities in order to ensure greater autonomy and quality of life for the individual.
For this, the treatment must be done with a multidisciplinary team composed of specialized doctors. The neurologist is the specialist in conditions related to the nervous system, who understands the disease and treats problems such as seizures. The physiatrist, on the other hand, is the doctor responsible for recognizing the damage and motor skills of the patient, in order to design a rehabilitation program.
Other specialties that may be present in the treatment are: orthopedist, pulmonologist, gastroenterologist, ophthalmologist, physiotherapist, psychologist, pedagogue, speech therapist, nutritionist, among others.
The treatment has the following focuses:
- Biomechanical: Focuses on principles of human movement to try to improve activities of daily living;
- Neurophysiological: This is the portion that takes care of the brain itself, especially in cases where there are seizures;
- Sensory: It is done through techniques to improve cognitive skills related to the processes of sensation and perception of the world.
Some therapies used are:
It is one of the most indispensable therapies for the treatment of cerebral palsy. Generally, treatment starts very early (as soon as the disease is discovered), and consists of performing specific exercises to improve the resistance and strength of the muscles, as well as gross motor skills and balance.
In this way, it is possible to prevent contractures and other problems related to muscle malfunction. Orthopedic devices can be used to improve mobility and stretch the muscles.
In the case of physiotherapy, it is a biomechanical approach.
With both a biomechanical and sensory approach, occupational therapy works on fine motor skills (precision of movements), sensation and perception.
When the child has sensory difficulties, an occupational therapist can use techniques to improve the cognitive abilities of sensation and perception. This is especially important for learning to take place more appropriately.
In addition, the occupational therapist helps in several other aspects: everyday tasks such as bathing, eating and dressing can be quite complicated for patients with cerebral palsy. Adaptations of spaces and routines are the responsibility of this professional who works to help the patient to develop as much autonomy as possible.
As part of a therapy to improve cognitive, physical and social skills, the child can also do recreational therapy, which consists of encouraging the child to participate in cultural and artistic events, sports, among others.
This type of therapy helps to improve self-esteem , speech and emotional well-being.
In the case of cerebral palsy, the role of the speech therapist goes beyond helping with speech and listening: it also helps with problems with swallowing.
The child can also count on assistance devices that facilitate the daily life.
In the scope of communication, some examples of such equipment are speech synthesizers, computer programs, image books, among others. The purpose of these devices is to assist communication in the case of people with speech problems.
Other types of devices that can be used are orthoses – which help with physical limitations -, glasses, magnifiers, hearing aids, among others.
When necessary, an orthopedist can perform surgery to improve the patient’s skills. Some surgeries are:
These surgeries seek to correct physical problems such as deformities and atypical gait, in order to reduce pain and preserve the function of structures, especially the joints. An example is the joint stabilization surgery, which allows more precise movements in the case of patients who are able to partially control their movements.
Selective dorsal rhizotomy
This surgery consists of small cuts in the spinal nerves to reduce spasticity. It is recommended only when conservative treatments like physical therapy and medication have not been able to help with the problem.
This treatment takes care of the brain itself, especially in cases where there are seizures. The neurologist can prescribe anticonvulsant medications to try to improve this aspect.
If the child also has behavioral and mood disorders, this can be treated with a psychiatrist and psychologist .
Alternative and complementary treatment
It is not uncommon for some children and adolescents with cerebral palsy to undergo some form of alternative therapy. However, many of these techniques have no evidence of effectiveness, that is, it cannot be said that they help in the treatment of the disease.
Some examples of alternative therapies are the use of special clothes to do resistance exercises, electrical stimulation, hyperbaric oxygen therapy, among others.
In addition, many also make use of dietary or herbal supplements that are reputed to have medicinal effects. It is worth remembering that this type of treatment can bring drug / food interactions or side effects, which can be harmful to health.
Always consult your doctor before beginning any alternative or complementary treatment.
Stem cell therapy
Stem cells are “blank” cells whose function is to form new specific cells in the body – skin, nerves, bones, among others. These cells are programmed using viral vectors that contain genetic material for the formation of specialized cells.
There are studies that evaluate the use of this technology to try to form nerve cells in order to repair the damaged brain. However, these researches are still underdeveloped and it may take time to be sure that this treatment is safe and effective.
The drugs used to treat cerebral palsy depend a lot, and there is no specific one for the problem. In general, they seek to improve spasticity and help with other symptoms of the disease, such as seizures and excessive salivation.
Which medications for spasticity will depend a lot on how it manifests itself. When it comes to localized spasticity, the most common is the use of botulinum toxin ( Botox ) in the form of injections directly into the muscle or nerve.
