Epidemiology and Classification of Cerebral Palsy - Coursework Example

Cerebral palsy Introduction This is a disorder that affects both posture and movement development as a result of several insults to both fetal as well as neonatal brain with final result of loss of abilities for movement and posture. Traditionally, its classification has been based on motor disorder that occurs, with varying numbers as well as types’ description. This incidence, however, has not been transformed for more than forty years irrespective of great progress in neonates’ medical care (Martin, 2006). Epidemiology In United States, cerebral palsy prevalence is seven cases per 1000 live births. It affects 500,000 people in United States and close to 6000 children are always diagnosed. Its prevalence is 500 people out of 1000 people in the population. More than 100,000americans under the age of 18 have been affected by the disease. It is also costly for the government since annual cost to societies exceeds 5 billion dollars. Apart from these, the disease also has other neurological malfunctions accompanying it, of which epilepsy constitutes a third of the total. If children are born immaturely, they are likely to get the disease as compared to full term babies. Despite all medical interventions and sophisticated obstetric care, this prevalence has not been transformed for more than 20 years. Classification The current classification has categorized the disorder according to the parts of the body they have effect on ,especially the limbs, these are: Spastic It accounts for 70-80% .this includes spastic diplegia which is typical in children with low birth weight. Lower extremities get involved more than the upper ones, with increase in muscle tone and positive Babinski reflex. The other is spastic quadriplegia, here the four extremes are involved hence rendering the patients the most disabled, with the patients becoming mentally retarded and having growth failure, visual defects, and microcephaly.The third is spastic hemiplegia with characteristics of severe language difficulties and seizures. Low birth weight and immense asphyxia and vascular insults are the major causes. Seizures are frequent with language difficulties as well as motor impairment becoming severe (Blesedell, 1998). Athetoid This accounts for 10-15% and is associated with involuntary as well as uncontrolled movement. Ataxic Accounting for 5% and characterized by problems with depth perception and balancing. Dystonic This kind has its effect as wide as encompassing all the characteristics of all the other types of cerebral palsy. Stages of cerebral palsy The cerebral palsy always affects the children during various stages of brain development. The disease may occur during the following stages of development.Primary neurulation is the brain development between 3-4 weeks of gestation.Prosencephalic development – this development occurs after 3-4 months of gestation. Neuronal proliferation – this development occurs after 3-4 months of the brain development.Neuronal migration – the development here occurs after 3-5 months. Organization – this occurs from 5 months of gestation to years of postnatal. Myelination – this occurs right from birth to postnatal years. Causes of cerebral palsy This disorder is not as a result of nerve of muscle problems, but due to the motor areas being damaged or poorly developed in the fetal or baby’s brain. The causes of the problem can be classified under prenatal causes, postnatal causes and neonatal causes. Prenatal causes Prenatal conditions may sometimes lead to the damage of the baby’s motor areas in the growing brain hence causing the cerebral disorder as well neurological problems. Some pregnancy-related infections include German measles or rubella and toxoplasmosis. Such infections are as a result of intrauterine infections, maternal illness, multiple births, congenital malformation, abdominal trauma, and teratogenic agents. Postnatal causes Some neurological injuries may occur after birth leading to acquired cerebral palsy. Some of the postnatal causes include trauma, coagulopathies, intracranial hemorrhage, and infections. Infections such as meningitis as well as encephalitis directly affect the brain and may lead to irreversible brain damage. Seizure disorder may also lead to cerebral palsy. For instance intracranial hemorrhage comes as a result of broken or even blocked blood vessels in the brain of the baby. This could lead to fetal stroke; other babies may get the fetal stroke while still in the womb due to placental blood clots blocking blood flow. Weaker blood vessels or poorly formed ones within the brain might also cause the stroke. Maternity infections like the pelvic inflammatory illness do increase the chances of fetal stroke. Neonatal causes Mother-fetus infection sometimes may occur during delivery. Serious illnesses may occur as a result of the infections leading to neurological damage to the new born. Birth asphyxia may also result in cerebral palsy. Some neonatal causes include unusual birthing presentations, prematurity, low birth weight, intracranial hemorrhage, and hyperbilirubinemia and growth retardation. Signs and symptoms of cerebral palsy Due to the adverse effects of the disease, it is very crucial for the disease to be identified and necessary medical steps be taken in its earlier stage. Symptoms appear in the baby’s early years and do not become worse overtime. Some of the signs of cerebral palsy include neonatal encephalopathy, poorly developed muscle tone, problems with breathing, musculoskeletal problems, problems with sensation,perception,behaviour,cognition and communication, displaying of neurological problems like epilepsy, strabismus, growth problems, mental impairments and also vision and hearing complications. The patients can have abnormal posture characterized by fisting using adducted thumbs, lower extremities get hyperextended as well as adducted. The trunk always gets hyperextended.other symptoms include poor coordination between the oral-motor mechanisms leading to difficulties and poor coordination in sucking and swallowing, lip closure, chewing the patients also develop problems of drooling. Abnormal muscle tone also reduces smooth movement of extremities and increases the axial tone. There is also delay in both primitive reflex integration and automatic responses leading to poor equilibrium, delay in protective response, tonic neck reflexes being