Cerebral palsy is neither a disease nor contagious - Gbadebo

By: Chioma Umeha

There is more awareness concerning cerebral palsy and its associated problems today.

Yes, since the past few decades, information on the many facets of cerebral palsy has significantly increased. Today, the medical community has great interest in studying cerebral palsy to determine its causes and the most effective ways to treat it. As knowledge and treatment techniques have expanded and improved, so too have the prospects of all children living with cerebral palsy. There are several misconceptions concerning cerebral palsy. Many are unaware that it is not a disease or illness.

Cerebral Palsy is a term used to describe a group of chronic conditions affecting body movements and muscle coordination. !t is caused by damage to one or more specific areas of the brain, usually occurring during foetal development, or during infancy. It can also occur before, during or shortly after birth.
“Cerebral” refers to the brain and “Palsy” to a disorder of movement or posture. If someone has cerebral palsy it means that because of an injury to their brain (cerebral) they are not able to use some of the muscles in their body in the normal way (palsy). This explains why children with cerebral palsy may not be able to walk, talk, eat or play in the same ways as most other children.

Cerebral palsy is neither progressive nor communicable. It is also not “curable” in the accepted sense, although education, therapy and applied technology can help persons with cerebral palsy lead productive lives. It is important to know that cerebral palsy is not a disease or illness. It isn’t contagious and it doesn’t get worse. Children who have cerebral palsy will have it all their lives.

 Many confuse the disorder with diseases?
Cerebral palsy is a broad term which encompasses many different disorders of movement and posture.
To describe particular types of movement disorders covered by the term, paediatricians, neurologists, and therapists use several classification systems and many labels. To understand the different types of cerebral palsy, one must first understand what experts mean by muscle tone. All children with cerebral palsy have damage to the area of the brain that controls muscle tone. As a result, they may have increased muscle tone, reduced muscle tone, or a combination of the two (fluctuating tone). Consequently, the parts of their bodies are affected by the abnormal muscle tone depends upon where the brain damage occurs.

The three main types of cerebral palsy are: Spastic cerebral palsy – (stiff and difficult movement); athetoid cerebral palsy – (involuntary and uncontrolled movement) and ataxic cerebral palsy – (disturbed sense of balance and depth perception). It is possible that there may be a combination of these types for any one person. In which case the condition would be described as; mixed cerebral palsy.

Give statistics of its occurrence?
Because cerebral palsy influences the way children develop, it is known as a developmental disability. In the United States today, more people have cerebral palsy than any other developmental disability, including Down syndrome, epilepsy, and autism. About two children out of every thousand born have some type of cerebral palsy. Studies have shown that at least 5000 infants and toddlers and 1,200 -1,500 pre-schoolers are diagnosed with cerebral palsy each year.

In all, approximately 500,000 people in the United States have some degree of cerebral palsy. There is still no system in place to monitoring cerebral palsy’s occurrence. However, studies have shown that the use of the electronic foetal heart rate monitor during labour and delivery has not decreased the rate of cerebral palsy primarily because of the mistakes made by doctors and nurses during the birthing process. Though children with very mild cerebral palsy occasionally recover by the time they are school-aged, cerebral palsy is usually a lifelong disability. In most cases, the movement and other problems associated with cerebral palsy affect what a child is able to learn and do to varying degrees throughout their life.

