Cerebral Palsy: Epidemiology and Etiology

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Table of Contents

Abstract
Defining Cerebral Palsy
Epidemiology of Cerebral Palsy
Etiology of Cerebral Palsy
Signs and Symptoms
Treatment and Prevention Measures
Asphyxia
ECMO
ECMO vs. Standard Care
Reference List

Abstract

Cerebral palsy (CP) is a major condition affecting many children in different parts of the world. This condition is caused by a number of factors such as asphyxia, accidents, birth complications, and pregnancy-related diseases. This paper, therefore, gives a detailed analysis of this condition. It begins by describing the epidemiology and etiology of CP. The major signs and symptoms of the condition are also described. The best treatment and prevention methods for CP are also discussed. The essay also discusses asphyxia and Extracorporeal Membrane Oxygenation

Defining Cerebral Palsy

Carr (2005) defines cerebral palsy (CP) as “a general term given to different neurological conditions that affect child coordination and movement” (p. 507). The conditions are characterized by persistent movement disorders. Physicians believe strongly that cerebral palsy arises from various problems affecting some parts of the brain that control coordination. This fact explains why abnormal brain development or damage can result in CP. Brain damage can occur during or immediately after birth. These conditions make it impossible for the affected individuals to have normal lifestyles. A study by McAdams and Juul (2011) indicated that one in every 400 citizens in the world was affected by this condition. Children “with cerebral palsy tend to exhibit at least one co-occurring condition” (McAdams & Juul, 2011, p. 6). For instance, 41 percent of individuals with condition exhibit cases of epilepsy in the United States (Novak, 2014). A small percentage of children with CP also show signs of Autism Spectrum Disorder (Novak, 2014). This means that children with CP have increased chances of having epilepsy or Autism Spectrum Disorder (ASD). Similar trends have also observed in different parts of the globe.

Epidemiology of Cerebral Palsy

According to the Centers for Disease Control and Prevention (CDC), cerebral palsy remains the leading cause of motor disability in many young children across the globe (Facts About Cerebral Palsy, 2016). Studies have indicated that around 1 to 4 babies in every 1,000 births portray signs of cerebral palsy (Facts About Cerebral Palsy, 2016). The affected children encounter a wide range of movement difficulties. A study conducted by the CDC in 2008 indicated that over 58 percent of individuals with the condition were able to walk without any support (Facts About Cerebral Palsy, 2016). The study also showed that 30 percent of the babies lacked (or had limited) walking abilities. The remaining percentage was observed to walk using different hand-held devices.

CP is therefore one of the most common causes of childhood disability. New studies have also been undertaken in order to understand the prevalence of this condition in different parts of the world. For instance, statistics from the US indicate that over 0.7 million people (children and adults) have CP (Facts About Cerebral Palsy, 2016). The condition also affects children below the age of 18. This means that more children are affected by cerebral palsy (Novak, 2014). A study conducted by the CDC indicated that around 10,000 annual births will result in cases of CP (Facts About Cerebral Palsy, 2016). This means that 10,000 infants are usually diagnosed with the condition every year in the United States (Novak, 2014).

Carr (2005) also observes that most of the studies conducted within the past two decades have presented differing results. Recent studies have indicated that between 2.3 and 3.6 children out of every 1,000 newborns will develop the condition (Facts About Cerebral Palsy, 2016). Studies have indicated that the most common one is Spastic Cerebral Palsy. This is the case because the condition constitutes over 60 percent of all CP-related cases. Spastic Cerebral Palsy has also been subdivided into unilateral, unaccounted, and bilateral (Carr, 2005). Experts argue that a fraction of babies born with the condition die a few days after birth (McAdams & Juul, 2011). New studies are also being conducted in order to have a clear understanding of the prevalence and epidemiology of CP.

Etiology of Cerebral Palsy

The etiology of cerebral palsy is something that has fascinated many researchers, child psychologists, and health specialists. CP is “caused by disruption or abnormality in brain development” (McAdams & Juul, 2011, p. 6). This kind of disruption is observed to occur before childbirth. The leading trigger of such abnormalities is something that is still unknown. The brain of an infant develops during pregnancy and after birth (Novak, 2014). Any form of injury before, during, or even after childbirth will cause CP. The nature and intensity of the injury will significantly determine the severity of the condition.

