Cerebral Palsy

CP – Cerebral Palsy = Encephalopathy = Spastic

Cerebral palsy is a term used to describe a group of chronic conditions affecting body movement and muscle coordination. It is caused by damage to one or more specific areas of the brain, usually occurring during foetal development; before, during, or shortly after birth; or during infancy. This means that these problems are not related to nerves or the muscles. Instead, control over posture and movement problems in the muscles or nerves. Instead, faulty development or damage to motor areas in the brain disrupt the brain’s ability to adequately control movement and posture.

“Cerebral” refers to the brain and “palsy” to muscle weakness/poor control. Cerebral palsy itself is not progressive (i.e. brain damage does not get worse); however, secondary conditions, such as muscle spasticity, can develop which may get better over time, get worse, or remain the same. Cerebral palsy is not communicable. Although cerebral palsy is not a disease and should not be referred as such, it is also “curable” in the accepted sense, training and therapy can help improve function.

Cerebral Palsy can be caused by injury during birth, although sometimes it is the result of damage done while the baby is still in the womb or later damage shortly after birth. Symptoms usually appear in the first few years of life and once they appear, they generally do not worsen over time.

Spastic Diplegia

Spastic diplegia is a form of cerebral palsy where both the arms and legs have abnormal stiffness. The legs are often more affected than the upper extremities. Spastic means stiff or contracted. The word Diplegia breaks down into “di,” meaning two, and “plegia,” the Latin word for weakness. Therefore, the two combine to make spastic diplegia which in turn means stiff or contracted muscles affecting two extremities causing weakness. Spastic Diplegia is sometimes also called paraplegia.

There are other forms of spastic diplegia other than cerebral palsy. Some forms of spastic diplegia are hereditary. You can differentiate the two by several factors:

* The age the patient begins to show symptoms of spastic diplegia
* A victim’s past clinical history
* Recorded problems at the time of birth or during pregnancy
* The presence of genetic factors

Individuals suffering from hereditary spastic diplegia typically have a family history of the disease and don’t show symptoms until late childhood or middle age. On the other hand, individuals suffering from the cerebral palsy form of spastic diplegia are usually diagnosed with the condition when they are young. Cerebral palsy spastic diplegia is the result of brain damage and mainly affects the legs. The damage involves brain malformations around the ventricles, which are the fluid filled spaces. Typically, the lack of oxygen during brain formation causes a development failure in the pyramidal tracts. MRI’s easily detect these malformed areas which are called periventricular leukomalacias.

Little’s Disease and Spastic Diplegia

Spastic diplegia was originally called “Little’s Disease.” It was named after William Little, a British surgeon who first described the disorder during the 19th century. The children he observed with the disease had stiffness in the legs and arms which did not progress in severity as they aged. Little’s disease was soon recognized to be a disorder, or group of disorders, rather than a disease, and the name changed to spastic diplegia or static encephalopathy.

Symptoms of Spastic Diplegia

Regardless of what you call the disorder, spastic diplegia, paraplegia, Little’s disease or static encephalopathy; the symptoms are the same. Both legs of spastic diplegia victims are spastic, meaning stiff or contracted. The legs are weak and walking is difficult. People with spastic diplegia often walk with a “scissor gait” caused by tight muscles in the hips and legs. The muscles become so tight the legs want to turn inward and sometimes cross over each other at the knees. A spastic diplegia victim’s arm, face and neck muscles are usually affected to a lesser degree compared to the legs. Other than physical characteristics associated with spastic diplegia, the disorder can also bring about mental retardation. .

Treatments for Spastic Diplegia Cerebral Palsy

Statistics show spasticity affects 80 % of individuals with cerebral palsy and cause many problems for sufferers of the disorder. In growing children, muscle stiffness inhibits the longitudinal growth of the muscle. This is especially bad because it causes orthopaedic deformities and muscle contractions, where the muscle locks into place permanently.

Spastic symptoms of cerebral palsy are usually treated with by using a combination of braces, physical therapy and even orthopaedic surgery where and when needed. However, there are new developments in the form of a new surgery named selected dorsal rhizotomy (SDR.) The surgery works best on young children, from the ages of 2 to 4 but can also benefit older children and some adults. SDR typically brings better results for individuals suffering only from spastic diplegia and not spastic quadriplegia, where there is significant spasticity in both the arms and legs.

SDR works to prevent the development of deformities by cutting nerve fibres in the spinal cord. Removing vertebrae to reach the spinal cord can cause spinal problems. Experts however agree that a successful SDR surgery can improve vision, speech and movement and thus can be worth taking the risk.. The surgery also helps reduce the number of orthopaedic surgeries a spastic diplegia victim will be needing in the future.

One major problem affecting the function and health of children with Cerebral Palsy (CP) is weakness and resultant lack of physical activity. Historically, exercise to promote physical fitness and strengthening were discouraged for children with spasticity, due to the concern that the spasticity and abnormal movement patterns would be enhanced. However, recent research has proved otherwise where exercise has proved to be able to improve the strength and function for children with CP.

Inactivity for children with CP may contribute to the development of secondary conditions associated with CP such as joint contractions, osteoporosis, and decreased respiratory and circulatory function. By regular exercise, physical fitness can be improved which in turn will help to prevent these secondary conditions. Active exercise and physical fitness can help prevent these secondary conditions. There is increasing recognition of the medical necessity in providing these children with a means of active exercise at school and at home.

Adaptive cycling is an ideal exercise for children with CP. Hand cycling has the potential to improve strength and cardio-respiratory fitness for walking endurance, gross motor function, and health related quality of life. Research studies focusing on the use of tricycles as an exercise activity for children with CP have resulted in supportive evidence for this intervention, for both muscle activation and function.