For generalized spasticity, that is, in the whole body, some drugs frequently indicated are:
- Diazepam (Valium);
Reduction of salivation
To control drool, some medications are:
- Scopolamine ;
In the case of seizures, the medications used are:
- Carbamazepine ;
- Topiramato ;
- Fenobarbital (Gardenal);
- Phenytoin ;
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
When the child is diagnosed with cerebral palsy, many parents soon despair that their child will have no future. This is not true. Children who suffer from motor dysfunction may well lead a dignified and meaningful life, as long as proper care is taken.
Depending on the severity of the situation, the child may need lifelong care. In order for the need for other people to be a little less, she can count on the help of an occupational therapist, a professional responsible for improving aspects of everyday life so that there is greater integration and autonomy for people with limitations.
In order for the child to develop well within its limitations, parents should not think that their child is incapable. If, from the beginning, parents believe this and take on tasks that they themselves could learn, the child will believe that he cannot do anything for himself and will be discouraged from developing his own skills, a condition called learned helplessness.
To help the child, parents can and should help them plan their future. Although the disease will not progress (worsen), the limitations can cause the prospect of a career to be discarded. However, depending on intellectual and motor skills, children with cerebral palsy can grow and become successful at work.
Even with the limitations, education cannot stop, right? Therefore, the school must also be an environment adapted for the child. If she is intellectually able to study at a school for healthy children, it would be best if she does so, even for reasons of integration with society.
However, this school must be prepared to deal with its physical limitations. Allowing wheelchair access is the first step.
In addition, teachers can adapt their desks to make better use of the child’s motor skills: an inclined desk facilitates mobility and writing, thicker pens and pencils wrapped in foam and attached to the table by an elastic band can be of great help . Papers fixed with a clipboard are also usually better than notebooks.
Classroom location is also important. Children with cerebral palsy should not sit in the back, as communication is difficult there and they may have trouble keeping up with the material.
The teacher may prefer to teach classes by writing in larger letters on the blackboard, making it easier to read if the child has sensory problems. If the child needs something or has a seizure, for example, help is much easier when he is already close to the responsible teacher.
When the child also has difficulties with language, “signs” with symbols can be used for communication. These signs may contain drawings or photos that illustrate what the child may be thinking or feeling: a glass of water for “thirst”, a plate of food for “hunger” and a toilet bowl for “wanting to go to the bathroom”. The teacher can show the signs until the child identifies and signals what he needs at the moment.
During adolescence and adulthood, it is normal for the individual with cerebral palsy to have psychological difficulties, especially when the condition is very limiting. Adolescents in particular tend to have a lot of problems in being different from other colleagues and, therefore, psychological monitoring is very important at this stage.
Participating in support groups is a good measure for the exchange of information and experiences, in addition to promoting a greater connection with other people going through the same situation. This practice can be beneficial for both the child and the parents.
The prognosis of CP depends a lot on the type and severity of the paralysis. While most children are able to survive into adulthood, those who suffer from very severe motor dysfunction may not be able to survive for long, especially children whose ability to swallow has been affected.
Progression of symptoms
Although brain damage does not worsen over time (as cerebral palsy is not a progressive disease), symptoms can end up worsening over time. This is because the malfunction and little use of the muscles leads to atrophy, which worsens its functioning, being a vicious cycle.
However, children who receive care from an early age are more likely to achieve a significant improvement in motor skills. When bones and muscles are more stabilized, there may be a need for surgery.
In general, intellectual problems are not noticed before the child starts school, and the severity of these limitations varies widely from person to person. Among people with CP, there are geniuses and there are people with a truly low IQ. For this reason, experts argue that one should not underestimate the intellectual capacities of these people and that they should have the opportunity to study and learn like everyone else.
Regarding the ability to take care of oneself alone in individuals with cerebral palsy, it can be said that it depends a lot on several factors.
In general, people with the most impaired motor skills may need caregivers in adulthood, but sometimes people with good motor skills (as far as possible) may have intellectual limitations so severe that they need help with many things as well.
In the meantime, there are also those who never need help, as they are able to take care of themselves.
Individuals with unaffected upper limbs are more likely to have good autonomy, as many of the day-to-day activities depend mainly on the arms and hands. However, only 50% of cases of cerebral palsy do not affect the upper limbs.
Puberty and sexuality
People with cerebral palsy may experience puberty sooner or later than normal. The delays, however, seem to be linked to complications such as malnutrition.
