Cerebral Palsy (cont.)
What is mixed cerebral palsy?
Many (possibly most) children with cerebral palsy have multiple symptoms with
combinations of the various forms of cerebral palsy. For example, children with spastic
cerebral palsy
often continue to have a head lag, which is representative of hypotonia.
Children with choreoathetoid or hypotonic cerebral palsy often have increased deep tendon
reflexes, which are suggestive of some spasticity.
What other conditions are associated with
cerebral palsy?
Since cerebral palsy is indicative of damage to or malformation of the brain, it stands
to reason that other symptoms that are associated with brain dysfunction can be
present in children afflicted with cerebral palsy. In fact other disorders, besides the
motor dysfunctions already described, are almost always seen in these patients.
Some of them such as poor speech, swallowing disorders, drooling, and poor fine
or gross motor coordination are the result of the motor disorder affecting
specific muscles involved in those functions. Other conditions are the results
of simultaneous injuries in areas of the brain besides the motor areas.
Cognitive disabilities, sometimes referred to as developmental delay, is
often associated with cerebral palsy. Up to 50% of patients with cerebral palsy have
cognitive disabilities.
However, many of these children can be educated and lead productive lives. It is
also just as important to note that many children with severe motor impairment
due to cerebral palsy, as is the case with many children with the choreoathetotic or the
diplegic form of cerebral palsy, are only mildly or not at all intellectually impaired.
Virtually all testing of a young child's cognitive development involves some
sort of motor activity on the part of the child. If a child is capable of
complex thoughts, but incapable of motor activity, the observer will not be able
to detect his or her mental aptitude. Therefore, one must be very careful in
assigning labels to patients with cerebral palsy. Certain features, however, are more likely
to be associated with significant cognitive disabilities in the patient with
cerebral palsy.
These include extensive damage occurring on both sides of the brain, children
with spastic quadriplegia, microcephaly (small head size), a documented genetic
disorder, and a documented prenatal infection.
Seizures are a common finding in patients with cerebral palsy. Perhaps a third of all
cerebral palsy
patients have seizures. Seizures are caused by abnormal electrical activity of
the neurons in the brain. The damaged or malformed brain is more prone to
seizures. Moreover, cognitive disability is frequently associated with epileptic
seizures.
The symptoms of seizures can vary depending on where in the brain they
originate. Generalized seizures engage the entire cerebral cortex at once, while
partial seizures only involve part of the cerebral cortex. Often, generalized
seizures begin as partial seizures but spread throughout the brain rapidly.
Generalized seizures may take the form of true convulsions ("grand mal"), in
which the entire body jerks in a rhythmic fashion, or the form of absences
("petit mal"), which interrupt the patient's activities for a brief period, but
does not cause a fall.
Other forms of generalized seizures can occur in the
cerebral palsy
patient. Atonic seizures cause the patient to slump suddenly to the ground or
forward in their chair, resembling a marionette in which the puppeteer suddenly
cut the strings. Tonic seizures are just the opposite and cause the entire body
to suddenly stiffen. Both tonic and atonic seizures can result in drop attacks
in which the patient falls to the ground, often resulting in injury.
Partial
seizures may involve the jerking of the arm and leg on the same side of the
body. Alternatively, they may be associated with strange sensory phenomena, such
as flashing lights, or emotions, such as fear, depending on where in the brain
the seizure occurs.
Vision deficiencies are frequently seen. Some of them, for example,
strabismus ("lazy
eyes") can be corrected by surgical procedures in the muscles of the eyes. Some
can be corrected with eye glasses (that may be difficult to implement in
non-cooperative children). In other children the visual deficiencies are the
result of brain injuries to the areas of the brain that are associated with
vision, rendering the child blind ("cortical blindness") even if the eyes
themselves are perfectly normal. At the present time there is no treatment to
improve this condition.
Children with cerebral palsy can have speech disorders of many types. Some, like poor
word pronunciation (dysarthria), are the result of impairment of the peripheral
mechanism of speech (poor lips, tongue, or palate coordination). In another
circumstance there is brain injury in the gray matter of the brain that
controls the central mechanism of speech (aphasia).
It is difficult for children with cerebral palsy to gain weight and frequently have
delayed growth. This is the result of several factors including feeding
disorders, gastroesophageal reflux, and in some instances,
for example,
children with choreoathetotic disorders, excessive caloric consumption. On the
other, hand obesity could be a problem in those children with
cerebral palsy that have and
limited mobility.
Individuals with the choreoathetotic form of cerebral palsy might have compressed nerves
or damage to the neck bones that can lead to damage to the spinal cord.
Other issues to be aware of are dental diseases, respiratory problems,
urinary
tract infections, osteoporosis and subsequent
fractures,
enuresis, encopresis,
constipation.
Next: How is a child evaluated for cerebral palsy? »
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