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What Is Cerebral Palsy?

March 21st, 2011

Cerebral Palsy, Erbs Palsy and any type of Palsy is a hardship that no one should endure.  Imagine a world were these horrific conditions do not exist.  We must move towards not only effective treatments and solutions to these debilitating conditions but, more importantly, prevention.  The simple truth is that many cases of cerebral palsy, erbs palsy and many other palsy conditions discussed below can be prevented.  You deserve a world free from cerebral palsy and erbs palsy.  Cerebral Palsy and Erbs Palsy Lawyers work hard to not only get you the money you deserve but prevent medical malpractice in the future with the consequence of a possible medical malpractice claim.  As such, your Cerebral Palsy Lawsuit or Erbs Palsy Lawsuit accomplishes two goals – 1) it provides you with the money you deserve for a Cerebral Palsy or Erbs Palsy child which has resulted from a Medical Malpractice claim; and, 2) it aids in prevention of similar medical malpractice involving births by the same doctor, medical professional or hospital/facility.  If your loved one has been a victim of Cerebral Palsy or Erbs Palsy through medical malpractice during birth or a doctor’s mistake call us today at 1(800)WE-FIGHT for a free, confidential consultation and let’s get to work on delivering compensation to you and your family and justice to the suffering.

Spastic Cerebral Palsy.

The word ‘spastic’ means ‘stiff’ and so children who have spastic cerebral palsy have a tendency to have stiff muscles. That stiffness may show itself only in one limb, two limbs, three limbs or four. There are various names for the different combinations of limbs which are affected in all types. I will not highlight these at the end of this section.

Spastic cerebral palsy is usually caused by injury to the cortex, especially the motor cortex and to a bundle of nerve fibres called the corticospinal tract. Obviously, spasticity is very uncomfortable and has negative consequences for the child’s development, depending upon how many limbs are involved and it’s severity.

Athetoid Cerebral Palsy.

This type of cerebral palsy is caused by injury to a structure below the cortex called the ‘basal ganglia.’ The basal ganglia plays a role in motor function, cognitive processes, emotional processes and our ability to learn. It also acts as a ‘braking’ mechanism on the thalamus, a part of the brain which mediates our sensory experiences. So, without this inhibitory role, one can imagine a thalamus in effect operating without its ‘braking system’ which might produce many of the sensory distortions we see in some children who have cerebral palsy. It also acts as a ‘braking system’ for movement, which enables us for instance, to sit still. In order to sit still a ‘brake’ has to be placed on all other movements. Consequently injury at this level hampers the ‘braking system’ and we see children who cannot sit still and are in constant movement and children whose sensory perception is distorted. Injury to this part of the brain also exhibits itself in many children by retention of the primitive postural reflexes, as it is the role of the basal ganglia to suppress these in order to enable the child to move.
Children with basal ganglia injury are also more likely to have hypotonia, (floppy muscle tone) and persistently impaired balance and ambulation performance.

Ataxic Cerebral Palsy.

Children who have this type of cerebral palsy are usually injured in a structure right at the back of the brain called the ‘cerebellum.’ The word ‘cerebellum’ actually means ‘little brain’ and it is not without justification, as at first sight it does look like a smaller version of the brain. It is located behind the brainstem and it forms massive connections with this structure and with the cerebral cortex. It is the only structure within the brain which is not fully formed at birth, taking a further two years to develop to it’s full complement of neurons.
The proper functioning of the cerebellum ensures that any movements we make are smooth and well coordinated. It seems that the motor cortex supplies commands to the body musculature, which are then refined by the cerebellum to ensure smooth coordination. Feedback on the success of the movement is then supplied from the cerebellum back to the motor cortex where the original movement command can be refined if the movement has been unsuccessful.

One might imagine then that an injury to the cerebellum will interfere with these functions. Movement can become slow and uncoordinated, the child may display problems with balance and equilibrium, the child might experience an ‘intention tremor’ – (a tremor which is made worse when the child tries to move). Injury to this part of the brain causes ‘Ataxia’ – this is where the muscle tone is hypotonic (floppy).

Higher cognitive functions, like language and visual processing, have long been thought to reside primarily in the brain’s cortex, however recent research involving premature infants is documenting an important role for the cerebellum — previously thought to be principally involved in motor coordination and shows that cerebellar injury can have far-reaching developmental consequences. This work also demonstrates that the cortex and cerebellum are tightly interconnected. Sophisticated MRI imaging of 74 pre-term infants’ brains revealed that when there was injury to the cortex, the cerebellum failed to grow to a normal size. This means that our children with spastic cerebral palsy will usually also experience some of the difficulties associated with injury to the cerebellum.

When the injury to the cortex was confined to one side, it was the opposite cerebellar hemisphere that failed to grow normally. The reverse was also true: when injury occurred in one cerebellar hemisphere, the opposite cerebral hemisphere was smaller than normal. So, there seems to be an important developmental link between the cortex and the cerebellum, – it seems that the two structures modulate each others growth and development. So it appears that the way the brain forms connections between structures may be as important as a direct injury to a brain structure itself.

