Cerebral Palsey - Term Paper Example

Running head: cerebral palsy Cerebral Palsy Cerebral palsy is a type of neurological impairment in which brain dysfunction due to some injury causes motor disability. According to the United Cerebral Palsy Association, ‘Cerebral palsy embraces the clinical picture created by injury to the brain, in which one of the components is motor disturbance. Thus cerebral palsy may be described as a group of conditions, usually, originating in childhood, characterized by paralysis, weakness, in coordination or any other aberration of motor function caused by the pathology of motor control center of the brain. In addition to such motor dysfunction, cerebral palsy may include learning difficulties, psychological problems, sensory defects, convulsive and behavioral disorders of organic origin’ (cited in Chauhan,1989; p.249). In short, cerebral palsy is a congenital defect and is of non progressive type caused due to developmental defects in the brain that occur immediately after birth, during birth, or before the birth. Usually children presenting with cerebral palsy are normal but have special needs related to motor, cognitive, social, and psychological functions. Children with cerebral palsy present with a variety of symptoms or manifestations. However, few symptoms are most common. Like, abnormal muscle tone makes movement of muscles either extreme or nil. Reflex and postural abnormalities cause the child to have abnormal positions at rest. Delayed motor development causes delay in the child’s ability to sit or stand on its own. Atypical motor performance such as abnormal gait, asymmetrical hand use, uncoordinated actions, difficult in chewing, swallowing etc may also be experienced (Yamamoto, 2007). Based on these symptoms, cerebral palsy is classified into three types: spastic type which includes symptoms related to muscle tone; athetoid or dyskinetic that includes symptoms presenting involuntary or uncontrolled movements; and ataxia which includes symptoms related to balancing activities. Immense research and study has been carried out to identify possible risk factors and causes of cerebral palsy. These risk factors and causes have been identified at various stages before, after and during pregnancy. Some risk factors include delayed pregnancy, serial abortions, thyroid problems, seizures, difficult and/or troubled labor etc; infections and injuries during and after pregnancy period; and postnatal issues such as hypotension, sepsis, hyponatremia, nutrition, seizures, etc (Styer-Acevedo, 2008). Besides physical impairment, cerebral palsy affects the child at cognitive, social as well as psychological levels. Physically, cerebral palsy may cause abnormal muscle movements, tremors, muscle stiffness; distortion of extremities like neck and trunk; imbalance of posture and uncontrolled motor activity. The site or region of body affected may also vary, and six regions have been identified. In paraplegia, spasticity of legs occurs. Quadriplegia involves arms and legs, and sometimes throat and face also. Hemiplegia is caused by lesion in one hemisphere of the brain leading to spasticity of extremities of opposite side of the body. Double hemiplegia involves all extremities, but more pronounced in one side. In monoplegia, only one limb is affected. Cerebral palsy may present with no motor disorder also causing aphasia or hemiaphasia due to brain injury. Visual and hearing impairments are also very common in this condition (Yamamoto, 2007). Besides these, difficulty in bowel and bladder movements is also common. Apart from these, children with severe cerebral palsy may experience insomnia, fatigue, malnutrition, decreased bone mass density, musculoskeletal pain or pain from gastraesophageal reflux (Levitt, 2010). Usually children exhibit only physical impairments of cerebral palsy; however, psychological manifestations begin post childhood. Levitt (2010) points out that cerebral palsy patients are intelligent. However, evidences suggest that children with cerebral palsy suffer from mental retardation and learning disorders. This is found to be highest quadriplegic patients. Owing to motor and hearing impairments, these patients also suffer from high incidence of dysarthria. Severity here varies, and can also lead to complete inability to speak though they understand normally (Petersen & Whitaker, 2003). Related to these are understanding and comprehending abilities. Cognitive problems are also related to the behavior of the child, which may not correspond with behavior of normal child of that age. Patients with cognitive dysfunctions do experience normal emotions such as happiness, affection, depression, and sadness. Children with visible physical deformities suffer from poor self image and peer relationships. This is especially true in people suffering with juvenile chronic arthritis (Penso, 1987). It could also be possible that children with limb deformities have lesser access to social engagement