Population-based studies from across the world shows prevalence estimates of CP ranging from 1.5 to more than 4 per 1,000 live births or children of a defined age range. Available records estimate that out of every 1000 births in Lagos, there are 60 with developmental delays which a good number of them are later diagnosed with cerebral palsy (CP) in the country. However, statistics shows that seven out of 10 children are referred to Lagos University Teaching Hospital (LUTH) for neurological developmental assessments have cerebral palsy.
Diagnosis of cerebral palsy
When an infant or child has brain damage, a variety of symptoms can lead doctors and parents to suspect that something is wrong. In the first few months of life, an infant with brain damage may demonstrate some or all of the following symptoms: Lethargy or lack of alertness; irritability or fussiness; abnormal, high-pitched cry; trembling of the arms and legs; poor feeding abilities secondary to problems of sucking and swallowing as well as low muscle tone. The rest are; abnormal posture, such as the child favouring one side of their body; seizures, staring spells, eye fluttering, body twitching and abnormal reflexes. During the first six months of life, other signs of brain injury may also appear in an infant’s muscle tone and posture. These signs include: Gradual change in muscle tone from low tone to high tone; a baby may go from floppy to very stiff; the child may hold his hand in tight fists; there may be asymmetries of movement, that is, one side of the body may move more easily and freely than the other side or the infant may feed poorly, with their tongue forcefully pushing food out of their mouth. Once a baby with brain damage reaches six months, it usually becomes quite apparent that he is picking up movement skills slower than normal. Infants with cerebral palsy are more often slow to reach certain developmental milestones, such as rolling over, sitting up, crawling, walking and talking. Parents are more likely to notice these developmental delays and abnormal behaviours, especially if this is not their first child. Sometimes when they express their concerns to their physicians, their child is immediately diagnosed as having cerebral palsy. More often, however, medical experts hesitate to use the term “cerebral palsy”at first. Instead, they may use such broader terms as: Developmental delay, which means that a child is slower than normal to develop movement skills such as rolling over and sitting up.

It can also be described neuromotor dysfunction, or delay in the maturation of the nervous system.
Some term it motor disability, indicating a long term movement problem, while others say it is a central nervous system dysfunction, which is a general term to indicate the brain’s improper functioning. Some experts describe it as static encephalopathy, meaning abnormal brain function that is not getting worse. What this all means is that a cerebral palsy diagnosis is not made over night. Rather, the condition is diagnosed by a complete examination of your child’s current health status. Doctors will test motor skills and look carefully at his or her medical history. They will also look for slow development, abnormal muscle tone, and unusual posture. When diagnosing CP, doctors must rule out other disorders that can cause abnormal movements. Cerebral palsy does not get worse, in other words, it is not progressive. Based on this fact, doctors must make the determination that your child’s condition is not progressively getting worse. Doctors will also use a number of different specialized tests in diagnosing cerebral palsy. For example, the doctor may order a CT (computed tomography). This is an imaging of the brain that can determine underdeveloped areas of brain tissue. Your doctor may also order an MRI (magnetic resonance imaging). This test also generates a picture of the brain to determine areas that may be damaged. In addition to these imaging tests, intelligence testing is also used. This helps to determine if a child is behind from a mental standpoint. In addition to diagnosing cerebral palsy through a complete and thorough examination of the child’s abnormalities and behaviours, a review of the mother’s pregnancy, labour and delivery and care received is also conducted.

How can early intervention help to ameliorate the condition of those living with cerebral palsy?
Children are our most valuable asset so everything we do to nurture their healthy development is an investment in our future. Due to complications at birth, involving mainly pre-term babies, and because they were born with, exhibit, or are at high risk for developmental delays or disabilities, some children under the age of three need extra attention. For such children, experience has shown that the earlier experts work with them, the more successful they are likely to be in minimizing or, in some cases, totally eliminating future concerns. For those who know the signs, children as young as 10 weeks can easily be identified as having developmental delays. Thereafter, occupational therapists working with other experts can work to determine the nature of the delay and possible implications for the future of the child. Once properly diagnosed, it would then be up to special education teachers to nurture the child and steer him towards maximizing the unique talents which such special children always have. The end result of such a process will be more gifted children and very few unskilled handicapped adults in our society. This is why Benola is committed to Early Intervention as a tool to aid the prevention or reduction of the later effects of developmental delays in children through the provision of support, education and access to resources for affected families.

Many used to confuse developmental disabilities with psychological disorder and as a form of disease. Explain?
Development disabilities can be defined as chronic conditions which develop when the brain of a child is still forming. Developmental disabilities may occur during pregnancy or early childhood or they may occur anytime till a person attains the age of 22. They are birth defects which may hamper the proper functioning of a body part or a body system. Most of the developmental disabilities cannot be medically treated; however with therapy their symptoms can definitely be controlled.

Nervous system disabilities
As the name suggests, nervous system disabilities affect the functioning of the nervous system, spinal cord as well as the brain. A child with nervous system disabilities is most likely to suffer from speech disorders, behavioural disorders, movement disorders and may experience convulsions. His learning, understanding and intelligence, might all be affected due to nervous system disabilities.