The cerebellum has also been implicated in the development of some types of literacy problems, including dyslexia.

Mixed Cerebral Palsy.

This quite simply is where several brain structures are injured, producing a mixture of symptoms of all three of the previous types mentioned.

Cerebral palsy is not limited to injury to the brain structures I have mentioned here, it is just that in the overwhelming majority of cases there is injury to one or more of these structures. An injury to one or more additional brain structures or nerve pathways can also add to the mix of symptoms, which is why no two children with cerebral palsy are exactly the same. They may have some shared symptoms, but they will not be totally alike.

What is the difference between hemiplegia, diplegia, quadriplegia, etc ?

These terms are quite simply a reference to how many limbs are affected.

Quadriplegia indicates that all four limbs are affected.

Diplegia indicates that the legs are affected.

Hemiplegia indicates that one arm and leg on the same side of the body are affected.

Double Hemiplegia is a term which is used when all four limbs are affected, but with different features on the right and left sides.

Alternatively, your doctor might use the term, hemiparesis instead of hemiplegia, and quadriparesis instead of quadriplegia. ‘plegia’ indicates a form of paralysis or difficulty in moving the affected limbs, whereas the term ‘paresis’ indicates a weakness in the affected limbs.

What problems can cerebral palsy produce in a child?

A child with cerebral palsy can experience difficulties in one, several or all areas of development, to a greater or lesser degree, depending upon the nature and severity of the brain injury. An injury can be so mild as to merely slow down development a little in just one area, or can be so severe as to completely stop development in all areas, rendering the child totally dependent in every way for every aspect of his care. Let’s do a quick A – Z tour of the kind of problems you could be facing.

Anxiety. – Some children with cerebral palsy suffer from anxiety. This can be due to the discomfort produced by stiff musculature, or can have other neurological causes such as the overproduction of norepinephrine in the brain, leaving the child on a hyper-anxiety inducing ‘high.’ There are techniques, which Snowdrop employs to relieve this situation, but in the most severe cases intervention can be necessary with anti – anxiety medications.

Breathing. – The respiratory rate of a newborn baby is between 40 – 70 breaths per minute, but by the time he is ready for pre-school at four years of age this has dropped to 25 breaths per minute. By the time a child is ready for secondary school, this has again dropped to approximately 16 breaths per minute and by adulthood the rate is around 12 per minute. In many children who have cerebral palsy this developmental pathway is either slowed or stopped, leaving for example a four year old child, who should have a rate of 25 breaths per minute, with a rate of 50 breaths per minute. As the breathing rate of a newborn is also shallow, this can mean that the oxygen levels in the brain are more difficult to maintain, exacerbating other problems such as epilepsy. It also makes the coordination of swallowing, chewing and breathing more difficult.

Constipation. – This is a big problem in many children who suffer spastic cerebral palsy, but to a lesser extent in the other types too. It is produced by lack of mobility, muscular stiffness, lack of muscular strength and bad co-ordination. Fortunately there are medications such as lactulose, senna and sodium picosulfate, which can ease the problem. On a more natural note, there is also Magnesium Oxide which can have a beneficial effect. Even so, many children still have have regular enemas. It is important to try to control this problem as constipation exacerbates so many more of the child’s problems, such as muscle tone, anxiety and epilepsy.

Digestion. – The digestive system of the child with cerebral palsy might also be compromised, with the child having poor absorption of nutrients, or having trouble in keeping food down, through excessive vomiting.

Epilepsy – This is more prevalent in spastic cerebral palsy, but does occur to a lesser frequency in all types. Epilepsy can be a big problem. I have seen children who are taking the most powerful medication cocktails you could imagine and still they have seizure after seizure. Often it is well controlled by medication, but sometimes depending upon the severity of the brain injury, it is more problematic. Epilepsy is simply the propensity of brain cells to misfire. Sometimes this sets of a chain reaction causing other cells to misfire and we then see the child having a seizure. Depending upon the extent of that chain reaction, the child may have a mild seizure such as an ‘absence’ where he simply ‘fazes out’ and stares into space for a few seconds, or he might experience a more violent, generalised seizure where he loses consciousness and his body rhythmically shakes.

Usually there is no danger from the fit itself, – even in the most violent looking seizures, the child will regain consciousness within a few minutes, the only danger being that when the fit begins, he might lose consciousness, fall and hurt himself. Very rarely however, some children will experience repeated seizures from which they cannot be roused, this is called ‘status epilepticus’ and is a situation where medical help should be sought without delay. For a more detailed description of different types of epilepsy, go to my book ‘Brain Injured Children. – Tapping the Potential Within.’

