Cerebral palsy (patient information)

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Overview
Cerebral palsy is condition, sometimes thought of as a group of disorders that can involve brain and nervous system functions such as movement, learning, hearing, seeing, and thinking. The term cerebral palsy refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don’t worsen over time. Even though cerebral palsy affects muscle movement, it isn’t caused by problems in the muscles or nerves. It is caused by abnormalities in parts of the brain that control muscle movements.

There are several different types of cerebral palsy, including spastic, dyskinetic, ataxic, hypotonic, and mixed.

What are the symptoms of Cerebral palsy?
Symptoms of cerebral palsy can be very different between people with this group of disorders. Symptoms may: Symptoms of spastic cerebral palsy, the most common type, include: The following symptoms may occur in other types of cerebral palsy: Other brain and nervous system symptoms: Other symptoms:
 * Be very mild or very severe
 * Only involve one side of the body or both sides
 * Be more pronounced in either the arms or legs, or involve both the arms and legs
 * Muscles that are very tight and do not stretch. They may tighten up even more over time.
 * Abnormal walk (gait): arms tucked in toward the sides, knees crossed or touching, legs make "scissors" movements, walk on the toes
 * Joints are tight and do not open up all the way (called joint contracture)
 * Muscle weakness or loss of movement in a group of muscles (paralysis)
 * The symptoms may affect one arm or leg, one side of the body, both legs, or both arms and legs
 * Abnormal movements (twisting, jerking, or writhing) of the hands, feet, arms, or legs while awake, which gets worse during periods of stress
 * Tremors
 * Unsteady gait
 * Loss of coordination
 * Floppy muscles, especially at rest, and joints that move around too much
 * Decreased intelligence or learning disabilities are common, but intelligence can be normal
 * Speech problems (dysarthria)
 * Hearing or vision problems
 * Seizures
 * Pain, especially in adults (can be difficult to manage)
 * Eating and digestive symptoms
 * Difficulty sucking or feeding in infants, or chewing and swallowing in older children and adults
 * Problems swallowing (at all ages)
 * Vomiting or constipation
 * Increased drooling
 * Slower than normal growth
 * Irregular breathing
 * Urinary incontinence

Who is at highest risk?
In some people with cerebral palsy, parts of the brain are injured due to low levels of oxygen (hypoxia) in the area. It is not known why this occurs. Premature infants have a slightly higher risk of developing cerebral palsy. Cerebral palsy may also occur during early infancy as a result of several conditions, including: In some cases the cause of cerebral palsy is never determined.
 * Bleeding in the brain
 * Brain infections (encephalitis, meningitis, herpes simplex infections)
 * Head injury
 * Infections in the mother during pregnancy (rubella)
 * Severe jaundice

When to seek urgent medical care?
Call your health care provider if symptoms of cerebral palsy develop, especially if you know that an injury occurred during birth or early infancy.

Diagnosis
A full neurological exam is critical. In older people, testing cognitive function is also important. The following other tests may be performed:
 * Blood tests
 * CT scan of the head
 * Electroencephalogram (EEG)
 * Hearing screen
 * MRI of the head
 * Vision testing

Treatment options
Cerebral palsy can’t be cured, but treatment will often improve a child's capabilities. Many children go on to enjoy near-normal adult lives if their disabilities are properly managed. In general, the earlier treatment begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them.

Treatment may include physical and occupational therapy, speech therapy, drugs to control seizures, relax muscle spasms, and alleviate pain; surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; wheelchairs and rolling walkers; and communication aids such as computers with attached voice synthesizers.

The goal of treatment is to help the person be as independent as possible. Treatment requires a team approach, including: Primary care doctor, dentist (dental check-ups are recommended around every 6 months), social worker, nurses, occupational, physical, and speech therapists, and other specialists, including a neurologist, rehabilitation physician, pulmonologist, and gastroenterologist

Self and home care

 * Getting enough food and nutrition
 * Keeping the home safe
 * Performing exercises recommended by the health care providers
 * Practicing proper bowel care (stool softeners, fluids, fiber, laxatives, regular bowel habits)
 * Protecting the joints from injury
 * Putting the child in regular schools is recommended, unless physical disabilities or mental development makes this impossible. Special education or schooling may help.

Communication and learning care

 * Glasses
 * Hearing aids
 * Muscle and bone braces
 * Walking aids
 * Wheelchairs
 * Physical therapy, occupational therapy, orthopedic help, or other treatments may also be needed to help with daily activities and care.

Medications

 * Anticonvulsants to prevent or reduce the frequency of seizures
 * Botulinum toxin to help with spasticity and drooling
 * Muscle relaxants (baclofen) to reduce tremors and spasticity

Surgery

 * Control gastroesophageal reflux
 * Cut certain nerves from the spinal cord to help with pain and spasticity
 * Place feeding tubes
 * Release joint contractures
 * Stress and burnout among parents and other caregivers of cerebral palsy patients is common, and should be monitored.

Where to find medical care for Cerebral palsy?
Directions to Hospitals Treating Cerebral palsy

What to expect (Outlook/Prognosis)?
Cerebral palsy doesn’t always cause profound disabilities. Cerebral palsy, however, is a lifelong disorder. Long-term care may be required. This disorder does not affect expected length of life. The amount of disability varies.

While one child with severe cerebral palsy might be unable to walk and need extensive, lifelong care, another with mild cerebral palsy might be only slightly awkward and require no special assistance. Many adults are able to live in the community, either independently or with different levels of help. In severe cases, the person may need to be placed in an institution. Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.

Possible complications

 * Bone thinning or osteoporosis
 * Bowel obstruction
 * Hip dislocation and arthritis in the hip joint
 * Injuries from falls
 * Joint contractures
 * Pneumonia caused by choking
 * Poor nutrition
 * Reduced communication skills (sometimes)
 * Reduced intellect (sometimes)
 * Scoliosis
 * Seizures (in about half of patients)
 * Social stigma