Treatment of Cerebral Palsy - Essay Example

Cerebral Palsy Cerebral Palsy (CP) is a collective term which encompasses a host of disorders. Understanding and diagnosing this disorder was once believe to be the sole responsibility of pediatricians and neurologists. Although detection of the disease starts here, a cooperative environment incorporating all facets of the health care disciplines are necessary to maximize benefits to the affected child. The primary symptom displayed by one inflicted with this disease is the retardation of movement and muscle development resulting in the patient's limited ability to perform many simple activities involving basic motor functions. Frequently outward affects of Cerebral Palsy are exhibited through: disturbances of sensation, cognition, communication, perception, and or behavior, and/or by a seizure disorder. (Stevens, 2005, 508) The uniqueness of this disease is that it exhibits itself differently from case to case. This is best exemplified through the wide range and breadth of motor skill limitations experienced by each individual patient. Once believed that the onset of Cerebral Palsy was a direct result of complications which occurred at birth or during the labor process prior to birth, much new research is offering alternate areas for study. The cause of Cerebral Palsy still remains unknown by advances it research have led to several promising areas deserving further research. The difficulty in diagnosing this disease in a timely fashion lies within the very roots of the congenital disease itself. Al though signs of Cerebral Palsy may be exhibited at or shortly after birth, at other times no symptoms may be evident until years later, making early diagnosis almost impossible. What has been shown through research thus far is that there are various 'warning' signs that place the infant in a high risk category for Cerebral Palsy. In examining Cerebral Palsy, researchers have found that the various warning signs exhibit themselves differently patient by patient. However, as stated above, certain symptoms displayed merit further testing to confirm the presence of this disease. Suspected causes for contraction of this disease thought to originate during the prenatal period include: Anoxia due to a problem with the umbilical cord Maternal infection such as rubella, Xoplasmosis, herpes simplex Metabolic disorders in the mother such as diabetes, a heart condition, hyperthyroidism, severe asthma Abdominal injury during pregnancy Absence or lack of prenatal care (Gibson, MacLennan, Goldwater & Dekker, 2003, 212) In addition, to prenatal risk factors associated with Cerebral Palsy, there are also additional warning signs associated with the Perinatal period which may be indicative of a predisposition for contraction of the disease. These include: Anoxia due to problems with the umbilical cord Asphyxia due to a mechanical respiratory obstruction Analgesics (the administering of drugs affecting the respiratory system) Trauma: to the head during labor/ delivery, hemorrhage, forceps application, poor position of the infant, breech delivery Pressure changes: being delivered too fast or too slow Prematurity and complications at birth, respiratory distress, and very low birth weight are well recognized risk factors for development of CP. (Gibson et al, 2003, 213) In addition to the warning signs listed above for the possible predisposition of congenital Cerebral Palsy research has shown that there are factor which may be indicative of acquired Cerebral Palsy as well. These include: - Trauma to the head such as a wound or fracture resulting in injury to the brain. Infections of the nervous system such as high fevers, meningitis, encephalitis, and brain abscess. Vascular problems of the brain such as thrombosis or hemorrhage. Anoxia due to strangulation, carbon monoxide poisoning, smoke inhalation, and near drowning. Neoplasm's of the brain such as cysts, tumors and hydrocephalus. (Gibson et al, 2003, 213) It should be noted new research is undermining the long held belief that hypoxia caused CP. This research "published in the October issue of The American Journal of Obstetrics & Gynecology found that the brain injury that leads to cerebral palsy was much more commonly associated with infection than with hypoxia. (Gibson et al, 2003, 214) Before examining this disease any further understanding its symptoms and recognizing the warning signs associated with it are necessary. The cause of CP has been linked to an aberration of the brain's development. The cause of this is unknown but the onset of symptoms generally appears when the afflicted child is quite young. It is non-progressive in nature and it is exhibited through the lack of control over body movement and control. A