Cerebral Palsy (CP): FAQs

1. What is Cerebral Palsy?

Cerebral palsy (CP) is characterized by reduced mobility and inability to maintain balance and correct posture. It is caused by abnormal brain development that has an adverse effect on the individual’s ability to control his or her muscles (“Causes and risk factors of cerebral palsy,” 2017). There are a few divisions of CP:

  • hemiplegia affects muscles on right or left side
  • diplegia affects upper or lower body muscles
  • quadriplegia affects the muscles in all limbs

2. What is the prevalence of CP?

About 150 million children are diagnosed with CP, globally. CP is the most prevalent physical impairment in children, and it is estimated to effect 2-3.5 children in every 1,000 live births. The distribution of CP is found to be very unequal, with 80% of the cases affecting low- and middle-income children (Zuurmond et al., 2018).

3. Who is at a higher risk for CP?

Some of the risk factors for CP include:

  • Children that were low birth weight. Children weighing less than 5 ½ pounds at birth are at risk, but children that weighed less than 3 ½ pounds are even more vulnerable.
  • Children born pre-maturely are also at a high risk. If the child was born before 37 weeks they are at risk, but even more so if they were born before 32 weeks.
  • Children that were born with a twin, triplet, etc. are also at a higher risk than a child that was the only birth.
  • Mother’s having infections during the pregnancy such as chicken pox, rubella, or other bacterial infections.
  • A child born with jaundice, which is the buildup of bilirubin. Untreated jaundice causes kernicterus. Kernicterus is a rare form of brain damage that leaves the child vulnerable to CP.
  • A child that is diagnosed with an infection in their brain during infancy, such as meningitis, or encephalitis.
  • A child that experiences brain injury from an accident or abuse.
  • Lack of oxygen flow to the brain which can be caused by strokes, blood clotting disorders, improper development of blood vessels in the brain, heart defects, or sickle cell anemia.

(“Causes and risk factors of cerebral palsy,” 2017)

4. How can I tell that a child has CP?

CP can develop throughout different points of infancy. Therefore, it is important to be aware of the signs that it is developing at different points of infancy. Overall it is important to ensure that the child is reaching crucial developmental milestones such as sitting, crawling, rolling over, and standing. It is also important to examine the child’s muscle tone, especially if the muscles appear stiff or floppy. The child’s posture should also be examined to make sure that the child is able to support themselves. It is also important to take note of excessive drooling and trouble swallowing.

  • Infants younger than 6 months
    • Inability to hold head up when being picked up after lying down.
    • Child may feel stiff or floppy. For example, when they are picked up their legs may go stiff or cross.
    • When holding the child, they may overextend their back or neck, as if to push themselves away from whomever is holding them.
  • Infants from 6 to 10 months old
    • Inability to roll over
    • Unable to bring their hands to their mouth and bringing their hands together
  • Infants older than 10 months
    • Abnormal crawling – if the child moves with only one leg and arm while the opposite leg and arm drag
    • If the child does not crawl on all four limbs. For example, if they move by scooting on their buttocks or hopping on their knees
    • If the child is unable to stand even when they hold onto an object for support.

(“What are they early signs of cerebral palsy,” 2016)

5. What are treatment options for children with CP?

Every patient is different, so it is important to discuss with the physicians and the family to see what treatment options are best for the specific patient.

  • Physical therapy and rehabilitation
    • Occupational therapy to help the child learn how to do every day activities.
    • Recreational therapy to help the child improve their mobility and coordination.
    • Speech and language therapy can improve the child’s pronunciation and help with swallowing. Additionally, speech therapists can come up with new forms of communication – such as sign language or devices.
  • Orthotic devices that can be placed on the affected limbs to help with movement and balance. Some examples are braces, wheel chairs, rolling walkers, and powered scooters.
  • Assistive devices and technologies such as computer-based communication devices, Velcro fastened shoes, and crutches. These devices can help make daily activities easier.
  • Medications have been found to help with CP. Medications that relax stiff or overactive muscles can help. If the child also experiences seizures, epileptic medications can be taken – however it should be known that these medications can have a negative impact on the developing brain.
  • In some extreme cases, the child may require surgery. Surgery can lengthen extremely tight muscles. The surgeon can improve the curvature of the spine or position the limbs better to correct movements. In severe cases, the surgeon can cut nerves to prevent spastic and abnormal movements.

(“What are the treatments for cerebral palsy,” 2016)

6. How can CP be prevented?

All the factors that contribute to the development of CP are not known. However, there are measures that can be taken to reduce the risk of CP in children.