Speaking of sexuality, there is no evidence that CP affects fertility, but there are some secondary conditions that can have an effect on sexual performance and desire. Gynecological exams may be difficult due to spasticity and self-examination for breast cancer may also be prevented in women. Often, the person examining them is a close person.
Some men may, before the age of 21, experience cryptorchidism, which is the rise of one or both testicles into the abdominal cavity, where they normally stay when the baby is still in the womb.
Often, cerebral palsy can considerably reduce a person’s life expectancy, especially in the most severe cases in which there are seizures and intellectual disability. It is believed that 5 to 10% of children with CP still die during childhood.
Conditions related to a better life expectancy are the ability to walk, roll and eat alone.
The productivity of a person with CP tends to vary a lot, depending on the skills they have. Children with many physical limitations may find it difficult to play with others – a task considered productive during childhood.
At school, some children may have difficulty writing, both for motor and intellectual reasons. Many who are able to write take longer than normal and their handwriting may not be understandable to teachers.
Another difficulty that the child may encounter at school is related to communication, since several people with CP have difficulties in speech.
Leisure times are important for anyone and can help an individual with cerebral palsy to better cope with their condition. Not all activities are suitable for people with disabilities, but there are many that can be done without major difficulties.
Depending on the level of limitation, the child may participate in sports games and tournaments as a para-athlete, for example.
Participation and barriers
Unfortunately, the participation of the individual with cerebral palsy in daily activities does not depend only on him, since the world is full of barriers.
These barriers can be personal, social and even political. An example of a personal barrier is the lack of confidence in yourself to try to make new friends. Social barriers include prejudice and lack of support from family, friends and the community in general.
Regarding the policy, there is a lack of services and products that make day-to-day tasks more accessible for disabled people. An example is the lack of elevators and ramps in buildings with many floors, preventing disabled people from reaching the highest floors.
Because it is a non-progressive disease, many people with cerebral palsy are able to live for a long time. However, advancing age is more complicated than in healthy people, as they begin to have common problems of old age as early as age 30.
Those who can walk can experience difficulties to continue walking early. In addition, the risk of obesity is higher in people with CP. Some unpleasant conditions that the patient may have are:
- Increased pain, especially chronic;
- Reduced flexibility;
- More spasms and contractures;
- Increased fatigue.
The most common causes of death from cerebral palsy are respiratory problems. However, when these individuals reach older ages, the most common causes are cardiovascular problems and neoplasms.
In addition to immobility itself, cerebral palsy can cause a series of consequences. Are they:
Contractures and deformities
When there is spasticity (muscle stiffness), the muscle may shorten. This process is called contracture and can prevent the growth of bones, cause them to become bent, in addition to resulting in bone, joint deformities and dislocations.
Children with trouble swallowing can end up suffering from malnutrition, which can hinder healthy growth and result in weaker bones. In order for nutrition to be adequate, some children may need tube feeding.
Muscle problems can affect breathing, so there is a greater chance of developing lung problems.
Due to pressure on bones and joints, these structures can wear out over time, resulting in a degenerative bone disease called osteoarthritis.
Lack of mobility, malnutrition and use of antiepileptics are factors that can contribute to low bone density (osteopenia), which makes bones more fragile and prone to fractures.
Due to the lack of movement, obesity can develop more easily in people with cerebral palsy.
Eye muscle problems
The eyes move because of a set of muscles. Changes in the tone of these muscles can cause problems with fixing or moving your eyes.
Patients with problems with swallowing may suck up food, leading to a choking, which can be fatal.
Due to problems in brain structures, patients may suffer from violent seizures that can lead to death by drowning in their own saliva, blood or vomiting.
It is not always possible to prevent cerebral palsy, since it happens due to several factors and not all of them are within our control. However, some tips to prevent your child from suffering from the problem are:
- Avoid consumption of alcohol, tobacco and other drugs during pregnancy. If you need to take any medication, contact your obstetrician to find out about the risks;
- Keep conditions like diabetes and high blood pressure under control, as both can bring many risks to the baby in addition to cerebral palsy;
- Always wash your hands with soap and water both during pregnancy and after birth when taking the baby, in order to avoid contracting infectious diseases that can lead to brain damage;
- Watch out for the baby’s soft spot! At birth, babies do not have their skull fully formed and closed, so there are some “soft” pieces on the baby’s head: they are the fontanelles. Avoid touching or hitting them somewhere, as this could directly affect the brain;
- Always be aware of the baby’s health and take him to the doctor whenever you suspect that he may be sick;
- Take care of impacts on the baby’s head, as they can cause head trauma.
Despite having a well-known name, few people know what cerebral palsy really is. Share this text so that more people can understand this condition!
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