vast majority of extremely premature babies, almost 90%, who are afflicted with Cerebral Palsy "have spasticity referring to an increased resistance to muscle stretch. In the no spastic forms of cerebral palsy, the primary neurological abnormality is ataxia- a lack of coordination of voluntary movements- or extra pyramidal dyskinesia- insuppressible, stereotyped, involuntary movements." (OBrien, 2002, S182) Statistics yield the fact that next to mental retardation, Cerebral Palsy is the second most common disease in infants born with extreme prematurity. The severity of the motor impairment varies from patient to patient. Symptoms range from gross motor impediment (inability to walk) to disruption of fine motor skills. Involving impairment of performing basic life skill sets such as dressing one's self, writing or feeding one's self. The third type of motor development that can be exhibited is exhibited in cranial nerve dysfunction. This symptom expressed through movements associated with the head includes an inability to move the eyes or difficulty swallowing. There are variant forms of Cerebral Palsy which exhibit variant degrees of motor function impairment. The most serious form of Cerebral Palsy affecting only 5-10% of existing cases is Ataxic. (O'Shea, 2002, 137) With this form of CP muscle tone is almost non existent. Limbs appear to just hang loosely and there is little control over movement and it has been linked to injury of the spinal cord. As the spinal cord is affected, the seriousness of this form of CP becomes obvious. Balance and coordination are also affected. This compounded with the limited muscle coordination and control severely hampers the patient's ability to even walk. Those suffering from Ataxic also display what is called 'Intention Tremors'. In a concentrated effort to control movement, for instances when the patient tries to grasp and hold a small item, the concerted effort causes the body to increasingly over exhibit the initial body movement. It is significant to note that Ataxic is the only form of CP that is degenerative, that is it worsens with age. A second form of CP is Athetoid, also known as dyskinetic CP. Spasms are associated with this type of Cerebral Palsy, the muscles will fluctuate between being too tight and being too loose, which are displayed through these protracted spasms, the continual tightening and loosening of the muscles. Sitting or standing becomes very difficult for the Athetoid patient. Another distinguishing characteristic of this form of CP is the variant's effect of the facial muscles. A patient may appear to be in a constant grimace due the lack of muscle control and even swallowing becomes very difficult often causing the patient to drool. Athetoid Cerebral Palsy is caused from damage to the damage to the cerebellum or basal ganglia, and like Ataxic CP Athetoid Cerebral Palsy is relatively rare and only affects approximately 10-20% (O'Shea, 2002, 139) of those inflicted with Cerebral Palsy. The third type of Cerebral Palsy is the most common form with approximately 80% of diagnosed cases of CP having this form of palsy. Called Spastic Cerebral Palsy, as the name suggests, the muscles are in frequent spasm causing the patient to exhibit uncontrolled, often pronounced twitching. As with the other two more severe forms of CP balance and walking are difficult tasks to perform, but not to the same level of difficulty as Athetoid and Ataxic forms. With Spastic CP there tightening and loosening of the muscles occurs uncontrollably and often joints, especially in the arms and legs, may become disfigured. As CP is a chronic disease affecting muscle control and movement. There are serious implications attached with it. The weakened muscles, lack of gross and fine motor skills, and lack of muscle and postural control affects the patients ability to perform necessary day to day tasks such as walking, running, walking up steps, and a mirade of other tasks that people take for granted every day. Because of this limitations this places on the patients' lives physical therapy if often recommended as a course of action to improve muscle strength and control to assist them in gaining ability to perform basic self sufficiency skills. It has long been recognized that" ... the accomplishment of the necessary or useful ' Life skills' should be the treatment goal." however, most studies have only measured changes at the impairment level. Clients, their families, and health service providers are often more interested in measuring the effect of interventions in terms of outcomes that reflect meaningful improvements in a person's ability to function within society. There is evidence supporting the view that strength-training programs improve muscle strength in