Cerebral Palsy (CP, Big Brain Paralysis) is a condition characterized by poor muscle control, stiffness, disability and other neurological dysfunction.
CP is not a disease and not progressive (getting worse).
In infants and premature babies, part of the brain that controls muscle movement are particularly vulnerable to CP injury occurs in 1-2 from 1000 infants, but 10 times more often found in premature infants and more frequently found in very small infants.
Cerebral Palsy can be caused by a brain injury occurs when the baby is still in the womb, the birth place, newborn and children younger than 5 years. But not most the cause is unknown.
10-15% of cases occur due to birth injury and reduced blood flow to the brain before, during and immediately after birth. Premature infants are particularly vulnerable to CP, probably because the blood vessels to the brain has not developed comprehensively, and easy bleeding or because the oxygen can not flow in sufficient quantities to the brain.
- Brain injury may be caused by high levels of bilirubin in the blood (often found in newborns), can cause kernikterus and brain damage.
- Severe disease in the first year of baby’s life (eg encephalitis, meningitis, sepsis, trauma and severe dehydration)
- Head injury due to subdural hematoma
- Injury of blood vessels.
Symptoms usually appear before the 2-year-old child and in severe cases, can appear at 3-month-old child.
Symptoms vary, ranging from the irregularities that are not apparent until severe stiffness, which causes changes in the form of arms and legs so the child must use a wheelchair.
CP is divided into 4 groups:
1. Spastic type (50% of all cases of CP), the muscles become stiff and weak.
Rigidity is happening can be:
- Kuadriplegia (both arms and both legs)
- Diplegia (both legs)
- Hemiplegia (arm and leg on one side of the body)
2. Type Deskinetik (Koreoatetoid, 20% of all cases of CP), muscular arms, legs and body spontaneously moves slowly, writhing and uncontrollable, but can also arise rough movements and twitching. Outburst causes worsening situation, the movement would disappear if the child slept
3. Type Ataxic, (10% of all cases of CP), consisting of tremors, unsteady steps with both legs far apart, interference coordination, and abnormal movements.
4. Mixed type (20% of all cases of CP), is a combination of 2 types above, which is often found is a combination of spastic and koreoatetoid type.
Other symptoms can also be found in the CP:
- Below normal intelligence
- Mental retardation
- Seizures / epilepsy (especially in spastic type)
- Sucking or eating disorders
- Breathing irregular
- The development of motor skills disorders (such as reaching for something, sit, roll over, crawl, walk)
- Disturbance speaking (disartria)
- Disturbance of vision
- Hearing loss
- Joint contractures
- Movement is limited.
In the examination will be found in delayed development of motor skills.
Infantile reflexes (eg sucking, and surprise) still exists even supposed to have disappeared.
Muscle tremors or stiffness was clearly visible, and children tend to fold his arms to the side, his legs moving like scissors or other abnormal movements.
- Various laboratory tests can be done to rule out other causes: MRI of head showed structural abnormalities or congenital abnormalities
- CT scan showed the head of structural abnormalities and congenital abnormalities
- Check hearing (to determine the status of auditory function)
- Check vision (to determine the status of visual function)
- Muscle biopsy.
CP is incurable and is a disorder that lasts a lifetime. But many things can be done to enable the child to live independently as possible.
Treatment usually depends on the symptoms and can include:
- Physical therapy
- Braces (buffer)
- Glass eye
- Hearing aids
- Education and special schools
- Anti-seizure drugs
- Drugs to relax the muscles (to reduce tremors and rigidity)
- Occupational therapy
- Orthopedic surgery
- Speech therapy to clarify speech and to help children overcome eating problems
- Treatment (for severe cases).
If there is no physical disturbance and severe intelligence, many children with CP will grow normally and go to regular school. Another child requires extensive physical therapy, special education and always need help in living their daily activities.
In some cases, to free the joint contractures due to deteriorating muscle rigidity, may need surgery. Surgery is also necessary to install the feeding tubes and to control reflux gastroesofageal.
The prognosis usually depends on the type and severity of CP. More than 90% of children with CP survived to adulthood.