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Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, vision, hearing, and speaking. Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children of their age. Other symptoms include seizures and problems with thinking or reasoning, each of which occur in about one-third of people with CP. While symptoms may get more noticeable over the first few years of life, underlying problems do not worsen over time.
The Moro reflex is an infantile reflex that develops between 28 and 32 weeks of gestation and disappears at 3–6 months of age. It is a response to a sudden loss of support and involves three distinct components:
- spreading out the arms (abduction)
- pulling the arms in (adduction)
- crying (usually)
Worster-Drought syndrome is a form of congenital suprabulbar paresis that occurs in some children with cerebral palsy. It is caused by inadequate development of the corticobulbar tracts and causes problems with the mouth and tongue including impaired swallowing. A similar syndrome in adults is called anterior opercular syndrome.
The Bobath concept is an approach to neurological rehabilitation that is applied in patient assessment and treatment. The goal of applying the Bobath concept is to promote motor learning for efficient motor control in various environments, thereby improving participation and function. This is done through specific patient handling skills to guide patients through the initiation and completing of intended tasks. This approach to neurological rehabilitation is multidisciplinary, primarily involving physiotherapists, occupational therapists, and speech and language therapists. In the United States, the Bobath concept is also known as 'neuro-developmental treatment' (NDT).
bibic is a small charitable organization based in the United Kingdom that supports children, young people and their families deal with a number of different conditions. The charity was founded by the late Keith Pennock who had a daughter with a learning disability. The work was derived from Glenn Doman's The Institutes for The Achievement of Human Potential (IAHP) in Philadelphia, USA.
Periventricular leukomalacia (PVL) is a form of white-matter brain injury, characterized by the necrosis of white matter near the lateral ventricles. It can affect newborns and fetuses; premature infants are at the greatest risk of neonatal encephalopathy which may lead to this condition. Affected individuals generally exhibit motor control problems or other developmental delays, and they often develop cerebral palsy or epilepsy later in life. The white matter in preterm born children is particularly vulnerable during the third trimester of pregnancy when white matter developing takes place and the myelination process starts around 30 weeks of gestational age.
Hypertonia is a term sometimes used synonymously with spasticity and rigidity in the literature surrounding damage to the central nervous system, namely upper motor neuron lesions. Impaired ability of damaged motor neurons to regulate descending pathways gives rise to disordered spinal reflexes, increased excitability of muscle spindles, and decreased synaptic inhibition. These consequences result in abnormally increased muscle tone of symptomatic muscles. Some authors suggest that the current definition for spasticity, the velocity-dependent over-activity of the stretch reflex, is not sufficient as it fails to take into account patients exhibiting increased muscle tone in the absence of stretch reflex over-activity. They instead suggest that "reversible hypertonia" is more appropriate and represents a treatable condition that is responsive to various therapy modalities like drug or physical therapy.
Diplegia, when used singularly, refers to paralysis affecting symmetrical parts of the body. This is different from hemiplegia which refers to spasticity restricted to one side of the body, paraplegia which refers to paralysis restricted to the legs and hip, and quadriplegia which requires the involvement of all four limbs but not necessarily symmetrical. Diplegia is the most common cause of crippling in children, specifically in children with cerebral palsy. Other causes may be due to injury of the spinal cord. There is no set course of progression for people with diplegia. Symptoms may get worse but the neurological part does not change. The primary parts of the brain that are affected by diplegia are the ventricles, fluid filled compartments in the brain, and the wiring from the center of the brain to the cerebral cortex. There is also usually some degeneration of the cerebral neurons, as well as problems in the upper motor neuron system. The term diplegia can refer to any bodily area, such as the face, arms, or legs.
Developmental coordination disorder (DCD), also known as developmental motor coordination disorder, developmental dyspraxia or simply dyspraxia, is a neurodevelopmental disorder characterized by impaired coordination of physical movements as a result of brain messages not being accurately transmitted to the body. Deficits in fine or gross motor skills movements interfere with activities of daily living. It is often described as disorder in skill acquisition, where the learning and execution of coordinated motor skills is substantially below that expected given the individual's chronological age. Difficulties may present as clumsiness, slowness and inaccuracy of performance of motor skills. It is also often accompanied by difficulty with organisation and/or problems with attention, working memory and time management.
A selective dorsal rhizotomy (SDR), also known as a rhizotomy, dorsal rhizotomy, or a selective posterior rhizotomy, is a neurosurgical procedure that selectively cut problematic nerve roots of the spinal cord. This procedure has been well-established in the literature as a surgical intervention and is used to relieve negative symptoms of neuromuscular conditions such as spastic diplegia and other forms of spastic cerebral palsy. The specific sensory nerves inducing spasticity are identified using electromyographic (EMG) stimulation and graded on a scale of 1 (mild) to 4. Abnormal nerve responses are isolated and cut, thereby reducing symptoms of spasticity.
The Communication Function Classification System (CFCS) for individuals with cerebral palsy (CP) is a five-level classification system which began development at Michigan State University and currently under further refinement at the University of Kentucky. The research, organized and conducted by Dr. Mary Jo Cooley Hidecker, Ph.D., CCC-A/SLP, follows two widely used classification systems for cerebral palsy: the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). Dr. Ray Kent of the University of Wisconsin–Madison, Dr. Peter Rosenbaum of McMaster University, and Dr. Nigel Paneth of Michigan State University are also an integral part of this research.
The William Little Foundation is a London-based charity operating internationally.