children and young adults with CP. In addition, there appear to be no detrimental effects such as increased spasticity. (Nicole & Hoff, 2002, 1722) Many treatments are available to help a child function at the highest level possible. I will touch upon a few of the most basic approaches used today to help a child achieve their optimal level of functioning. The major goal of physical therapy is to help these children afflicted with CP to improve the quality of life and independence by strengthening the larger muscles, including legs, arms, back and abdomen. "Physical therapists help children to learn how to move and balance. They may help children with cerebral palsy learn to walk, use a wheelchair, stand by themselves, or go up and down stairs safely. In physical therapy will work on fun skills such as running, kicking and throwing, or learning to ride a bike." (Nicole & Hoff, 2002, 1723) Normally as diagnosis of CP is made the physician or pediatrician will immediately recommend that the child begins a physical therapy program. In addition to working with the children to strengthen muscle tone and improve coordination and balance, physical therapy is preventative in nature as well. Early diagnosis and early enrollment in a physical therapy program will help deter the progression of other complications such as muskuloskeletal problems involving joint disfigurement and excessive bone rigidity. Another treatment method used in cases of CP is occupational therapy. Whereas physical therapy centers on large muscle development, the occupational therapist specializes in treatment of small muscles and improving their dexterity. Some of examples of these muscle groups include the hands, the feet, fingers and toes, and facial muscles. Developing these fine motors skills allows the Cerebral Palsy child more autonomy and independence which fosters a sense of normalcy and self confidence. Another form of treatment utilized for those with Cerebral Palsy is surgery, although it once was used almost exclusively used only in the adult patient. Results of the surgery are usually remarkable in that the patient is able to perform basic skills he was previously unable to do, such as walking, because of the CP. "Surgery is not always necessary, but it is sometimes recommended to improve muscle development, correct contractures, and reduce plasticity in the legs." (Alvin & Becker, 2000, 486) One of the common characteristics of children with CP is that they often have to walk on their toes due to the affected muscles. If physical and occupational therapy coupled with use of splints and braces to support the legs are still ineffective in allowing the child to walk surgery to lengthen the tendons in the legs is sometimes performed. Another type of surgery used occasionally for the CP child involves cutting the sensory nerves at the hip. This is often successful in reducing spacticity. The last form of therapy used in treating of CP is drug therapy. With the pharmaceutical advancements that have been made there are many drugs available that reduce the spastic effect of the muscles. However there are many different types of drugs and not all will relieve the symptoms of all forms of spacticity so often drug therapy involves a period of trial and error, prescribing different medications until one is found that will relieve the symptoms of each particular child's Cerebral Palsy. Drug therapy, although, it reduces the symptoms does not cure the disease. However, the use of drug therapy can be beneficial in optimizing the child's quality of life when used in conjunction with other treatment options. Now having given an overview of the disease and the normal course of treatment to alleviate symptoms and improve muscle tone and coordination. I'll examine some recent studies and new methodologies for treatment of Cerebral Palsy. As earlier stated, Spastic CP is the most prevalent form of Cerebral Palsy. Usual treatment for this form of CP involved a combination of therapies discussed earlier: physical therapy, occupational therapy, the use of splints and braces, and drug therapy. "More recently, health care professionals have begun to use botulinum toxin a (BtA) as an adjunct to interventions in an attempt to reduce muscle tone and spasticity to improve function." (Wasiak & Wallen, 2004, n.p.) Early indications are that this treatment may be very effective in reducing the symptoms associated with Cerebral Palsy. Ubhi, Ives and Roussounis in 2000 published finding on a clinical study they had done on ofBT-A treated children showed clinical improvement in VGA compared to 17% of placebo botulinum toxin as a treatment for Cerebral Palsy. Findings indicated "Forty eight per cent treated children." (468) In findings of a similar study they found that "efficacy analysis revealed an overall response rate in 82% of patients, with treatment goals fully achieved in 3% of patients and partially achieved in 94% of patient, younger patients achieved the best response, with effects diminishing with increasing age. Investigators concluded that botulinum toxin is safe and effective for the treatment of spasticity in children."