Attention deficit hyperactivity disorder (ADHD)
Attention deficit hyperactivity disorder can be identified in children by their inability to concentrate, being forgetful and feeling hyperactive all the time. There are a number of ADHD causes such as changes or malfunctioning of certain brain structures, parents suffering from hypertension or a psychiatric disturbance, chemical poisoning, alcoholism, smoking or drug abuse by the woman when she is pregnant and lastly, exposure of the child to certain environmental toxins like lead, polychlorinated biphenyls, etc.

Another example of nervous system disabilities is autism. Various behavioural and speech disorders may be caused in a child due to autism. Although exact cause of autism is not known, still some researchers are of the opinion that it may be caused due to certain genetic, environmental and neural development factors. Differences in the brain chemicals, known as neurotransmitters are the main cause behind autism. Environmental factors such as exposure to certain chemicals, exposure to drugs, eating certain kind of foods can exacerbate this condition.

Cerebral palsy
Most cases of cerebral palsy develop even before the child is born. Very rarely does it occur during childbirth, although if the baby is premature or is under weight and suffers from intraventricular haemorrhages, it can lead to development of this condition in him. But mostly this condition develops when the brain development of the unborn child is affected when the mother is alcoholic, smokes, takes drugs, is malnourished, is exposed to certain chemicals or suffers any mental of physical trauma when she is pregnant. Some other reasons for a child to develop cerebral palsy are any injury to the brain due to accident, asphyxia, bacterial infections such as encephalitis or exposure to certain chemicals and allergies.

Down syndrome
Down syndrome is a chromosomal disorder caused due to an extra 21st chromosome, resulting in mental retardation as well as malformation in a newly born child.

Congenital rubella syndrome
Congenital rubella syndrome is caused when the rubella virus negatively affects the fetus, mostly during the first trimester of pregnancy. A child who has congenital rubella might be deaf and may even have cataracts in the eye.

Most of these conditions of developmental disabilities have no permanent cure. However, by certain therapies and special education classes, children or people suffering from them can lead better lives. Children suffering from the conditions can go in for speech therapy, physical therapy, occupational therapy and behavioural therapy. A combination of these therapies will help in reducing learning, emotional, social, language and physical problems that a child might be suffering from.

What are the developmental milestones for a normal baby?
Most babies at 10 Weeks, startle to sound, hold up their heads and look at objects. At six months, they reach for objects, turn their heads towards sounds, roll over and are able to hold toys. At nine, they continue to babble, sit alone and can imitate actions. They take their first steps, respond to their own name and play with a variety of toys at one; they walk alone, can build a tower of three blocks, use up to 20 words and enjoy interacting with care-givers at 18 months. When they are two, babies begin to use two-word phrases to communicate, walk up and down the stairs and are able to eat and drink independently. However, if you have any concerns about the development of your child, you should see a doctor at the earliest opportunity, who will direct you to an appropriate specialist.

What are the United Nations (UN) standard rules on the equalization of opportunities for persons with disabilities?
The 58th World Health Assembly resolution on disability, including prevention, management and rehabilitation requests the World Health Organization (WHO) Director – General to provide support to member states in strengthening implementation of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities. WHO supports in particular the implementation of the United Nations Standard Rules and promotes their use for the development of national policies related to disability and rehabilitation. For instance Rule 1 is titled: Awareness-raising, says; “states should take action to raise awareness in society about people with disabilities, their rights, their needs, their potential and their contribution.

What is assistive technology?
Assistive Technology is a generic term for devices and modifications (for persons or within a society) that help overcome or remove a disability. The term is also used to describe any device, software or resource that can increase skills and maximize an individual’s potential due to any of the following: economic limitations, language barrier, cultural differences, educational barriers and the disability itself. Often, there are technologies available that can help increase the opportunities of individuals with developmental disabilities and enhance the quality of their life and families. However, adults and families with children who have special needs, especially those living in developing countries, including Nigeria, often have difficulty accessing conventional resources.

This story was published in Daily Newswatch on April 25, 2013.


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