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Birth Injuries
Cerebral palsy is a broad term used to describe a group of chronic disorders impairing control of movement that appear in the first few years of life and generally do not worsen over time. The term cerebral refers to the brain's two halves, or hemispheres, and palsy describes any disorder that impairs control of body movement. Thus, these disorders are not caused by problems in the muscles or nerves. Instead, faulty development or damage to motor areas in the brain disrupts the brain's ability to adequately control movement and posture.
Symptoms of Cerebral Palsy
Symptoms of cerebral palsy lie along a spectrum of varying severity. An individual with cerebral palsy may have difficulty with fine motor tasks, such as writing or cutting with scissors; experience trouble with maintaining balance and walking; or be affected by involuntary movements, such as uncontrollable writhing motion of the hands, or drooling. The symptoms differ from one person to the next, and may even change over time in the individual. Some people with cerebral palsy are also affected by other medical disorders, including seizures or mental impairment. Contrary to common belief, however, cerebral palsy does not always cause profound handicaps. While a child with severe cerebral palsy might be unable to walk and need extensive, lifelong care, a child with mild cerebral palsy might only be slightly awkward and require no special assistance. Cerebral palsy is not contagious nor is it usually inherited from one generation to the next. At this time, it cannot be cured, although scientific research continues to yield improved treatments and methods of prevention.
Spastic cerebral palsy
In this form of cerebral palsy, which affects 70 to 80 percent of patients, the muscles are stiffly and permanently contracted. Doctors will often describe which type of spastic cerebral palsy a patient has, based on which limbs are affected. The names given to these types combine a Latin description of affected limbs with the term plegia or paresis, meaning paralyzed or weak.
When both legs are affected by spasticity, they may turn in and cross at the knees. As these individuals walk, their legs move awkwardly and stiffly and nearly touch at the knees. This causes a characteristic walking rhythm, known as the scissors gait.
Individuals with spastic hemiparesis may also experience hemiparetic tremors, in which uncontrollable shaking affects the limbs on one side of the body. If these tremors are severe, they can seriously impair movement.
Athetoid, or dyskinetic, cerebral palsy
This form of cerebral palsy is characterized by uncontrolled, slow, writhing movements. These abnormal movements usually affect the hands, feet, arms, or legs and, in some cases, the muscles of the face and tongue, causing grimacing or drooling. The movements often increase during periods of emotional stress and disappear during sleep. Patients may also have problems coordinating the muscle movements needed for speech, a condition known as dysarthria. Athetoid cerebral palsy affects about 10 to 20 percent of patients.
Ataxic cerebral palsy
This rare form affects the sense of balance and depth perception. Affected persons often have poor coordination; walk unsteadily with a wide-based gait, placing their feet unusually far apart; and experience difficulty when attempting quick or precise movements, such as writing or buttoning a shirt. They may also have intention tremor. In this form of tremor, beginning a voluntary movement, such as reaching for a book, causes a trembling that affects the body part being used and that worsens as the individual gets nearer to the desired object. The ataxic form affects an estimated 5 to 10 percent of cerebral palsy patients.
Mixed forms
It is common for patients to have symptoms of more than one of the previous three forms. The most common mixed form includes spasticity and athetoid movements but other combinations are also possible.
What is Erb's Palsy?
Erb's Palsy is a term used to cover a number of paralyses to the arm.
This injury can occur when a baby is trapped by its shoulder behind the mother's pelvis after the head been delivered. Fragile nerves in the child's neck and arm may be over-stretched or torn from the spinal cord in the effort to deliver the baby. As our diet has improved, the birth weight has risen while the female pelvic anatomy has remained the same. We know babies weighing 4.5 kilos and more can be at risk, though this birth trauma can happen to smaller babies.
There are three main categories of injury:
Erb's Palsy
This is a paralysis of the fifth (C5) and sixth (C6) cervical nerves. Outward signs are that the arm is turned towards the body, the elbow does not bend and the hand is in a "waiters tip" (turning backwards) position.
Klumpke's Palsy
This is a paralysis of the seventh (C7) and eight (C8) cervical and first thoracic (T1) nerves. Outward signs and that the hand is limp, the fingers do not move and there is often an associated Horner's Syndrome.
Horners Syndrome is when the eyelid droops, the cheek does not sweat and the pupil is smaller than the unaffected eye.
Complete Brachial Plexus Paralysis
This is when all five nerves, termed as the brachial plexus, are affected. The entire arm from the shoulder down is paralysed, there is often an associated Horner's Syndrome. Demonstrable sensory lossin the arm is present and there can be an associated Torticollis. Torticollis is when the baby faces toward his good side and is unable to face forward for any length of time.
How does Erb's Palsy occur?
The cause of Obsterical Erb's Palsy is mainly due to trauma at birth. Although large (macrosomic) babies are more likely to develop shoulder dystocia because their shoulders become trapped under the pubic bone, most cases of Erb's Palsy do not occur in large babies. The Palsy occurs when there is traction on the shoulder underneath the pubic arch. This can often cause the head to stretch too far away from the shoulder and hence tension is placed on the brachial plexus.
This tension may stretch or even pull apart the fibres within one or more nerves. Extreme force on the plexus may rupture nerves entirely or tear them from the spinal cord.
How do I know how severe the injury is?
A high proportion of babies (approx, eighty percent) recover in the first three months, however, there are twenty percent who are left with someresidual paralysis. It is believed that recovery can be gauged by the contractions of biceps and deltoid muscles which are as follows:
Complete: Start at one month and are nomal by two months.
Good: Start by three months and are complete by five months.
Average: Start after three months.
However, having said that, recover largely depends on the extent of injury. The nerves within the brachial plexus can be simply bruised, stretched, or if the injury is severe they can be torn away at the spine. Each child is an individual and can have only bruising, a minture of bruising and tearing, or tearing and total severing of the nerves.
Is there any treatment?
Some brachial plexus injuries may heal on their own. Many children improve or recover by 3 to 4 months of age. Treatment for brachial plexus injuries includes physical therapy and, in some cases, surgery.
What is the prognosis?
The site and type of brachial plexus injury determine the prognosis. For avulsion and rupture injuries there is no potential for recovery unless surgical reconnection is made in a timely manner. For neuroma and neuropraxia injuries the potential for recovery varies. Most patients with neuropraxia injuries recover spontaneously with a 90-100% return of function.
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Resources
National Institute of Neurological Disorders and Stroke (NINDS)
Hemikids
Ontario Federation for Cerebral Palsy (OFCP)
Cerebral Palsy Association of British Columbia
Cerebral Palsy Canada
Scope
Welcome to Cerebral Palsy Action
Cerebral Palsy Association of Western Australia
Cerebral Palsy Support Network
Cerebral Palsy Society of NZ
Tradewinds Foundation for Cerebral Palsy
Cerebral Palsy Support Network
United Cerebral Palsy Homepage
United Cerebral Palsy Association of Eastern Connecticut
UCP of Southern Maryland, Inc.
United Cerebral Palsy Greater Houston
UCP in South Florida
United Cerebral Palsy of New York City
United States Cerebral Palsy Athletic Association Home
American Academy for Cerebral Palsy and Developmental Medicine
North American Growth in CP Project |
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