mainly because of their disability rather than mental status. Participation in daily activities involving family and friends is also very limited due to lack of confidence caused by motor and cognitive disabilities. These children are further affected by the averse attitude of other members of the society. Even lack of accessories and assistance and hindrances in premises and settings also affect the child’s active involvement in social groups. Due to these barriers, these children tend to spend more time with family than friends, and are hence more comfortable in learning and doing activities in the company of family members and tend to distance from outsiders. Children with cerebral palsy tend to develop psychological problems as their age progresses to adolescence. These begin in the form of physical changes like weight gain due to immobility; and further lead to psychogenic issues related to change in mental attitude because of effort required to learn new skills (Hersen & Reitman, 2008). These changes further impact their self image and can worsen self perception, peer relationships and ability and willingness to learn new motor patterns. Added to these, external factors such as attention from others and bullying by peers add further agony to their psychological wellbeing. From a treatment and management perspective, the World Health Organization proposes that the therapy and management of cerebral palsy should be comprehensive covering the body functioning, structures, activity and participation (Levitt, 2010). Intervention and treatment of patients suffering from cerebral palsy vary according to the disabilities, and range from physiotherapy to psychological intervention including cognitive and behavioral therapies. This entire process would involve the patient, the family, medical staff, allied health professionals, educational team, physiotherapist as well as psychotherapist. Levitt (2010) asserts that the motivation of child by people, which includes friends and family, and child’s own intrinsic motivation have a profound impact on his/her improvement. Therapy and treatment depends upon the outcomes desired based on functional assessment of the patient, which could be for long term or short term outcomes. Therapy and management of this condition should be designed considering different perspectives of the impairment exhibited by the patient. It should cover management of impairments which restrict functions and routine tasks. Thorough care should be taken to check and control secondary and increasing impairments. The therapy should focus on functional aspects considering the contexts of patient’s home, school and community. As a part of the therapy, parents, extended family and friends as well as the society, to the possible extent, should be well educated regarding the patient’s condition in order to foster right attitude towards the disabled person. To reinforce the patient’s confidence and self esteem, therapists should encourage the patient and parents to put into use personal attributes of the disabled individual (Levitt, 2010). In summation, cerebral palsy refers to a variety of motor and sensory disabilities caused by birth due to injury caused during or before birth. This damage manifests in different forms affecting mobility, cognitive and sensory functions of the child. Prognosis and diagnosis of this disorder is complicated and causes and risk factors associated with cerebral palsy are many and mostly related to fetal and neonatal stages and a few descending from genetic aspects. Whatever form this defect manifests, it has a profound impact on the physical, cognitive and psychological aspects of the person all of which are interdependent. Hence, treatment and management involves a holistic approach that encompasses medicinal and dietary interventions, physiotherapeutic, cognitive and behavioral therapies achievable through coordination of patient and family, physiotherapists, psychotherapists as well as societal involvement. References Chauhan, S.S. (1989). Education of exceptional children. New Delhi: Indus Publishing. Hersen, M and Reitman, D. (Eds.) (2008). Handbook of psychological assessment, case conceptualization, and treatment, children and adolescents. New Jersey: John Wiley and Son. Levitt, S. (2010). Treatment of cerebral palsy and motor delay. 5th ed. London: John Wiley and Sons. Penso, D.E. (1987). Occupational therapy for children with disabilities. NSW: Taylor & Francis. Styer, Acevedo, J. (2008). The infant and child with cerebral palsy. In Tecklin, J.S’s Pediatric physical therapy. 4th ed. Philadelphia: Lippincott Williams & Wilkins. Petersen, M.C and Whitaker, T.M. (2003). Cerebral Palsy. In Wolraich, M. (Ed.) Disorders of development and learning. 3rd ed. PMPH-USA. Yamamoto, M.S. (2007). Cerebral Palsy. In Atchison, B.J and Dirette, D.K’s (Eds.) Conditions in occupational therapy: effect on occupational performance. 3rd ed. Philadelphia,USA: Lippincott Williams & Wilkins. Read More