This “damage during brain development affects the child’s muscle control, reflex, posture, coordination, and tone” (McAdams & Juul, 2011, p. 8). As well, the damage can affect the child’s fine and gross motor skills. The “oral motor functioning is also affected thus making it impossible for the child to have a normal development” (Facts About Cerebral Palsy, 2016, para. 5). Scientists have undertaken new studies in order to understand the major causes of brain damage that have the potential to cause CP.

Environmental and genetic forces have been observed to affect brain development. This is also known as prenatal disturbance whereby specific cells fail to move to their designated locations. Brain functioning is affected when “poor insulation fails to provide adequate covering over nerve cells that play a critical role in transmission” (McAdams & Juul, 2011, p. 7). Some events during birth disrupt the functioning of the brain. Poorly managed birth processes damage blood vessels. This development results in a situation whereby the brain fails to get enough oxygen. This situation is known as asphyxia. Synapses occurring between brain cells can occur due to an infection or trauma (Collet et al., 2001). An accident can also occur thus resulting in head injury. The affected infant will develop numerous problems due to poor brain development.

Certain health issues and infections during pregnancy increase chances of giving birth to babies with CP (McAdams & Juul, 2011). Some of these “infections include taxoplasmosis, syphilis, cytomegalovirus, and varicella” (Collet et al., 2001, p. 583). Pregnant women exposed to various toxins such as mercury, lead, and methyl have higher chances of giving birth to babies with CP. Some diseases affecting newborn babies such as viral encephalitis, bacterial meningitis, and jaundice can cause CP (Facts About Cerebral Palsy, 2016). Premature births can increase the chances of cerebral palsy. People should therefore be aware of these predisposing factors in order to engage in the best health practices.

Signs and Symptoms

According to O’Shea (2008), some signs and symptoms of cerebral palsy might be unnoticeable at birth. However, some of the signs will become visible as the child grows. That being the case, the signs of CP in newborns might be different from those exhibited by older children. To begin with, babies show a number of signs that can suggest they have CP. Affected babies tend to feel light and floppy. The children will also be unable to support their heads in an upright position. Muscle spasms during early childhood can be indicative of cerebral palsy. Poor postures and inabilities to control muscles are common among babies with the condition (Facts About Cerebral Palsy, 2016). The other common sign of the condition is delayed child development. A child with the condition is unable to sit up after six months (Collet et al., 2001). Babies with this condition have numerous swallowing problems. Feeding also becomes a major challenge for the mother.

The severity of the CP will dictate the signs and symptoms portrayed by the affected child. It is also agreeable that the brain injury will not aggravate with age (Ashwal et al., 2004). Toddlers with severe types of CP will be unable to walk by the age of 12 months. The “affected toddler might also be unable to speak simple sentences by the age of 2 years” (O’Shea, 2008, p. 818). The affected child might be unable to coordinate certain motions. For example, the toddler might be unable to pick up a stick or spoon (Aisen et al., 2011). Drooling is also common among the affected children. Delays in different motor skills such as sitting up, pushing, and crawling are clear signs of cerebral palsy (O’Shea, 2008).

Some neurological signs and symptoms have been noted in children with this condition. The affected individuals might have hearing and seeing difficulties. Seizures might also affect people with the disease. Oral diseases tend to occur frequently (Collet et al., 2001). Psychiatric conditions might also be observed in individuals with CP. A small percentage of people with CP might show signs of ASD and epilepsy. Intellectual disabilities make it impossible for children with CP to achieve their academic goals. Brain abnormalities contribute to neurological challenges such as touch misperceptions and urinary incontinence (O’Shea, 2008).

The symptoms and signs of exhibited by different persons depend on the type of cerebral palsy. Cerebral palsy is categorized into two broad groups. The first group focuses on how the condition affects different body parts and movement (Aisen et al., 2011). Bilateral cerebral palsy is subdivided further into diplegia and quadriplegia. Diplegia occurs when both legs are affected by the condition. Quadriplegia is when all the legs and arms are affected. Hemiplegia is “the unilateral form of CP whereby one side of the child’s body is affected by the condition” (O’Shea, 2008, p. 817). This means that the leg and arm on one same side are affected (Ashwal et al., 2004).