Over time, the approach to cerebral palsy management has shifted away from narrow attempts to fix individual physical problems – such as spasticity in a particular limb – to making such treatments part of a larger goal of maximizing the person's independence and community engagement. Much of childhood therapy is aimed at improving gait and walking. Approximately 60% of people with CP are able to walk independently or with aids at adulthood. However, the evidence base for the effectiveness of intervention programs reflecting the philosophy of independence has not yet caught up: effective interventions for body structures and functions have a strong evidence base, but evidence is lacking for effective interventions targeted toward participation, environment, or personal factors. There is also no good evidence to show that an intervention that is effective at the body-specific level will result in an improvement at the activity level, or vice versa. Although such cross-over benefit might happen, not enough high-quality studies have been done to demonstrate it.
Dyskinetic cerebral palsy (DCP) is a subtype of cerebral palsy (CP) and is characterized by impaired muscle tone regulation, coordination and movement control. Dystonia and choreoathetosis are the two most dominant movement disorders in patients with DCP.
Athetoid cerebral palsy, or dyskinetic cerebral palsy, is a type of cerebral palsy primarily associated with damage, like other forms of CP, to the basal ganglia in the form of lesions that occur during brain development due to bilirubin encephalopathy and hypoxic–ischemic brain injury. Unlike spastic or ataxic cerebral palsies, ADCP is characterized by both hypertonia and hypotonia, due to the affected individual's inability to control muscle tone. Clinical diagnosis of ADCP typically occurs within 18 months of birth and is primarily based upon motor function and neuroimaging techniques. While there are no cures for ADCP, some drug therapies as well as speech, occupational therapy, and physical therapy have shown capacity for treating the symptoms.
Pamela Evans is a British author who is also trained as a medical doctor and a published academic.
Ataxic cerebral palsy is clinically in approximately 5–10% of all cases of cerebral palsy, making it the least frequent form of cerebral palsy diagnosed. Ataxic cerebral palsy is caused by damage to cerebellar structures, differentiating it from the other two forms of cerebral palsy, which are spastic cerebral palsy and dyskinetic cerebral palsy.
Spastic cerebral palsy is the type of cerebral palsy characterized by spasticity or high muscle tone often resulting in stiff, jerky movements. Cases of spastic CP are further classified according to the part or parts of the body that are most affected. Such classifications include spastic diplegia, spastic hemiplegia, spastic quadriplegia, and in cases of single limb involvement, spastic monoplegia.
The Manual Ability Classification System (MACS) is a medical classification system used to describe how children aged from 4 to 18 years old with cerebral palsy use their hands with objects during activities of daily living, with a focus on the use of both hands together. Like the Gross Motor Function Classification System (GMFCS), there are five levels - level I being the least impaired, only finding difficulty in tasks needing speed and accuracy, and level V being the most impaired, not being able to handle objects and having severely limited abilities for even simple actions.
Diane Louise Damiano is an American biomedical scientist and physical therapist specializing in physical medicine and rehabilitation approaches in children with cerebral palsy. She is chief of the functional and applied biomechanics section at the National Institutes of Health Clinical Center. Damiano has served as president of the Clinical Gait and Movement Analysis Society and the American Academy for Cerebral Palsy and Developmental Medicine.
References
- ↑ Morris, C; Bartlett, D (January 2004). "Gross Motor Function Classification System: impact and utility". Developmental Medicine and Child Neurology . 46 (1): 60–5. doi: 10.1111/j.1469-8749.2004.tb00436.x . PMID 14974650.
- ↑ El-Sobky, Tamer A.; Fayyad, Tamer A.; Kotb, Ahmed M.; Kaldas, Beshoy (2017). "Bony reconstruction of hip in cerebral palsy children Gross Motor Function Classification System levels III to V". Journal of Pediatric Orthopaedics B. 27 (3): 221–230. doi:10.1097/BPB.0000000000000503. PMID 28953164. S2CID 4204446.
- ↑ Rethlefsen, Susan A.; Ryan, Deirdre D.; Kay, Robert M. (October 2010). "Classification Systems in Cerebral Palsy". Orthopedic Clinics of North America. 41 (4): 457–467. doi:10.1016/j.ocl.2010.06.005. PMID 20868878.
- ↑ Reid, Susan M; Carlin, John B; Reddihough, Dinah S (November 2011). "Using the Gross Motor Function Classification System to describe patterns of motor severity in cerebral palsy". Developmental Medicine & Child Neurology. 53 (11): 1007–1012. doi:10.1111/j.1469-8749.2011.04044.x. PMID 22014320.
- ↑ Towns, Megan; Rosenbaum, Peter; Palisano, Robert; Wright, F Virginia (5 November 2017). "Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy?". Developmental Medicine & Child Neurology. 60 (2): 147–154. doi: 10.1111/dmcn.13602 . PMID 29105760.
- ↑ Posłuszny, Adam; Myśliwiec, Andrzej; Saulicz, Edward; Doroniewicz, Iwona; Linek, Paweł; Wolny, Tomasz (4 March 2016). "Current understanding of the factors influencing the functional independence of people with cerebral palsy: a review of the literature". International Journal of Developmental Disabilities. 63 (2): 77–90. doi:10.1080/20473869.2016.1145396. S2CID 147588114.
- Palisano, Robert; Rosenbaum, Peter; Walter, Stephen; Russell, Dianne; Wood, Ellen; Galuppi, Barbara (2008). "Development and reliability of a system to classify gross motor function in children with cerebral palsy". Developmental Medicine & Child Neurology . 39 (4): 214–223. doi: 10.1111/j.1469-8749.1997.tb07414.x . PMID 9183258.
- Palisano, Robert J.; Rosenbaum, Peter; Bartlett, Doreen; Livingston, Michael H. (2008). "Content validity of the expanded and revised Gross Motor Function Classification System". Developmental Medicine & Child Neurology. 50 (10): 744–750. doi:10.1111/j.1469-8749.2008.03089.x. PMID 18834387. S2CID 45875650.