We take mobility for granted. As essential as it is for day-to-day functioning, we don’t think twice about stooping down to pick up something off the floor, or walking from Point A to Point B as exercise or with a specific aim. Mobility is everything for a living being. However, individuals with Cerebral Palsy (CP) don’t have it so easy. Impaired mobility is regarded as one of the most common challenges associated with the disorder.
Typically, young toddlers take their first steps/learn to walk anywhere between 10 and 18 months. The first signs and symptoms of CP appear during infancy (perinatal brain injury) and through toddlerhood. Children with the condition may experience challenges at any or all levels of attaining this milestone — from sitting up and standing without support to actually taking the first steps. Motor skills are affected in varying degrees. The damage to the brain causes severe motor impairment that the child will have to depend on assistive devices like canes, walkers, gait trainers, orthotics, among others Occupational, and physical therapy are prescribed as part of the treatment for CP.
What is Cerebral Palsy?
Cerebral Palsy is defined as a group of disorders that impair a person’s mobility, posture, and sense of balance. It is caused by abnormal brain development or irreparable damage to the immature and developing brain.
CP can affect the whole body, be limited to one or two limbs, or one side of the body. CP is not a degenerative disorder. This means its symptoms will not get worse with time. However, timely diagnosis and immediate treatment can better the person’s ability to be as independently mobile as possible.
Types and causes
Initially, it was believed that CP was caused by lack of oxygen at the time of birth. However, research today indicates that there can be several causes of CP and low oxygen at birth is just one of them. CP is essentially caused by the abnormal development of the brain while in-utero, at the time of birth, within the first month of birth, or even during a child’s first year. It is mostly congenital, but in some cases, it may be acquired after birth.
So, what causes this abnormal development of the brain? Let’s take a look:
- Low birth weight: Newborns who weigh less than 1500 gm at the time of birth have a greater chance of CP.
- Premature birth: Children born before 37 weeks are at risk of CP. Children born before 32 weeks are at an even greater risk.
- Multiple births: Twins, triplets, multiple births, cases where the baby’s twin or triplet passes away in-utero or shortly after birth are at risk of CP. Multiple births are often premature, have low birth-weight, etc.
- Infections during pregnancy: Fever in mother during pregnancy and/or at the time of birth can lead to complications and risk of CP. Infection in the body increases the cytokine count in the brain and blood of the baby during pregnancy. Cytokine causes swelling, which can greatly damage the baby’s brain, thus increasing the risk of CP.
- Assisted reproductive technology: Pregnancies resulting from infertility treatments are high-risk pregnancies. A lot of these pregnancies result in multiple births and/or preterm births, thereby increasing the risk of CP in these children.
- Untreated jaundice and kernicterus: Some newborns may have excess bilirubin build-up in their bodies at the time of birth which causes yellowing of skin and whites of the eyes. This is jaundice. If left untreated it can lead to kernicterus, which also exponentially increases the risk of CP.
- Health concerns of mother: Thyroid issues, seizures, intellectual disability in a mother can increase the risk of CP in her children.
- Trauma and complications at birth: Premature detachment of the placenta, umbilical cord issues, uterine rupture, untreated placenta previa, etc can disrupt oxygen supply to the baby and put them at risk of CP.
What are the early signs of Cerebral Palsy?
The signs of CP can vary due to the different types and levels of disability caused by CP. While the earliest sign of CP is delay in reaching motor milestones, there can be several associated symptoms we need to watch for. These are:
In infants younger than 6 months of age –
- Child’s body feels stiff or floppy
- When you pick up the child, their legs become stiff and they cross or scissor
- When cradled in your arms, the child appears to overextend their back and neck as though they are trying to push away from you
- The child’s head lags when picked up from lying-on-the-back position
In infants between 6 months to 10 months of age –
- Child cannot roll over
- Child cannot bring their hands together
- Child keeps one hand fisted and reaches out with only one hand
- Bringing hand to mouth can be challenging
In babies older than 10 months of age –
- Lopsided crawling
- Scooting on buttocks or hopping on knees, without crawling on all fours
Other common symptoms include:
- Muscle movement disorders such as stiff muscles (spasticity), exaggerated reflexes, tremors, or involuntary jerking movements
- Lack of muscle coordination and balance (ataxia)
- Variations in muscle tone, where muscles become too stiff or too floppy
- Difficulty in walking
- Difficulty in the development of fine motor skills such as sitting up, crawling, holding onto and picking up objects
- Delay in speech development
- Difficulty in eating, excessive drooling, and problems with swallowing
- Delayed growth
- Intellectual disabilities
- Neurological problems such as seizures (epilepsy), abnormal touch, or pain sensations, etc
- Bladder and bowel problems
- Mental health issues such as behavioral problems and mental disorders
Why does Cerebral Palsy affect mobility?
Irreparable damage to the brain leads to impaired muscle tone and movement. It affects that part of the brain that is responsible for the ability to move muscle. It can also lead to flaccid muscles ), poor motor coordination, impaired reflexes, impaired balance, incorrect posture, involuntary movements, etc. The extent of mobility issues or challenges depends on the type of CP. Let’s look at the different types of CP below:
Spastic: This is the most common type of CP. It is characterised by jerky movements as well as tight and overly-toned muscles. Tight and stiff muscles make controlling motor movements extremely challenging. Children/adults with this type of CP find it difficult to walk, and can tend to have a jerky and awkward gait.
Dyskinetic: In this type of CP, the child/adult struggles with involuntary movements in the muscles. The muscle tone may vary from flaccid and loose to spastic and stiff . In such cases, the individual finds it very difficult to control their movements.