asymmetric, moro and consistent palmar grasp. The reflexes of the deep tendon are also brisk and with colonus (Mirenda, 2005). Life expectancy of children with cerebral palsy There is always reduced lifespan due to the illnesses that come as a result of cerebral palsy, however any child who has lived past ten years has chances of living longer, except if the impairments are very severe hence might not let the child reach adulthood. Examples are children who cannot dress and learn hence may not reach 25 years while children who cannot walk, feed, and dress themselves have 80% chance of reaching 20 years. Impacts of cerebral palsy Physical impacts The children suffering from cerebral palsy do experience a lot of difficulties in walking, feeding, dressing, learning, hearing, seeing, and using their limbs, sometimes these body parts completely fail to function. Around 65% of people with cerebral palsy do have mental retardation. Other complications include Osteoarthritis, degenerative arthritis, and premature aging. Emotional impacts Since this is a neurological disorder, it has a great emotional impact on the patients, such as depression, stress, and fatigue which reduces the quality of life and lifespan of the victims. It also causes Post-impairment syndrome and pain. Financial impacts The children suffering from this complication require a lot of resources in order to be able to cope up with life and live normally as others. The financial provision expected from the family is high since the patients demand medication and treatment, gadgets to help in recovery, special teachers, and also more time. The government also spends more money on cerebral palsy control, like constructing informal care centers, provision of direct health, home modifications, and direct programmes. Diagnosis Diagnosis is always done during the initial two years from birth. However mild symptoms require 4 or 5 years of age. Evaluating the motor skills and medical history is crucial in the diagnosis since it prevents the condition from worsening. Additional special tests, consecutive check-ups and complete medical history are always crucial in ruling out other complications that might be at fault or have same symptoms as cerebral palsy.neuroimaging techniques provides doctors with information on damaged brain. It uses methods like cranial ultrasound, computer tomography scan, and magnetic resonance imaging scan. For instance this picture of brain was taken using magnetic resonance imaging scan. Development history is used to identify areas that need improvement. Physical examinations are also taken with great emphasis on growth patterns, skin stigmata of neurocutenous diseases and dimorphic features as well as in-depth neurologic examination. The diagnosis is often based on the abnormality patterns of neurologic exams (Stevenson, 2003). Pathophysiology The insult to the developing brain is the cause of cerebral palsy. The period of insult may range right from before birth to postnatal period, however, after postnatal period, there are other causes that can be identified. For instance hypoxic-ischemic encephalopathy. Such causes can be noted. Cerebral insults always alter the tone of the muscles, reflexes of muscle stretch, postural reactions, and also primitive reflexes. Treatment Monitoring and controlling seizures, orthopaedic impairments, and sensory impairments is the key to recovery. However spasticity can be controlled by the use of medication like the botulinum toxin or bacflomen.Family efforts can also be incorporated since family support will greatly encourage the patient hence successful management of the disease. By working closely with the service agencies throughout the process, like identification, development progress monitoring, and referral, the physicians could optimize on early interventions. Special needs People with cerebral palsy are different from other children due to their inability to perform some tasks that others perform, therefore they need to be given more encouragement and equipments necessary for their recovery be provided. They also need special teachers to train them and also enhance their recovery, those who are already blind might be taught how to read using fingers. Friendship and sharing is important in their recovery therefore they should be encouraged to socialize and should not be isolated from others. Every medical support and therapy is required so as to better their quality of life, hence increased lifespan, Long-term care as well as support should be provided. Home modifications, locating sitters, community activities, and leisure activities should be provided. Family approach Since there is difficulty in prediction of later abilities using assessement of the earlier development, the family should strive to be hopeful and realistic regarding the future ability of the child. In case of any unknown future implications, the patient should honestly disclose the uncertainty and accept the family support. The physicians are also very important in advocating for both the family and the child since they coordinate therapeutic, educational, and medical services as well as providing support for the family while conducting the process of long-term management as well as diagnosis. The pediatrician may refer to developmental pediatrician, child neurologist, or geneticist for more consultations (Melton, 1985). Conclusion Cerebral palsy, unlike any other physical problems, is a severe illness which makes a person susceptible to other illnesses like depression and which has adversely effects on a person’s quality of life while denying the person complete utility of the basic body parts. It also reduces the lifespan of individuals. Due to this, a lot of medical researchers are being carried out to provide permanent solution to the problem. Reference Martin, S., (2006). Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders. Boulder: Westview. Beukelman, D, & Mirenda, P (2005), Augmentative & Alternative Communication: Supporting Children & Adults With Complex Communication Needs, Baltimore, MD, Paul H Brookes. Melton, D., (1985), the Story of a Brain-Injured Child, Philadelphia, The Better Baby Press. Blesedell, E., (1998), Willard and Spackman's occupational therapy. Philadelphia: Lippincott- Raven Publishers. Stevenson, D., (2003), Fetal and Neonatal Brain Injury Mechanisms, Management and the Risks of Practice. 3rd ed. New York, Cambridge University Press. . Read More