Cerebral palsy, chronic disorder of posture and movement

Cerebral palsy is a chronic disorder of posture and movement caused by central nervous system damage.
Cerebral palsy consists of involuntary reflex movements and contractions (spasms) muscle that can affect a region, half of the body or body completely.
A number of conditions such as mental retardation, seizures or visual and auditory disorders are frequently associated with cerebral palsy.

Cerebral palsy is a result of infringement of or abnormal development of the nervous system (brain). In most cases the cause is unknown. Lesion or dysfunction can occur during pregnancy, during birth or in the first 2-3 years of life.
The causes of cerebral palsy occur during pregnancy or birth may be genetic or chromosomal abnormalities, infection or other diseases of the mother or fetus occurred during pregnancy or peripartum complications (during labor). Any of these can affect the normal growth and development of the fetus or missing fetus or newborn needs blood, oxygen and nutrients. Diseases of the newborn as untreated hypoglycemia can also cause brain damage that cause cerebral palsy.
Cerebral palsy due to premature birth is linked to impaired brain development. Children born prematurely have an increased risk of brain hemorrhage (intraventricular hemorrhage or IVH). Periventricular leukomalacia, a disorder of the white matter of the brain, is more common in babies born prematurely than those born at term. Both increase the risk of cerebral palsy.
Causes that can cause cerebral palsy during the first two or three years of life linked to brain damage from a serious illness such as meningitis, following a brain injury or head injury arising from an accident or from a temporary lack of oxygen to the tissues that if an event of drowning.

Signs of severe cerebral palsy can be observed immediately after birth include:

• Difficulty in sucking and swallowing;
• Weak or sharp cry;
• Abnormal position, or the body is very relaxed and soft or too stiff, when taken in arms, extend their babies back, arms and legs, these abnormal positions are different and more severe than those that occur in children with colic .

Some problems related to cerebral palsy may occur or become apparent once the child grows.
These include:

• Affected limb muscle atrophy. Nervous system cause limitation of movement in the affected limb. Limitation of movement affects the normal development of muscles;
• Perceptions and abnormal sensations like pain to light touch. Even daily activities like brushing teeth can cause pain. Abnormal sensations may aggravate identify common objects by touch, such notification bubble difference between a soft and a hard baseball;
• Skin irritation. Abundant salivation is common when the affected facial muscles and neck. Abundant salivation irritate the skin, especially around the mouth, chin and anterior chest;
• Dental disease. Pain that may occur due to washing increases the risk of tooth decay and gingivitis (gum inflammation). Can contribute to the development of gingivitis and adverse effects of drugs used to treat seizures;
• Trauma. Risk of falls and other accidents, according to control muscle rigidity (hampered mobility) joints and overall muscle tone. Seizures associated with cerebral palsy can also cause accidental bruises;
• Infections and chronic diseases. cause severe cerebral palsy supply difficulties. Bowel inhalation into the lungs increases the risk of developing pneumonia. Adults have increased risk of heart and lung damage.
• Some children with cerebral palsy shows a series of behavioral disorders such as excessive sleepiness, irritability and loss of interest in the world around them.

All patients with cerebral palsy have impaired movement and posture. However, most children do not show signs of cerebral palsy at birth. Parents and guardians can see the first signs of cerebral palsy, the child’s inability to turn from side to side, to sit, to country (to go crawl) or go to usual age .
Signs of cerebral palsy may become increasingly evident with age. Some developmental problems may occur only after the first year of life. Brain damage that causes cerebral palsy does not worsen with age, although they may appear, are subject to change or become more severe as the child grows.
Specific symptoms depend on the type of cerebral palsy and the severity of mental debility and degree of development of other complications or other disease association.
Type of cerebral palsy present and what part of the body is affected will determine the child’s mobility.
Most patients with spastic cerebral palsy shows the form of cerebral palsy that affects only one part of the body. For example, there may be symptoms only at a member or only half a body. Most children find ways to accommodate their disability. Some people can do themselves, others take their living and working situations that provide some degree of assistance (aid). If damage both States are recommended to use a wooden scooter (a device used for support while sleeping), a modified wheelchair, a wheelchair or other equipment.
Cerebral palsy that affects the entire body causing the biggest problems. Severe spastic cerebral palsy and athetosis (dyskinetic, involuntary jerky movements) are forms of cerebral palsy total. Many of those affected can not care for themselves or because of severe functional impotence or because of mental retardarii. However, some patients may survive with the help of family members or persons qualified to do so.
Complications like epilepsy or other chronic physical impairment of cerebral palsy can be difficult to diagnose before one to three years. Sometimes such predictions are possible only at school age when learning skills, communication and other skills can be quantified. Level of support and supervision depends on the number and severity of problems.
Mental debility degree is an important predictor of daily functionality. Approximately 75% of patients with cerebral palsy have some degree of cognitive impairment. About 60% of them are mentally retarded (from moderate to severe form) and the rest are normally developed but have a learning difficulty.
Other diseases, such as visual or hearing disorders are frequently associated with cerebral palsy. Some of these are diagnosed early, others as the child grows. Also, like people with normal physical development, cerebral palsy patients shows a series of social and emotional concerns throughout life. Due to physical limitations can occur besides other concerns above, and therefore patients with cerebral palsy require understanding and encouragement from others.
Of all children diagnosed with cerebral palsy, 90% reach adulthood.
A more accurate assessment of quality of life depends on the type of cerebral palsy present, the severity and impact of other diseases that are associated with cerebral palsy. Most adults with mild or moderate and severe form each are independent (by themselves) and works. Ability to live independently and engage improved for patients with cerebral palsy. They are the result of better support from family members and more advanced technologies like computers equipped with microphone, electric wheelchair and other devices.

