Cerebral palsy – causes, division, health problems

Proven content

Cerebral Palsy (MPD) is a set of symptoms resulting from damage to the central nervous system at an early stage of development. The disorders are non-progressive and include mainly movement and posture impairment which may be accompanied by impairment of sensation, perception, communication, behavior, and cognition, as well as epilepsy. The clinical picture of the disease changes as the brain grows, although no new damage occurs within it.

The disease affects 2/1000 children, and more often it affects premature children.

The most common triggers of MPD include:

1. prematurity and intrauterine growth impairment – 40-50%
2. asphyxia – about 10%
3. perinatal injury – 5-10%
4. infections: cytomegaly, toxoplasmosis, rubella, herpes and others – 5-10%
5. chromosomal abnormalities – 5-10%
6. sepsis, meningitis, jaundice of the basal testicles, hypoglycemia, medications, alcohol, maternal thyroid disease, postnatal infections, injuries and others – 5-10%
7. idiopathic factors – 5-10%

The definition of cerebral palsy is a clinical diagnosis. There are no specific laboratory tests that confirm or exclude the disease. Imaging studies also do not show changes typical of MPD. The image of the brain of sick children in computed tomography and magnetic resonance imaging is often normal. Suspicion of MPD in an infant should be evoked by delayed psychomotor development accompanied by additional motor abnormalities. Another disturbing symptom is the reduction in the tension of the neck and torso muscles, which is the cause of the head positioning. In addition, the child does not develop the ability to perform further anti-gravity movements and movements with individual parts of the body.

Breakdown of MPD

1. spasmodic hemiplegia (hemiplegia)

In infants, it manifests itself in the asymmetry of spontaneous movements and body position. Then there is an increased muscle tension in paralyzed limbs, adduction and flexion position of the upper limb with the bent wrist. Children’s mental development is normal.

1. bilateral hemiplegia (hemiplegia bilateralis)

An early symptom is flexural positioning, over-expression of neonatal reflexes, and restriction of spontaneous movements. The limbs are paralyzed, with a predominance of the upper limbs, expressed by increased muscle tension, mainly the flexors. These children are often characterized by microcephaly and psychomotor retardation. Most of them do not develop walking skills, have difficulties developing speech and suffer from epilepsy.

1. bilateral spasmodic paralysis (diplegia)

It mainly affects the lower limbs and manifests itself as a spontaneous limitation of the spontaneous movement activity of the lower limbs, the child’s standing on their toes, and the inability to perform independent alternating movements with the lower limbs.

1. extrapyramidal form

The baby has involuntary movements, especially the muscles of the face, articulation and the entire head.

1. cerebellar form

It is most often characterized by a delay in the control of posture and locomotion, and in older children also by impaired coordination of movements.

1. mixed character

The most common health problems for children with MPD

Impaired motor activities

As soon as possible, the child’s motor skills should be improved by recreating the movement pattern in accordance with its development order. Kinesiotherapists, who perform appropriate exercises with the child, play a major role here. The most commonly used methods are: Vojta, Bobath, Petö, spacesuit and hippotherapy. Exercises conducted in the water promote muscle relaxation.

Epilepsy

It occurs in 50-90% of children with quadriplegic MPD and in 30-60% of children with hemiplegia, less often with other forms of MPD. It usually appears between the ages of 4-5, presents with flexion seizures (West syndrome) and is more resistant to treatment. Seizures are associated with an increased risk of injury, hospitalization for appropriate treatment and increased parental anxiety.

Pain

The causes of pain in these children are deformities of the musculoskeletal system and abnormal muscle tone. Pain medications provide relief.

Infections of the respiratory tract and oral cavity

The syndrome of skeletal deformation and muscle tension disorders also leads to an increased amount of mucus in the respiratory tract and the inability to evacuate it. This is conducive to more frequent and longer falling ill with respiratory tract infections. Mucus-reducing medications are effective in preventing and treating mucus. Common in children with MPD, dysphagia is associated with the discharge of food content into the respiratory tract, which results in a higher incidence of pneumonia.

Impaired function of the masseter muscles increases the susceptibility of teeth to tooth decay and gingivitis. Prophylactically, after each feeding, the teeth should be cleaned with cotton wool soaked in a saline solution, and with a brush with water or toothpaste in older children.

Disorders of the digestive tract

Gastrointestinal symptoms concern 90% of children with MPD. The most troublesome symptoms include: dysphagia, gastroesophageal reflux, dysphagia, choking, vomiting, and chronic constipation. The consequences of these disorders are malnutrition, anemization and even cachexia. Improving the nutritional status is possible thanks to the correct feeding position and the correct administration of meals. In some children, only percutaneous endoscopic gastrostomy (PEG) is successful. It is a probe that is inserted through the abdominal wall into the stomach in order to feed it with the appropriate food. The use of this method enables faster weight gain and significantly shortens the feeding time, which so far lasted from 5-20 hours a day. Complications following PEG insertion are mainly leakage around the stoma and dermatitis.

Protective vaccinations

Children with MPD should be immunized on a schedule. Annual flu vaccination is recommended for these children.

Permanent multi-specialist care

The clinical picture of the disease is very rich and it changes with the growing up of the child, which entails the necessity of multi-specialist care. In these cases, the attending physician is a neurologist who assesses the type and degree of neurological deficit. Orthopedic consultations are also extremely important due to the possibility of dislocations within the hip joints or abnormalities in the skeletal system. The competences of orthopedic doctors and rehabilitation doctors include the selection of rehabilitation equipment and the use of appropriate preventive treatments.

Among numerous consultations and advice, care should not be taken to maintain the normal functioning of the disabled child and his relatives. The most positive effects are brought by improving children up to 4 years of age in the atmosphere of a family home under outpatient medical care.