  • Mother’s should seek regular prenatal care during pregnancy.
  • Mother’s should seek medical attention if they become sick at any time during the pregnancy and receive recommended immunizations, especially the flu shot.
  • Once the baby is born it is important to ensure that they receive vaccinations for meningitis, encephalitis, HiB vaccine, and pneumococcal vaccine
  • Ensuring that the child has a safe environment to grow in, in order to prevent injuries to the brain.

(“Causes and risk factors of cerebral palsy,” 2017)

7. What challenges do children with CP face in Africa?

One of the major challenges children with CP face is having access to healthcare in rural areas. In addition, there is lack of knowledge, low quantity of medications, and limitations in diagnostics and screening. The cultural stigma around neurological disorders often results in families not seeking medical attention for the child. Facilities also do not have disability-friendly layouts to accommodate children with CP (Donald et al., 2014). Due to the nature of CP, children are also more vulnerable to malnourishment (Polack et al., 2018).


What was the context of the research

Cerebral palsy (CP) affects a large number of children, globally. Not only does CP present problems with brain development, but it also leaves children vulnerable to other adverse health effects, such as malnourishment. Cerebral palsy compromises motor functioning, which affects chewing, food ingestion, and the ability to self-feed. Children with CP require a high level of assistance during feeding and caregivers have reported issues with drooling and choking. The well-being of the caregiver is influenced by the stress associated with the high level of care required when feeding a child with CP. The difficulties associated with feeding may seem daunting to the caregiver, and thus further contribute to reduced nutritional intake. In turn, malnourishment aggravates the symptoms of CP by further reducing muscle strength, decreasing immunity functioning, and exacerbating declines in brain development. In a study conducted by Polack et al., researchers estimated the occurrence of malnutrition, discovered the difficulties associated with feeding children with CP, and analyzed the caregiver’s quality of life (QoL).

What were the methods of the research

The cross-sectional study consisted of 76 children with CP. The children had to have a confirmed diagnosis by a pediatrician or a physiotherapist and be aged between 18 months and 12 years. Data was collected in Upper East, Greater Accra, Brong Ahafo, and Ashanti. Data on the demographics of the children, their caregivers, and the severity of CP was collected through a questionnaire. The severity of each child’s CP was organized using the Gross Motor Function Classification System. Feeding difficulties, such as choking and eating enough, were assessed through a questionnaire that required the caregiver to rank the difficulties of feeding from “never” to “always.” To uncover the nutritional state of the children, anthropometric measures were taken. The care giver’s quality of life (QoL) was measured by utilizing the Pediatric Quality of Life Inventory Impact Module, which addressed issues of physical, emotional, social, and cognitive functioning, communication, worry about daily activities, and family relationships.

What did the study find

Polack et al., established that caregivers do face difficulties when feeding the child and are worried about the nutritional state of the child. 75% of the caregivers answered that the child “always” needed assistance when being fed. About two-thirds were “always” worried about feeding the child, and 50% were “always” concerned that the child was not eating adequately.

In regard to malnutrition, there was a high prevalence of malnourishment. For children under five years old, 65% were underweight, 54% experienced stunted growth, and 58% were wasted, meaning they had low weight for their height. Wasting is a strong indicator of child mortality for children under the age of five. There were similar results for older children. For children between 5 and 10 years old, 56% were stunted in their growth ad 63% were underweight.

The main risk factors for the child being underweight were difficulties associated with feeding and severity of CP. In this study, if a child was reported to have a higher level of difficulty when feeding, they were 10.7 times more likely to be underweight. 71% of children with severe cases of CP were underweight, while 43% of children with mild cases of CP were underweight.

Overall, the caregivers in this study had a low QoL with a median score of 12.5 out of 100 on the Pediatric Quality of Life Inventory Impact Module. Caregivers that reported high levels of difficulty feeding had a median score of 9, which is much lower than those who reported the least amount of difficulty when feeding and scored 24.6. Caregivers who cared for children that were underweight scored 10.8, and caregivers that cared for children who were not underweight scored 11.8.

What were the conclusions of the study

The study found that two thirds of the sample were malnourished and one third was severely malnourished. The proportion of children underweight in this study is 6 times the national average in Ghana. Additionally, lower QoL in caregivers who reported greater difficulties in feeding adds to already existing research that feeding children with CP is stressful for the caregiver. Polack et al., exemplified that malnourishment is an issue that needs to be addressed for children with disabilities. Moving forward, it is crucial to improve training for caregivers of children with CP in order to improve the nutritional status of the children, and the well-being of the caregivers.

Keywords

Cerebral palsy, caregiver, quality of life, malnutrition, Ghana, disabilities

Link

https://onlinelibrary.wiley.com/doi/epdf/10.1111/dmcn.13797

What is it talking about overall?

Caregiver qol, health status of children with CP, difficulties with children with CP