Cerebral Palsy

Byfikirperestajans@gmail.com

Cerebral palsy (CP) is a neurological condition affecting movement and posture, resulting from brain damage occurring during pregnancy, birth, or postnatal periods. Once brain damage occurs in cerebral palsy, it remains stable and does not progress. In other words, the disease itself is not progressive. However, if appropriate treatments are not applied, the symptoms may worsen as the child grows. This is not due to disease progression but rather the natural growth of the child. While the skeletal system lengthens, the muscles may not grow at the same rate. If treatments that help maintain appropriate muscle length are not provided, deformities in the bones (such as hip dislocation, misalignment in the legs, and scissoring gait) may develop.

Causes and Risk Factors of Cerebral Palsy

  • Premature birth and low birth weight
  • Conditions causing oxygen deprivation during birth
  • Difficult labor
  • Maternal health problems such as infections and high blood pressure during pregnancy
  • Genetic or metabolic disorders
  • Accidents and trauma leading to brain hemorrhage or damage

Symptoms

  • Muscle stiffness (spasticity) (rarely, hypotonic cerebral palsy characterized by muscle weakness)
  • Difficulty in movement coordination
  • Delays in motor skills such as sitting, crawling, and walking
  • Weakness in core muscles
  • Involuntary movements
  • Rarely, speech, vision, hearing, and learning difficulties

When Should Parents Seek Medical Attention?

Developmental milestones are crucial in child growth. Parents should consult a pediatric neurologist or pediatric orthopedic specialist if:

  • The baby cannot hold their head up by 6 months,
  • Cannot sit without support by 9 months,
  • Cannot pull themselves up to stand using furniture by 12 months,
  • Cannot walk without support by 18 months.

Diagnosis

Cerebral palsy is typically identified during a child’s movement and developmental evaluation.

  • A detailed neurological examination is conducted by a doctor.
  • Brain imaging tests (MRI, CT scan) and other medical evaluations may be requested if necessary.
  • Early diagnosis is critical for effective treatment and supportive interventions.

Treatment and Support Methods

Cerebral palsy treatment is based on a three-pillar approach, and the effectiveness of treatment is maximized when these three aspects work together:

  1. Physical Therapy: Strengthens muscles, improves joint mobility, and enhances posture and gait.
  2. Orthotic Support: Devices such as AFOs help maintain proper posture, alignment, and mobility.
  3. Medical Management: A multidisciplinary approach involving pediatric orthopedics, pediatric neurology, pediatric neurosurgery, and child psychiatry.

Physical Therapy and Rehabilitation

  • Physical Therapy: Strengthens muscles, increases joint flexibility, and improves posture and walking.
  • Occupational Therapy: Enhances daily living activities and fine motor skills to increase independence.
  • Speech and Language Therapy: Supports speech, language, and swallowing difficulties.
  • Hand Therapy: Improves functionality in the less-used hand.

Orthotic Management

Orthotic devices help:

  • Reduce movement and posture issues.
  • Align joints properly.
  • Enhance walking and standing abilities.
  • Prevent or correct deformities.

Pediatric Orthopedics and Surgical Interventions

  • Spasticity can lead to joint and bone deformities during growth.
  • Botox therapy is commonly used in early childhood to manage muscle spasticity.
  • Hip dislocation or subluxation is a common issue in CP patients and requires close monitoring. In severe cases, hip surgery is necessary.
  • Crouch gait correction surgery may be needed in adolescence.
  • Foot deformities like flatfoot or hallux valgus may require surgical correction.
  • Hand and arm deformities can be treated with Botox, tendon transfers, or lengthening procedures.

Follow-up Care

Regular follow-up examinations are crucial for updating treatment plans and monitoring developmental progress. This requires team collaboration, and all specialists involved should contribute to follow-up care.

Each child with cerebral palsy has a unique condition. Early diagnosis, proper rehabilitation, and family support can significantly improve quality of life. With dedication and appropriate guidance, families can help their children achieve greater independence and happiness.