Cerebral Palsy – Definition, Assessment and Interventions

Definition

Cerebral palsy (CP) is characterized by aberrant control of movement or posture and appears early in life secondary to central nervous system damage. ‘Cerebral’ refers to the brain and ‘palsy’ means weakness or lack of muscle control. CP distorts messages from the brain to cause increased muscle tension (hyper tonus) or reduced muscle tension (called hypo tonus), which can fluctuate depending, or messages may be mistimed, inaccurate, or not sent at all. This affects the timing, quality and synchronisation of messages; generally resulting in erratic movement of the muscles however, it is important to note that it is the message pathway that is affected rather than the muscles themselves. Characteristically, loss of selective motor control, abnormal muscle tone, imbalance between muscle agonists and antagonists and impaired balance are symptoms.

CP is not a contagious or hereditary disease; it is a condition usually the result of changes in, or injury to, the developing brain before or during birth, or sometimes in early childhood; usually as a result of a diminished blood supply and lack of oxygen to areas of the brain, causing damage to brain cells.

CP can be categorised into four main areas, according to the parts of the body it affects:

  • Quadriplegia – all four limbs are affected, can also include the muscles of the face and mouth.
  • Diplegia – all four limbs are affected, but legs more so than arms.
  • Hemiplegia – one side of the body is affected.
  • Paraplegia – both legs, but neither of the arms, are affected.

Common symptoms and affected areas:

There are four main types of CP:

  • Spastic – this is the most common type of cerebral palsy. Spasticity means stiffness or tightness of muscles, which is most obvious when the person tries to move.
  • Athetoid – athetosis means uncontrolled movements, which often lead to erratic movements.
  • Ataxic – this is the least common type of cerebral palsy. Ataxia means a lack of balance and coordination. It often presents as unsteady, shaky movements called tremors.
  • Mixed type – a combination of types of cerebral palsy.

Assessment: Signs in early childhood

Indicators of Cerebral palsy:

  • Early feeding difficulties
  • Delayed development
  • Poor muscle control
  • Muscle spasms
  • Lack of coordination

Standardised Assessments:

Pediatric Evaluation of Disability Inventory (PEDI)

This is an instrument for evaluating function in children with disabilities aged 6 months to 7.5 years. The PEDI is a questionnaire is used by someone familiar with the child and focuses on self care and mobility in everyday life. The PEDI measures both functional performance and capability in three domains: (1) self-care, (2) mobility, and (3) social function (Berg, Jahnsen, Froslie, & Hussain, 2004).

The Gross Motor Function Measure (GMFM)

This was developed to measure the gross motor function of children with cerebral palsy. Administering the GMFM-88 may take approximately 45 to 60 minutes for someone familiar with the measure The GMFM-66 should take less time to administer as there are fewer items. The GMFM and PEDI are two assessments that compliment each other when trying to get a complete picture in evaluating changes in the child. The GMFM as well as the PEDI are very useful and valuable in assessing functional motor abilities of children with cerebral palsy. Both measures focus on different aspects of functioning and build on different sources of information.

Selective control assessment in cerebral palsy:

This recently revised test assesses selective joint control of individual joints, based on the reasoning that control of joints is the basis of movement, and purposeful movement is the basis of different functions and therefore does not instill testing a patient’s quality and level of functional skills, as this does not hold true in clinical or life situations. This assesses the degree of voluntary moor control in palsy patients, especially when he treatment aim is functional and improved gait. A grading system has been developed accordingly in order to get a realistic level of functional abilities as well as baseline for comparison with those of normal development

Critique: Assessment and grading system used in clinical situations proves clinically sound and easy to apply.

Implications and interventions

Cerebral palsy may affect a person’s mobility, their ability to talk, or their outward appearance. Where speech is affected, the person with a disability will understand what is said to them, but may find it difficult to respond. There are many health professionals that can assist a person with cerebral palsy to engage in daily activities. Occupational therapists establish goals with the individual, and works together to achieve these goals. For example, if a client has the goal of mobilising independently, an occupational therapist would prescribe a wheelchair specifically to his/her needs, and train the person on how to use it.

Speech therapists work with the person to improve communication and swallowing. For example, a speech therapist may design a communication board specific to what the person wants to express.

Physiotherapists work with the person to improve movement of the limbs. For example, the physiotherapist may prescribe specific stretches to increase the persons range of motion.