Cerebral Palsy (cont.)
What are the types of cerebral palsy?
Based upon the form of motor impairment, cerebral palsy can be divided into types:
- spastic cerebral palsy,
- choreoathetoid cerebral palsy, and
- hypotonic cerebral
palsy.
These categories are not rigid,
and the majority of patients probably have a mixture of these.
What is spastic cerebral palsy?
Spastic cerebral palsy refers to a condition in which the muscle tone is
increased, causing a rigid posture in one or more extremities [arm(s) or leg(s)]. This rigidity
can be overcome with some force, ultimately giving way completely and suddenly
-- very much like the familiar jackknife (or clasp knife). The spasticity leads
to a limitation of use of the involved extremity, largely due to the inability
to coordinate movements. Often the spasticity occurs on one side of the body
(hemiparesis), but it can also affect the four limbs (quadriparesis) or be
limited to both legs (spastic diplegia). When the condition occurs in both legs,
the individual often has a scissoring posture, in which the legs are extended
(straightened) and crossed.
Besides the increased muscle tone there is also increased deep tendon
reflexes, impaired fine and gross motor coordination, muscle weakness, and
fatigability among other problems.
Spasticity is often the result of damage to the white matter of the brain,
but it can also be due to damage of gray matter.
The degree of spasticity can vary, ranging from mild to severe. Children who
are mildly affected may experience few limitations of their function while
severely affected children may have little to no meaningful use of the affected
limb(s). Spasticity, if not properly treated, can result in contractures, which
are permanent limitations in the ability of joint movement. Contractures can be
greatly limiting in the care of children with cerebral palsy. Spasticity can also be quite
painful, requiring medication to relax the muscle tone.
The same fundamental processes that influence spasticity of the limbs can
also result in abnormalities of movement and muscle tone in other body systems. In
the muscles of the head and face, for example, cerebral palsy can greatly limit the
coordination and production of speech, even when the child is perfectly capable
of understanding speech. There can also be limitations of chewing, swallowing,
and facial and eye movements. These symptoms can be particularly troubling for
afflicted children and their families.
Many patients with spastic cerebral palsy cannot control their output of urine. This
inability is not necessarily due to problems in thinking but is caused by
heightened reflexes of the bladder. When the bladder fills in these children, it
is just like tapping on it with a reflex hammer, thus making it contract more
vigorously than normal and causing a spilling of urine. This incontinence can be
quite embarrassing, especially in a cognitively intact child.
Next: What is choreoathetoid cerebral palsy? »
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