Ataxic: This type of CP affects balance and is invariably limited to the legs. Individuals with this type of CP may walk with their feet spread wide in order to maintain balance. It is known to interfere with the person’s ability to walk as well as affects the performance of fine motor activities like grasping, writing, etc.
Hypotonic: This type of CP greatly reduces muscle tone, making them overly flaccid and floppy. The weakened muscles affect posture and make it difficult to sit up straight. Children with Hypotonic CP may face difficulty in breathing, speaking, etc. They may also have poor reflexes and exhibit abnormalities in walking.
In some cases of CP, patients experience symptoms of more than one type of CP. Invariably, it is a combination of spastic and dyskinetic CP. Such a diagnosis is called Mixed Cerebral Palsy.
The Gross Motor Function Classification System (GMFCS) is a system of classifying the severity of CP that further helps in describing the individual’s abilities and challenges when it comes to mobility. The GMFCS has ascertained the five levels of mobility as follows:
- Level 1: Walking without limitations
- Level 2: Walking with some limitations
- Level 3: Walking with the help of assistive devices like cane or a walker
- Level 4: Mobility with self-operated wheelchair
- Level 5: Mobility with wheelchair operated by another person
In order to evaluate the degree of difficulty in mobility, the above classification can help greatly.
Evaluation and Treatment
A gait assessment is the most common technique to evaluate the manner in which a child walks, as well as any other limitations they may be facing. This assessment will help the therapist to understand the degree of difficulty and also prescribe ways to make corrections. The assessment will gauge strength, reflexes, muscle tone, balance, range of motion, and other deficits relating to motor functions.
In some extreme cases, surgery may be required to repair deformity in limbs so that the child can walk more easily and be more independent. Surgeries may be required to lengthen muscles and tendons that have contracted. This can improve mobility, and reduce spasticity and pain.
There are specific medications for specific symptoms of CP. These target the underlying issues pertaining to muscle tone. Among the medications prescribed, muscle relaxants are the most common because they improve muscle flexibility.
Assistive devices like canes and walkers for children can improve mobility, help with gait and balance, as well as build self-confidence in them. For individuals who cannot walk at all or suffer excruciating pain, a wheelchair makes their life easier and also instills dignity and contentment. Orthotic devices that improve function and mobility in knee, spine, foot, ankle-foot, hip, etc are also recommended depending on the severity of impairment.
Physical therapy will help improve muscle tone, coordination, sense of balance, and also increase flexibility. The therapist will prescribe certain exercises, stretches, and other related activities to help improve the child’s gait, strength, and physical function. Physical therapy is an important part of treatment because it takes the child closer towards attaining independence and self-mobility.
Occupational Therapy has shown significant improvement in the performance of basic motor functions like walking, grasping, brushing teeth, bathing, and other everyday functions. Occupational therapy for CP involves developing the patient’s ability to carry out simple tasks and activities. It aims at improving strength, dexterity, balance, and coordination. At the same time, it also helps improve cognitive abilities such as decision-making, reasoning, memory, perception, problem-solving, etc. Occupational therapy for CP offers a better quality of life, and helps the patient live a life of dignity and independence.
At Plexus, recommend an all-inclusive approach so that your child can attain maximum independence when performing daily activities, as well as improve the overall quality of their life. Under the guidance of Dr Na’eem Sadiq, India’s most renowned stem cell specialist and neurologist, we provide advanced Stem Cell Therapy for Cerebral Palsy. Our team of highly skilled stem cell specialists administer autologous mesenchymal stem cells extracted from the patient’s bone marrow itself. Stem cell therapy is safe, has zero side-effects, and is known to have significantly improved the functionality, mobility, and quality of life of children with cerebral palsy.
Plexus Neuro and Stem Cell Research Center is India’s leading center for regenerative rehabilitation. With more than a decade of clinical experience, we are India’s foremost authority on stem cell research.
Like you, we also want only the best for your child. And that is why we bring you only the best. We urge you to get in touch with our team of experienced and compassionate therapists who will hold your hand throughout the process of evaluation and treatment. We want to assure you that Cerebral Palsy will not get in the way of your child living a life of dignity and independence. Let them experience the joys of childhood. We’ll take care of the rest.
Book an appointment with us today.
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Will a child with CP ever walk?
Of course! CP might affect the age at which your child attains the walking milestone, but they will definitely be able to walk based on their functional deficits and severity of motor problems. Based on the child’s assessment, the Therapist will recommend hand-held mobility devices or assistive devices to help your child walk and move independently.
Can people with CP walk normally?
It depends on the extent of brain damage and the presentation of motor deficits in the patient. Some children with CP are able to walk properly after undergoing stem cell therapy along with a tailored rehabilitation program. Does cold weather affect CP?
Our brain regulates our body temperature depending on the weather or ambient temperature. However, children with CP may find it difficult to regulate their body temperature and are therefore vulnerable to extreme weather conditions. Cold weather can cause the muscles to stiffen.
Is CP painful?
Unfortunately CP can be extremely painful due to muscle stiffness and cramps. This pain can take different forms and can affect different parts of the body. The pain can also vary in its intensity.
What are the long term effects of CP?
Eventually the abnormal development of the brain may affect development of language and intellectual functioning. Many adults with CP are known to have other illnesses too, some of these may be age-related, while some may be acquired as a result of CP.
Does CP affect memory?
CP may affect the child’s ability to build short-term memories. It may also cause memory loss.
Can CP cause anger issues?
CP can cause behavioural issues. Some of these behaviours include being headstrong, anxious, hyperactive, short-tempered, or exhibiting anti-social behaviours.