CEREBRAL SPASTIC PARALYSIS

DEFINITION

Cerebral palsy is characterised by an injury to the immature brain (before the age of two) that causes movement problems in the limbs. In some cases, deformities of the limbs may occur due to weakened muscles. Children with cerebral palsy may have impaired cue sensitivity and, in severe cases, impaired cognitive development, which affects the child’s intelligence. Cerebral palsy can be caused before, during or after birth, often due to birth asphyxia or prematurity.

Cerebral palsy is increasingly prevalent in developed countries. These countries have more and more resources and more and more premature babies are surviving, in many cases with sequelae such as paralysis.

Cerebral palsy is a neurological disorder that affects a person’s ability to move and control their movements. It can be caused by a number of different factors, including:

  1. Injuries during labour or birth: Injuries during labour or birth, such as lack of oxygen during birth, can damage the brain and cause cerebral palsy.

  2. Infections during pregnancy: certain infections during pregnancy, such as rubella virus or cytomegalovirus, can affect the baby’s brain development and cause cerebral palsy.

  3. Head injuries: Head injuries, such as those from car accidents or falls, can damage the brain and cause cerebral palsy.

  4. Genetic disorders: Some genetic disorders, such as Down’s syndrome, can increase the risk of developing cerebral palsy.

It is important to note that in many cases, the exact causes of cerebral palsy are not known. Some people may be born with cerebral palsy without an obvious cause.

There are different types of cerebral palsy, and they are divided into two main types:

  • Neurological types of cerebral palsy:
    • Spastic: this is the most common form of cerebral palsy. It is characterised by some muscles being stiff or tense (with increased muscle tone).
    • Dystonic-athetoid: this is the type of paralysis in which the limbs show involuntary movements.
  • Anatomical types of spastic cerebral palsy. Depending on which limbs are affected, there are three types:
    • Hemiplegic: This is when the limbs, upper and lower, on the same side are affected.
    • Tetraplegic: affects all four limbs.
    • Diplegic: affects only the lower limbs.

Evaluation

In order to provide appropriate treatment, a good assessment is necessary. The weakness of the affected muscles or heterogeneity of the spasticity makes the patient’s evolution complex. Therefore, it is necessary to assess the patient multiple times in order to make the best decision about treatment, including sensitivity and strength testing.

Limb function is assessed by performing a function test. These tests are done before and after surgery in order to assess the patient’s improvement.

It is very important to establish functional goals for the treatment, which will be established according to which tasks or activities of daily living are most relevant for the patient.

SPASTIC HEMIPARESIS: PROBLEMS WITH THE UPPER LIMB

EXTREMIDAD SUPERIOR CON TERAPIA ESPÁSTICA

Half of the patients experience a decreased tactile sensitivity in the upper extremity due to cerebral palsy.

In these cases we also see that some muscles are tight (spastic muscles) and others are weak, which makes it difficult for patients to move. Because of spastic hemiparesis, children have motor problems such as: having an “unnatural” position of the limb, experiencing less joint balance (poor range of motion), difficulty in hand functions such as grasping or manipulating objects, change in aesthetic appearance.

There are patients with cerebral palsy who have all four limbs affected. These are usually the people with the most severe forms of the condition. With surgery, the aim is to increase joint balance in order to give the patient a better quality of life, improve body hygiene and facilitate care.

The improved hygiene comes about because, with surgery to lengthen various muscles and tendons, it allows the joints to open up. This means that there are no longer any folds, where infections and rashes are common due to sweating and rubbing.

NON-SURGICAL TREATMENT

This condition requires multiple disciplines such as occupational therapists, physiotherapists, orthopaedic surgeons, nutritionists and neurologists. As mentioned above, each patient is affected to a different degree by cerebral palsy. As a result, treatments can be many and varied. One form of non-surgical treatment is physiotherapy, botulinum toxin and occupational therapy. It is important to assess the patient periodically, to monitor their recovery and whether they need further treatment.

With occupational therapy, what we want to achieve is to help patients develop tools and techniques to help them carry out activities of daily living. Physiotherapy, through passive joint exercises and splints, will prevent muscles from shortening and help mobility.

Botulinum toxin helps to relax the muscles, and is administered by puncturing spastic (tight) muscles. It is a treatment usually used when patients are 8 years old or younger, prior to surgery. The effect of this treatment lasts between 4 and 6 months, although it may stop being effective after multiple punctures.

SURGICAL TREATMENT

Treatment for cerebral palsy may include a combination of medical, physical, occupational and life skills therapies. In some cases, surgical treatment may also be recommended. Types of surgery that may be helpful for cerebral palsy include:

  1. Orthopaedic surgery: to correct bone or muscle deformities that may limit mobility.
  2. Bladder and bowel surgery: to treat bladder and bowel control problems that are common in people with cerebral palsy.
  3. Brain stimulation surgery: involves placing electrodes in the brain to stimulate certain areas and improve motor function.
  4. Physiotherapy surgery: to correct spinal deformities or improve posture.

It is important to note that not all people with cerebral palsy will need surgery and that the choice of treatment depends on individual factors, such as the severity of the cerebral palsy and the specific needs of each person. It is important to talk to a doctor or health care team about the treatment options available and how they can help improve quality of life.

The treatment of cerebral palsy may include medical, physical, and occupational therapies. In some cases, surgery may also be recommended. Types of surgery that may be useful include orthopedic, bladder and intestine, brain stimulation, and physical therapy. Not all people with cerebral palsy will need surgery and it is important to speak with a doctor about available treatment options. Contact us for more information!

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