The second broad category of CP is based on the severity of the condition. The most common one is Spastic Cerebral Palsy. This category affects between 65 and 75 percent of people with CP (Aisen et al., 2011). The child’s muscles usually feel uncomfortable and tight. It occurs after the motor cortex has been damaged. Dyskinetic cerebral palsy “occurs when the basal ganglia in the brain is damaged” (Ashwal et al., 2004, p. 856). This condition is characterized by involuntary movements of different body parts. The third type is given the name ataxic cerebral palsy. This kind of CP is rare and constitutes around 6% of individuals with the condition (O’Shea, 2008). Ataxic CP is usually characterized by shaky body movements. Individuals affected by the condition are usually unable to have proper balance. They also lose their sense of space because the cerebellum is damaged.

Treatment and Prevention Measures

Cerebral palsy is a complicated condition that should be treated using appropriate methods. The condition requires long-term care in order to support the health needs of the affected persons. A competent medical team is necessary in order to get the best results. The teams should be composed of neurologists, pediatricians, orthopedic surgeons, physical therapists, and social workers (Ashwal et al., 2004). Children should receive quality support from special education teachers. Such educators will address the educational needs of the affected individuals. The teacher outlines the best resources and tools that can deliver the targeted outcomes (Carr, 2005). The role of a speech pathologist is to diagnose and treat every form of language disorder. The professional collaborates with different members of the medical team in order to support the affected child.

Medications are also widely used to manage most of the complications and pains associated with CP. Effective medicines have the potential to promote various functional abilities. Complications arising from different CP symptoms such as spasticity can be managed using a wide range of medicines. Carr (2005) encourages parents and guardians to be aware of the problems affecting their children before selecting the most appropriate medicines. Some symptoms of CP affect specific muscles or the entire body. That being the case, doctors should consider such symptoms before administering the most appropriate drugs.

Isolated spasticity can be treated using Botox (onabotulinumtoxin). This drug is used to improve drooling (Butt & MacLaren, 2013). However, Botox injections can result in weakness, terminal pain, and bruising. The drug can also cause difficulties in swallowing and breathing. Spasticity affecting the whole body should be treated using appropriate medicines such as Dantrium, Gablofen, and Valium (McAdams & Juul, 2011). According to experts, Valium (or diazepam) should never be used for long because it causes dependency. The “common side-effects of the drug include drooling, weakness, and drowsiness” (O’Shea, 2008, p. 822). Dantrium can cause diarrhea and prolonged nausea. Some medicines such as scopolamine and trihexyphenidyl can be prescribed to deal with drooling.

Therapies have the potential to support the health needs of many individuals with cerebral palsy. Such therapies make it possible for more children to improve their functional abilities. Carr (2005) believes strongly that physical therapy can produce positive results. This kind of therapy focuses on exercises. Muscle training will result in increased flexibility, motor development, balance, coordination, and mobility. Splints or braces can also be used to support the needs of the child. Such tools will ensure the muscles do not remain rigid. Experts believe that such therapies can also result in improved motor development.

Occupational therapists can also use appropriate equipment and tools to ensure more children engage in various activities. For instance, electric wheel chairs and walkers can make it easier for affected children to engage in various activities. Such adaptive equipment increases the level of mobility and motor development (Collet et al., 2001). Language therapy is also relevant for children who cannot speak fluently. Speech pathologists should analyze the unique needs of the identified toddlers. Such pathologists will encourage their children to use a number of communication devices. The commonly used devices include voice synthesizers and computers. These devices will improve the children’s ability to respond to different questions and communicate with their peers. Butt and MacLaren (2013) argue that appropriate speech therapies can address various problems associated with body muscles. Surgery is also recommended when the cases of CP are severe. Deformities and contractures should be rectified using orthopedic surgery. Surgical procedures can strengthen different muscles and eventually improve mobility. Such operations make it possible for the individuals to use crutches and walkers.

