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Hemiparesis, or unilateral paresis, is weakness of one entire side of the body. Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke.
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, which each 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.
Spasticity is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles.
The International Classification of Functioning, Disability and Health (ICF) is a classification of the health components of functioning and disability.
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)
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).
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 and/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 destroys problematic nerve roots in 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 Wyoming. 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.
The Gross Motor Function Classification System or GMFCS is a 5 level clinical classification system that describes the gross motor function of people with cerebral palsy on the basis of self-initiated movement abilities. Particular emphasis in creating and maintaining the GMFCS scale rests on evaluating sitting, walking, and wheeled mobility. Distinctions between levels are based on functional abilities; the need for walkers, crutches, wheelchairs, or canes / walking sticks; and to a much lesser extent, the actual quality of movement.
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.
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
- 1 2 Jeevanantham, Deepa; Dyszuk, Emily; Bartlett, Doreen (2015). "The Manual Ability Classification System". Pediatric Physical Therapy. 27 (3): 236–241. doi:10.1097/PEP.0000000000000151. PMID 26020598. S2CID 1310474.
- ↑ 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.
- ↑ Öhrvall, Ann-Marie; Eliasson, Ann-Christin (27 February 2010). "Parents' and therapists' perceptions of the content of the Manual Ability Classification System, MACS". Scandinavian Journal of Occupational Therapy . 17 (3): 209–216. doi:10.3109/11038120903125101. PMID 19707950. S2CID 218879745.
- ↑ McConnell, Karen; Johnston, Linda; Kerr, Claire (September 2011). "Upper limb function and deformity in cerebral palsy: a review of classification systems". Developmental Medicine & Child Neurology. 53 (9): 799–805. doi: 10.1111/j.1469-8749.2011.03953.x . PMID 21434888.
- ↑ Eliasson, Ann-Christin; Krumlinde-Sundholm, Lena; Rösblad, Birgit; Beckung, Eva; Arner, Marianne; Öhrvall, Ann-Marie; Rosenbaum, Peter (19 June 2006). "The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability". Developmental Medicine & Child Neurology . 48 (7): 549–54. doi: 10.1111/j.1469-8749.2006.tb01313.x . PMID 16780622.
- ↑ Wagner, Lisa V.; Davids, Jon R. (20 September 2011). "Assessment Tools and Classification Systems Used For the Upper Extremity in Children With Cerebral Palsy". Clinical Orthopaedics and Related Research . 470 (5): 1257–1271. doi:10.1007/s11999-011-2065-x. PMC 3314769 . PMID 21932104.
- ↑ Paulson, Andrea; Vargus-Adams, Jilda (24 April 2017). "Overview of Four Functional Classification Systems Commonly Used in Cerebral Palsy". Children. 4 (4): 30. doi: 10.3390/children4040030 . PMC 5406689 . PMID 28441773.