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Cerebral Palsy and Children
Cerebral palsy is characterized by non-progressive abnormalities
in the developing brain that creates a cascade of neurological,
motor, and postural deficits. Although postural and motor deficits
are defining feature, some secondary are present such as sensory,
cognitive and psychosocial. Early diagnosis of CP is very important
to elicit the services that the child and family may need to
optimize the child's potential and to help prevent secondary
disabilities.
The evaluation for CP usually takes place over a period of months
in early development. The team may include a pediatrician, occupational
therapist, physical therapist and speech pathologist. They typically
are looking at retention of primitive reflexes and automatic
reaction, variable tone, hyperesponsiveness, tendon reflexes,
asymmetric in the use of extremities, poor sucking or tongue
control and involuntary movement.
Children with cerebral palsy have damage to the part of the brain
that controls muscle tone. Muscle tone is the amount of resistance
to movement in a muscle. It is what lets you keep your body in
a certain posture or position. For example, it lets you sit up
straight and keep your head up. Changes in muscle tone let you
move. For example, to bring your hand to your face, the tone
in your biceps muscle at the front of your arm must increase
while the tone in the triceps muscle at the back of your arm
must decrease. The tone in different muscle groups must be balanced
for you to move smoothly.
There are four main types of cerebral palsy - spastic, athetoid,
ataxic, and mixed.
Spastic: People with spastic cerebral palsy have
increased muscle tone. Their muscles are stiff. Their movements
can be awkward. Seventy to eighty percent of people with cerebral
palsy have spasticity. Spastic cerebral palsy is usually described
further by what parts of the body are affected. In spastic diplegia,
the main effect is found in both legs. In spastic hemiplegia,
one side of the person's body is affected. Spastic quadriplegia
affects a person's whole body (face, trunk, legs, and arms).
Athetoid or dyskinetic: People with athetoid cerebral
palsy have slow, writhing movements that they cannot control.
The movements usually affect a person's hands, arms, feet, and
legs. Sometimes the face and tongue are affected and the person
has a hard time talking. Muscle tone can change from day to day
and can vary even during a single day. Ten to twenty percent
of people with cerebral palsy have the athetoid form of the condition.
Ataxic: People with ataxic cerebral palsy have
problems with balance and depth perception. They might be unsteady
when they walk. They might have a hard time with quick movements
or movements that need a lot of control, like writing. They might
have a hard time controlling their hands or arms when they reach
for something. People with ataxic cerebral palsy can have increased
or decreased muscle tone. Five to ten percent of people with
cerebral palsy have ataxia.
Mixed: Some people have more than one type of
cerebral palsy. The most common pattern is spasticity plus athetoid
movements.
The symptoms of cerebral palsy vary from person to person. Symptoms
can also change over time. A person with severe cerebral palsy
might not be able to walk and might need lifelong care. A person
with mild cerebral palsy, on the other hand, might walk a little
awkwardly, but might not need any special help
Cerebral Palsy and Sensory feedback
In the neurologically impaired child the inability to adapt
how the senses are used for postural control are affected. Certain
movements' strategies for controlling the body's position in
space depend on certain senses more than others. When the sense
needed in controlling movement is not available the ability to
use that movement strategy for postural control is lost. Disruption
of sensory information can affect postural control in the following
ways One the sensory problems can prevent the development of
accurate internal models of the body for postural control, affecting
a patients ability to accurately determine the orientation of
the body with respect to gravity and the environment, secondly,
disruption of central sensory mechanisms can affect a child's
ability to adapt sensory inputs to changes in task and environmental
demands. Third the sensory problems can disrupt motor learning,
affects the child's ability to adapt and change efficiently.
Lastly, the loss of sensory information can impair a child's
ability to anticipate instability, modifying the way he/she senses
moves to prevent disruptions to postural control. For example,
Somatosensory ( tendons, joints , skin receptors ect. )inputs
are very important when ankles strategies are used to compensate
for unstable support surfaces. Alternatively visual and vestibular
senses appear to be more important when hip movements strategies
are used to control balance in this situation.
Parents do not be afraid to insist on having an occupational
therapist on your team with knowledge of sensory integration
strategies.
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