According to physicians, chances of preventing cases of CP are non-preventable. However, parents can minimize chances of having affected babies. One of the widely accepted prevention methods is vaccination against certain infections such as rubella. Pregnant mothers should engage in positive health lifestyles and get proper pre-natal support (O’Shea, 2008). Parents should also support the developmental stages of their children.

Asphyxia

Carr (2005) explains how asphyxia is a potential cause of cerebral palsy. Asphyxia is “a rare occurrence whenever the body and brain of a baby receives inadequate (or no) oxygen” (p. 514). This loss of oxygen remains a major challenge that can result in death or physical disfigurement. Several years ago, asphyxia was believed to be the main cause of cerebral palsy among newborn babies. Modern scientists have indicated conclusively that asphyxia causes 7 percent of all CP cases.

Several events are known to cause asphyxia during birth. A prolapsed umbilical cord can choke the newborn child thus resulting in injury or death (O’Shea, 2008). Prolonged bleeding during or before delivery can also result in asphyxia. Abnormal child presentation during birth is another potential cause of this condition. Shoulder dystocia is also a common cause of birth asphyxia during birth (Collet et al., 2001). Maternal shock can result in fetal distress and bleeding. Such occurrences can result in placenta abruption thus causing asphyxia.

ECMO

Extracorporeal Membrane Oxygenation (ECMO) is “a healthcare procedure whereby a machine is used to do the work of the heart and the lungs” (Butt & MacLaren, 2013, p. 3). This method is used to support children and adults who are extremely weak. Newborn babies showing signs of cerebral palsy can also be supported using this machine. ECMO is a powerful method that makes it possible for the baby to recover and rest (Zwischenberger & Lynch, 2009). It should be observed that the machine does not heal the lungs or the heart. However, it makes it easier for the organs to heal and eventually function effectively. The method is therefore appropriate for patients whose hearts or lungs fail to respond to various treatments.

ECMO vs. Standard Care

The use of ECMO has led to numerous debates within the medical profession. Studies have indicated clearly that ECMO is a powerful method that can support individuals with severe conditions such as Acute Respiratory Distress Syndrome (Zwischenberger & Lynch, 2009). The machine is appropriate when the other methods of ventilation become unsafe or insufficient. Some experts encourage doctors to embrace the power of standard care (Butt & MacLaren, 2013). The patient’s health situation should therefore be considered before selecting the best treatment method. ECMO might be a controversial machine for supporting different patients. However, the method can improve the healing process and eventually supporting the health needs of many people.

Reference List

Aisen, M., Kerkovich, D., Mast, J., Mulroy, S., Wren, T., Kay, R.,…Rethlefsen, S. (2011). Cerebral palsy: clinical care and neurological rehabilitation. The Lancet, 10(9), 844-852.

Ashwal, S., Russman, B., Blasco, P., Miller, D., Sandler, M., Shevell, M.,…Stevenson, R. (2004). Practice Parameter: Diagnostic assessment of the child with cerebral palsy. American Academy of Neurology, 62(1), 851-863.

Butt, W., & MacLaren, G. (2013). Extracorporeal Membrane Oxygenation. F1000Prime Reports, 5(55), 1-17.

Carr, L. (2005). Definition and classification of cerebral palsy. Developmental Medicine and Child Neurology, 1(8), 508-518.

Collet, J., Vanasse, M., Marois, P., Amar, M., Goldberg, J., Lambert, J.,…Majnemer, A. (2001). Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. The Lancet, 357(9256), 582-586.

Facts About Cerebral Palsy. (2016).

McAdams, R., & Juul, S. (2011). Cerebral Palsy: Prevalence, Predictability, and Parental Counseling. NeoReviews, 12(10), 1-19.

Novak, I. (2014). Evidence-Based Diagnosis, Health Care, and Rehabilitation for Children with Cerebral Palsy. Journal of Child Neurology, 29(1), 1141-1156.

O’Shea, T. (2008). Diagnosis, treatment, and prevention of cerebral palsy. Clinical Obstetrics and Gynecology, 51(4), 816-828.

Zwischenberger, J., & Lynch, J. (2009). Will CESAR Answer the Adult ECMO Debate. Lancet, 374(1), 1307-1308.

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