What is Cerebral Palsy?
It's pretty well-established that your brain is a critical part. It's like if your body was a computer and your brain is the mainframe. It controls everything whether you're aware of it or not. Cerebral palsy means brain disease causing paralysis. So inherently cerebral palsy refers to the damage to the brain that causes loss of muscle control.
Like for example if the cerebellum was damaged, patients might have issues with fine motor skills like writing or typing. That being said though cerebral palsy is a broad umbrella term to cover a wide variety of issues. Since ultimately the muscles are affected in severity, so it depends on which part of the mainframe has been affected.
Cerebral palsy is considered a neurodevelopmental disease meaning that something happens to an area of the brain during its initial development which is an extremely sensitive period. If that area doesn't develop right then, it can't carry out whatever function it's supposed to control.
The majority of cerebral palsy cases are thought to happen before birth or prenatally, which typically means the underlying cause is really hard to pin down. Exposure to radiation or infection during fetal development can cause cerebral palsy. In this case, the developing brain doesn't get enough oxygen potentially from problems like the placenta not being able to supply enough oxygen and nutrients.
Cerebral palsy doesn't have to happen prenatally, though in some postnatal cases like head trauma, infection. A very small proportion of cases are due to a genetic mutation. Even though this brain damage or injury or abnormality is permanent, one super important point to remember about cerebral palsy is that it doesn't get worse over time and for that reason it's considered a nonprogressive disease.
Types of Cerebral Palsy:
Cerebral palsy is classified by the type of muscle movements that result, from the brain injury and how that affects what activities the patient can perform. And on the basis of this, there are two types of Cerebral Palsy.
1. Spastic cerebral palsy:
Spastic cerebral palsy accounts for about 70 percent of cases and is characterized by having tight or stiff muscles which can make the patient's movements seem jerky. This tightness results from a lesion in the upper motor neurons. So with a lesion which just means some abnormality, the ability of some of these neurons to receive GABA might be impaired. GABA is the main inhibitory neurotransmitter. So if nerve impulses can't be inhibited which is a double negative, then those nerves are basically overexcited, leading to hypertonia, which is an abnormal increase in muscle activity. Basically, like if the muscles were constantly flexed.
Symptoms of the Spastic cerebral palsy:
• Some people with spastic cerebral palsy have a scissor gait. Adductor muscles are always partly flexed, which causes your knees and your thighs to touch constantly.
• Some patients have a toe walk because their calves are always flexed, which pulls the Achilles tendon up and causes someone to go up on their toes.
2. Athetoid or dyskinetic cerebral palsy:
This one involves damage or injury to the basal ganglia. The basal ganglia are the structure here which essentially helps us initiate and prevent certain movements. If the basal ganglia become damaged, patients can lose the ability to prevent movements and therefore they can have involuntary movements, meaning out of their control. So dyskinetic cerebral palsy is characterized by dystonia and/or Coria.
Symptoms of Athetoid or dyskinetic cerebral palsy:
• Dystonia is random slow and uncontrolled movements in the limbs and trunk.
• Coria is random dance like movements since the small uncontrolled movements seem to move from muscle to muscle.
3. Ataxic cerebral palsy:
Ataxic refers to an order or arrangement so Ataxic essentially means without order, which is in reference to patients with this type being shaky or uncoordinated. And this is caused by damage to the cerebellum. The cerebellum helps us with coordination and fine or precise movements.
Symptoms of the Ataxic cerebral palsy:
• These patients often have clumsier or unstable movements and poor balance when doing things like walking or picking something up.
• Although different from patient to patient, many patients with muscle control issues have other symptoms as well. Patients often experience pain from tightened muscles or abnormal posture and stiff joints.
• Also, abnormal movements might make it difficult to sleep at night and patients can develop sleep disorders.
• Even eating can become difficult as well which can range from the preparation of food to the action of chewing and swallowing the food.
• Other brain-related issues are also associated with difficulties with speaking and communication, vision problems and learning disabilities.
Treatment for cerebral palsy:
Since cerebral palsy involves a permanent abnormality to the brain structure, it's not curable. But that doesn't mean it's not treatable. Treatment for cerebral palsy usually involves a multidisciplinary approach pulling from a number of clinical specialties like neurologists, rehabilitation specialists, occupational therapists, speech therapists and others.
Physical therapy can be used to build strength and improve walking ability, along with stretching to reduce contracture, which is a permanent shortening of muscle tissue from being hypertonic or contracted for so long.
Sometimes muscle relaxants are given, or botulinum toxin is injected into certain muscles to reduce hypertonicity and relax the muscles, which can both help reduce pain associated with hypertonus and also help fit patients with specific orthotic braces.
Sometimes surgery might also be performed to help with a variety of issues like loosening, tight muscles, straightening out bones that have been subject to abnormal muscle forces over time and cutting certain nerves to reduce their associated movements or spasms.
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