Feeding and drinking. – These are two more areas which are affected by breathing. It is sometimes difficult for the child with brain injuries to co-ordinate swallowing, chewing and breathing, – something we do unconsciously and which we take for granted. This can result in the child aspirating (breathing in) liquid and food with the consequent risk of infection such as pneumonia. Other problems include the fact that the child might not have the required muscular co-ordination to chew, or might have so strong a suckling reflex that instead of chewing, he suckles his food. Actually getting some children with severe cerebral palsy to take solid food at all can be a difficult task. Sometimes, as a result of all these difficulties a doctor might recommend that a naso-gastric tube be fitted, or that the child has an operation called a gastrostomy, through which they are fed.

Homeostasis. – Some children with cerebral palsy who have injuries to a part of the brain called the ‘hypothalamus,’ or connections to and from it have trouble with several aspects of maintaining their equilibrium. This may display itself as a lack of a drive for hunger, thirst, etc, or too much of a drive for these. So some children might not realise they are hungry, whilst others might be incessantly so. It may also display itself as an inability to maintain body temperature, the child either becoming cold or hot easily.
Learning Difficulties. Many people assume that most children who have cerebral palsy also have learning difficulties, – this is not the case. Many children with cerebral palsy have difficulty in displaying their intelligence because of their sensory, physical, and / or communication difficulties, but that intelligence is often most certainly there! Only approximately three out of ten children with cerebral palsy have severe learning difficulties.

Orthopaedics, Orthopaedic impairment can take many forms in the person with cerebral palsy. One or more limbs can be impaired, different muscle groups in the body can be affected, there can be difficulty due to stiffness of the muscles with ligaments and tendons tightening, there can be difficulties due to low muscle tone too. Children can suffer from contractures and dislocations. There can also be problems with scoliosis of the spine. There are surgical procedures which can help to alleviate some of these difficulties, and there are also medications such as muscle relaxants. The best way of maintaining your child’s body however is regular physiotherapy. The physiotherapist is so important to the child with cerebral palsy and to Snowdrop. They help to prevent the development of orthopaedic and associated problems, thereby preserving a clear developmental base upon which to build.

Salivation. – Many children with cerebral palsy produce excess amounts of saliva. This can cause big problems with choking, aspiration and infection, chewing and eating, drinking and language development. It can signal an imbalance in the autonomic nervous system, which has two branches, – the sympathetic and parasympathetic nervous systems. When the parasympathetic branch is over-active, production of saliva increases. Over salivation can also be stimulated by problems with the brain’s vestibular system. There are medications which can be used to help slow down the rate of salivary production, one of the more common being ‘scopolomine patches,’ which are gently stuck on behind the ear.

Sensory Problems. – This is a huge problem area for many children with cerebral palsy, whose sensory perception can be dulled, distorted or amplified in one or more of the sensory modalities. Children can have a mixture of these problems in different senses, so that a child might for instance have acutely oversensitive hearing and simultaneously be undersensitive in vision. As specific sensory systems supply the information necessary for the efficient operation of motor systems, problems here can have the effect of retarding the development of mobility, hand function, language and communication and socialisation.

Let’s take a brief look at this. If a child’s visual development is delayed or stopped, then language development, socialisation, mobility and hand function can be affected. Mobility speaks for itself, if a child cannot see it could be dangerous to move. Language and socialisation development will be affected because the child will not be able to complete the essential developmental stages of making eye – contact, regulating mutual attention and will not be able to see the face of a communicating partner. All of which are vital precursors to the development of language and socialisation.
If a child’s auditory development is affected then it is obvious that language and consequently socialisation, which in turn depends so much on language development, will also be affected. The development of spoken language is dependent upon exposure to spoken language. If tactile development is affected then mobility and hand function will also be problem areas. If you cannot feel where your body, limbs and hands are, then you will have difficulty in the conscious control of them. So we can see how important sensory development is in enabling other developmental functions to operate normally.

Sleeping, – There are two categories of children to talk about here, the first is the child who cannot sleep. The second is the child who can sleep but does not do so at the correct times. The effect is the same for the parents who have to stay awake to ensure the child’s well-being. In the first category, the child has a neurological reason why he cannot sleep, – he perhaps for some reason does not produce enough serotonin, or maybe he overproduces ‘noradrenaline.’ In the second category it could be the child’s body clock which is askew, or it might be sensory oversensitivity which is preventing him from sleeping. Ultimately this child will sleep, usually when he collapses from exhaustion.

Teeth, Dental problems can occur, especially if the child is hypersensitive to touch in his mouth, or if he produces excess saliva, or grinds his teeth.

Teeth grinding, – Apart from being like the Chinese water torture for the person having to listen to it, this can cause dental pain for the child who does it. Often, it is done when the child feels stressed and more often than not is linked to overproduction of saliva.

It is my hope that this short text has been informative and that most of all it has given parent some good information about cerebral palsy and also some hope that their children can make progress!

If your child or loved one suffers from cerebral palsy, erbs palsy or any palsy condition you may be entitled to money.  Contact the Cerebral Palsy Lawyer at 1(800)WE-FIGHT for a free, confidential legal consultation.  We have convenient locations and can even have a Medical Malpractice Lawyer come to you for free.

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