Premature birth and low birth weight
40-50% of children who develop cerebral palsy are born prematurely. The risk of developing cerebral palsy increases as birth weight is lower. Usually premature babies have lower than normal weight, lower by about 2.5 kg, and term infants may have low birth weight. There is a higher risk of premature birth and low birth weight in twin pregnancies compared with single fetus. There is also more likely in children born prematurely or with low birth weight to present difficulties during the growing period which may affect brain development. For example, a condition called periventricular leukomalacia, which would affect the white matter of the brain, is more common in babies born prematurely than those born at term.

Risk factors before birth
The risk to a fetus brain abnormalities and consequently develop cerebral palsy is higher when the mother contacted some diseases throughout pregnancy as:

• Infections such as rubella, cytomegalovirus and toxoplasmosis infection. The risk is higher if infections occur in early pregnancy, uterine or vaginal infection in the mother. These infections can cause inflammation of the placenta (corioamniotita), which can disrupt normal brain development;
• Exposure to certain chemicals as thyroid hormone or estrogen;
• Alcohol and illegal drugs
• Other conditions such as bleeding from the uterus between six and nine months of pregnancy, large amounts of protein in the urine (proteinuria) or elevated blood sugar (hyperglycemia).

Risk factors for cerebral palsy at birth

Although rare, some children develop cerebral palsy as a result of complications during pregnancy. Risk factors include:

• Premature birth. Babies born prematurely are at increased risk of developing brain hemorrhage (intraventricular hemorrhage) that are deparalizie causes brain;
• Prolonged or difficult labor. Lack of oxygen, brain infections or physical trauma (secondary use of forceps or other instruments) are all factors that may increase the risk of developing cerebral palsy. In turn, cerebral palsy can cause birth difficult due to movement and posture disorders associated with the disease;
• Early separation of a normally inserted placenta. Usually the placenta separates from the uterus after a few minutes after the baby is born. Where is separated before birth, decreases blood supply and oxygen from the mother, which increase the risk of developing cerebral palsy
• Uterine or vaginal infections mother as strep infection that can be transmitted fetus during birth. cerebral palsy can occur if the infection affects the brain child.

Risk factors for cerebral palsy occurs after birth

Risk factors for developing cerebral palsy soon after birth or during the first two or three years are linked to brain damage and include:

• A serious disease as severe jaundice, meningitis, or lead poisoning (very rare). Early signs include difficulty breathing related, low levels of thyroid hormone (thyroxine) and low blood sugar (hypoglycemia). Babies born prematurely or with low birth weight are susceptible of developing these diseases;
• Severe head injury after an accident or breakdown. These include the child’s injuries as shaking, pushing or other forces (abused child syndrome, which is also called intentional brain injury);
• Decreasing the amount of oxygen supplied to the brain may be the result of a brain tumor or an event innecare;

Other risk factors
Children born to very young mothers and over 35 years have an increased risk of developing cerebral palsy.
Genetic or chromosomal defect that thrombophilia, a blood disorder increases the risk of cerebral palsy.

Consult a specialist:
See your specialist if the child with cerebral palsy shows:

• Respiratory problems
• Choking during breastfeeding (feeding) and it fails to remove food

Consult a specialist:

• Pregnant women with suspected rubella or another infection that was exposed to toxic substances like strong chemicals or radiation, using alcohol or drugs prohibited;
•  The child shows a seizure for the first time.
• If a child is diagnosed with cerebral palsy Consult a specialist if it:
• A seizure (the first crisis of his life);
• Constipation that is not controlled with outpatient treatment;
• Skin irritation worsens, exudative, bleeding or painful;
• Difficulties which are not controlled outpatient nutrition such as:
• Bouts of coughing and choking during suckling, if food is aspirated into the lungs increases the risk of developing pneumonia
• Chewing difficult accompanied by weight loss and hunger
• Frequent accidents that threaten the safety of the child
• Other complications in micturition disorders (urine), bleeding gums, increased joint stiffness.

