The term Cerebral Palsy encompasses a broad spectrum of motor disability caused by damage to the developing brain. The condition is non-progessive however the clinical picture does change due to growth.
The cause is sometimes unknown but typical causes include prematurity, birth asphyxia, trauma, infection (including meningitis and encephalitis), vascular causes and genetic causes.
In order to provide a detailed clinical picture of how a child will be affected, Cerebral Palsy is descibed in terms of classification.
- Distribution – body parts affected
- Quadriplegia– all four limbs affected. Often includes trunk.
- Diplegia – lower limbs affected, may or may not include upper limb involvement.
- Hemiplegia – one side of the body affected.
- Types – relating to the type of tone
- Hypertonia – increase in muscle tone, stiffness, resulting in altered muscle contraction. Muscle pairs are unable to operate normally causing movement in typical patterns. This can lead to muscle shortening and fixed contractures and deformities.
- Hyptonia – reduction in muscle tone, floppiness. Apparent weakness of muscles making movement, particularly against gravity, difficult.
- Dyskinetic – fluctuating tone ranging between low and high. Typical features include involuntary movements and reduced stability.
Where the tone changes are rapid and associated with prolonged increase in tone prior to tone reduction, the term dystonia is used. Dystonic spasms are a typical feature and tend to manifest as the same movement pattern. Athetosis is the term used to describe the type of cerebral palsy where the flucuations in muscle tone are more rhythmical and smooth. The associated involuntary movements are smooth and vary in range depending on the boby part. They are slow, writhing movements typically seen in the hands and feet. Wider ranging movements can be seen in the shoulders and hips. It can be difficult to know when such spasms/involuntary movements will occur, however certain trigger factors may be noted.
- Ataxia – absence of order. Features include hyptonia, reduced balance and co-ordination, and spacial awareness.
Problems often associated include vision, hearing, speech, feeding, learning difficulties, epilepsy and sensory motor difficulties.
Physiotherapy can be extremely beneficial for children with Cerebral Palsy, particularly during the early years and periods of growth. It is important to maximise the child’s potential in the early stages and minimise likely complications. Techniques used can assist the child to develop more typical movement patterns, improve their muscle strength and minimise contractures and deformaties. This enables the child to reach their maximum functional ability and actively participate in life.