(469) The prognosis for the treatment of Cerebral Palsy is improving daily. Advancements such as these will go far in improving the outlook for those suffering from this disease. Finding out your child has Cerebral Palsy is a devastating experience for any parent. After sifting through the blame and guilt, the parents ultimately want to know how this disease will impact their child's life. Until a child reaches the age of two a full prognosis can not, with accuracy, be made as to the total engulfment of the disease - that is the amount of muscles affected: "hemiplegia, diplegia, or quadriplegia" (Smith & Shilt, 2004, 1627) These three words define the number of limbs affected by the Cerebral Palsy, as their prefixes infer. However, what is known about Cerebral Palsy may offer some comfort to parents. CP is not a regressive disease. What this means is that once diagnosed a child's condition will not grow worse and worse. If they are able to walk when the diagnosis is made, they will continue to be able to walk. "If regression occurs, it is necessary to look for a different cause of the child's problems. If a child to be able to walk, some major events in motor control have to occur." (Murphy, Irwin & Hoff, 2002, 1722) What this mean is really quite simple. If a child with CP can walk up a flight or stair unassisted or himself, Cerebral Palsy will not cause him to suddenly lose those abilities. If a child who suddenly loses ability to perform certain motor skills he was able to do prior to the diagnosis of CP there is another cause or illness. Likewise, and probably even more difficult to predict at an early age are a Cerebral Palsy child's mental capabilities and other skills, such as speech. If diagnosed with CP as an infant, obviously a pediatrician cannot predict whether the child will be able to talk or what his mental capacity will be. Normal developmental time is required to determine these factors. It is important to point out that a child with Cerebral Palsy is not limited mentally because of the disease. Although muscular control problems found with a person with CP may not be able to undergo more standardized methods of measuring mental capacity, especially if speech is affected, there are other methods of determining mental capacity. Being diagnosed with Cerebral Palsy is far less debilitating than a child born with mental retardation. A small comfort to parents of a child diagnosed with the disease but a very important fact to be disseminated to them. Another recent development has been the use of three dimensional motion analysis to determine prognosis of the child suffering from Cerebral Palsy. This advanced use of TM Gait Analysis with its computerized application gives a much more complete picture of the specific scope of each child's Cerebral Palsy. Utiliyzing this type of imagining helps the medical team when planning for surgery and when developing physical and occupational therapy plans. Being a relatively new aid in understanding more about CP, there still remains some controversy on whether the obseravation yields better results when a child uses a treadmill or walks on a regular surface, but as more is learned about this emerging technology and best practices are established it should prove to be invaluable. Other recent advancements have included new surgical treatments including: Tendon Transfer Tendon Lengthening - Abductor Release Tendon Lengthening of the Heel cord Osteotomy (removal of part of the bone) These recent advancements are showing great promise in treating the symptoms of Cerebral Palsy. Technology continues to advance the understanding of Cerebral Palsy and great strides have been made in the investigating this disease. In the not so distant past, a child born with Cerebral Palsy had little hope of a 'normal' life. Researchers and medical professionals are changing that day by day. Once where only braces and splints were thought possible, hope exists. 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Internet 16 http://www.dpo.uab.edu/binrmie/cp.htm#prognosis: 17 http://www.onlinelawyersource.com/cerebera palsy_athetoid cerebera palsy.html 18 http://www.about-cerebral-palsv.Orglindex.html 19 http://www.cw.bc.ca/orthopaedics/cp.asp 20 http://www.gait.aidi.udcl.edu/res695/homepage/pdortI10/dinic/cpalsy/cpveb.htm#RT FToC12 21 http://www.apma.om/topics/Orthpics/Orthotics.htm Read More