Diagnosis of cerebral palsy:
Signs of cerebral palsy may not be present at birth. We recommend the doctor to closely monitor signs of cerebral palsy in the newborn or child if it shows risk factors. These factors may be problems that occur during pregnancy or childbirth, premature births or illnesses can occur during the first two or three years of life.

Doctors are cautious in making a diagnosis of cerebral palsy too early because some children with motor dysfunction early after birth may not develop later cerebral palsy. Sometimes symptoms can occur with maturation of the nervous system will develop brain, nerves and muscles. May take several years before a child with the disorder of movement and posture is diagnosed with cerebral palsy.

Cerebral palsy diagnosis is made based on the observation delay in physical development of the young child, based on disease history (history), physical examination, screening tests and other tests like MRI (which is done to rule out other organic causes).
These steps include:
Find information about the medical history of the child and about the evolution of the mother. Delays in development are usually seen by parents or doctor during routine checks. These controls are a good opportunity for the doctor to find details of motor or sensory abilities, especially on those which should appear in the first or second year of life;
A physical examination for signs of cerebral palsy. During the physical exam your doctor can determine if your child keeps newborn reflexes more than normal, which is a sign of cerebral palsy. The basic muscle function and posture, visual and auditory disturbances will also be evaluated;
Screening tests. Your doctor will run a series of questionnaires related to development and other tests to determine the extension of developmental delays and determine whether more extensive evaluation is required;
The brain MRI to identify brain abnormalities and other associated diseases. Taken together, the results of these investigations can guide the diagnosis of cerebral palsy. If the diagnosis is uncertain, additional tests may be performed to assess brain tissue or to exclude other diseases. Sometimes these tests can be useful in assessing severity cerebral palsy.
Tests may include:
Additional questionnaires to assess developmental disorders
CT brain
Cerebral ultrasound.

Evaluation and monitoring of cerebral palsy

Once diagnosed cerebral palsy, a child will be assessed for the presence of other underlying conditions which may occur in cerebral palsy as:

• Other developmental disorders beyond those already identified skills development will be evaluated periodically to determine if other symptoms such as speech and language delays appear as nervous system development;
• Intelligence tests to identify submedii intelligence (mental retardarii);
• Seizures – EEG is useful for detecting abnormal activity in the brain when the child has a history of seizures;
• Difficulty eating and sucking;
• Auditory and visual dysfunction;
• Psychological evaluation for behavioral disorders.

In most cases, your doctor can identify long-term effects of physical damage from the age of one to three years. In some cases these predictions are not possible until school age, during which the ability to learn, communication skills and other skills can be quantified. Level of support and supervision necessary for a child depends on the number and severity of the disorder.

Some children require regular performing the following tests:

• Radiography to detect dislocation or displacement of coxofemoral joint (hip), children with cerebral palsy are irradiated several times between 2 and 5 years. It is recommended that an X-ray in case of hip pain or if there are other signs of hip dislocation as abnormal movements of the hip or knee. Spine radiography is recommended in order to identify deformities of the spine (scoliosis)
• Targeted analysis needed to identify disturbing and therapeutic decisions.

Additional tests may be required depending on the child’s symptoms and other associated diseases.

Cerebral palsy can not be cured, however many treatments can help patients maximize their skills and muscle tone, prevent complications and to improve quality of life. Brain damage that causes cerebral palsy does not progress over time. However, new symptoms can occur or get worse over time due to child growth and development.
Specific treatment varies from one patient to another and may change the same patient if there are other disorders us. In general, treatment focuses on measures that improve quality of life and overall health.

General treatment

• Physical therapy is an important part of treatment that begins immediately after the diagnosis and may continue throughout the patient’s life. This treatment can begin before a diagnosis of certainty to be made​​, depending on the patient’s symptoms;
• Medicines can control some of the symptoms of cerebral palsy and can prevent complications. These may include antispasmodic and muscle relaxing injections for improvement can improve movement rate. Other drugs may be used for common disorders associated with cerebral palsy as anticonvulsants to prevent seizures;
• In rare cases, orthopedic surgery (for muscles, tendons and joints) or selective posterior rhizotomy (splitting the roots of the spinal nerves or brain) for contracture or other mobility is impaired immediately after diagnosis of a newborn or young child who severe bleeding disorders.

Usually the biggest problem is fear of how parents could develop severe disease. It is good to learn about cerebral palsy to better understand the disease and meet some of the obstacles and their overcoming joy to patients with this disease. Determine the safety information on how to help their child.