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What is CEREBRAL PALSY

Cerebral palsy is a term used for motor dysfunction, the insult which has occurred to the developing fetal or infant brain. The damage is caused to the motor control of the brain during pregnancy, childbirth or upto 3 years of age. The child may present with spasticity, involuntary movements, unsteadiness in walking, convulsions, visual and auditory problems, speech, psychological problems, learning disabilities and orthopaedic problems. Cerebral palsy is a permanent disorder of the central nervous system. There is no known cure. Usually, medical intervention is limited to the treatment and prevention of complications arising from the disorder. A multi disciplinary approach is hence required for the management of these children.

Common symptoms of CEREBRAL PALSY

  • Drooling of salivaDrooling is unintentional loss of saliva from the mouth. Drooling in patients with CEREBRAL PALSY is related to swallowing difficulties rather than hypersalivation. Treatments may include: reward or prompting to encourage swallowing,surgery, where salivary glands are usually turned towards the back of the mouth so that saliva runs towards the back rather than the front of the mouth, exercises to increase muscle tone, improve oral-motor (swallowing and chewing) function and improve sensory awareness, medication, where drugs might be used to dry up salivary secretions.
  • Child is 8 month old but does not sitThe child may have a neurological damage resulting in inability to sit. If there has been a history of pre term delivery, jaundice or maternal infections please consult your paediatrician. Early intervention and physiotherapy will give the best results. So it should be started soon.
  • Child is 1.5 years old but does not walkThe child may have a neurological damage resulting in inability to use his body parts effectively or may be the child is under stimulated and subsequently was never encouraged to walk. Inadequate vision may also be the causative factor.
  • Walking on toesThis is because of spasticity in tendoachillis muscle. Regular stretching exercises with use of Ankle foot orthosis will improve this condition. If spasticity is severe then injection Botulinum toxin type A may be beneficial. If contracture is present then surgical release is required.
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  • Crossing of LegsThis is because of contracture of adductors and medial hamstrings. Scissoring impairs sitting cross legged and walking. It can also lead to dislocation of hip joints. Regular stretching exercises, use of abduction braces, Botulinum toxin type A or surgery may be required.
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  • W sittingIn this position the child sits with his legs turned inwards. It is normal till around 1 year for a child to sit like that. Afterwards this habit should be broken. The child may have tight hip adductor muscles which prevent him from sitting cross legged. Also the femur may be turned inwards ( excessive femoral anteversion) which permits the child to 'w' sit. Hip abduction exercise need to be done. Sometimes a brace has to be used that prevents 'w' sitting. Older children may have dislocation of hips and hence hip radiographs need to be done.
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  • Sitting with a bent backExcessive dorsal kyphosis (bent back) is a common feature in cerebral palsy. These children have weak trunk and abdominal muscles. The condition will improve with time. It is best to consult your physiotherapist and orthopaedic surgeon to rule out other problems.
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  • Fisting of handFisting may be normal till 2-3 months of age. After this age the child should release objects and also open their fingers. This abnormal pattern tends to improve with age and physiotherapy. The reason for abnormally prolonged fisting may be some identified or unidentified cortical damage to the brain which doesn't allow the child to take the thumb out of the palm and restrict his early grasping skills. It may also be due to some shoulder related injuries during the delivery process leading to tight thumb adductors.
  • ConvulsionsApproximately 20-30% children of cerebral palsy have convulsions. Common causes include birth asphyxia, infections and trauma. Sometimes they may be non responsive to medications. An epileptologist must be consulted frequently. It is necessary to increase the dose of medications as age increases. It is essential that convulsions must be stopped as they continue to damage the immature brain.
  • SquintInjury to brain leads to imbalance in the muscles of the eye which leads to squint. Some children may have defective vision in one eye leading to squint. An ophthalmologist must be consulted so that exact diagnosis can be done. Simple methods like spectacle correction, patching of eye can be used to improve the symptoms. Surgery may be required at a later stage.
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