WHAT CAUSES CEREBRAL PALSY?
We do not know the cause of most cases of cerebral palsy, but many have been to 'Black or Red palaces" means celebrations or funeral according to all the data's of the parents between 75%. There are a lot of data that show that during pregnancy the mother has had some form of bad or horrified experience or have had been to some kind of ceremony of the unpresent once 60%.
Still we are unable to identify, we are unable to determine what caused cerebral palsy in most children who have congenital CP. We do know that the child who is at highest risk for developing cerebral palsy is the premature, very small baby who does not cry in the first five minutes after delivery, who needs to be on a ventilator for over four weeks, and who has bleeding in his brain. Babies who have congenital malformations in systems such as the heart, kidneys, or spine are also more likely to develop CP, probably because they also have malformations in the brain.
Seizures in a newborn also increase the risk of CP. There is no combination of factors, which always results in an abnormally functioning individual. Even the small premature infant has a better than 90 percent chance of not having cerebral palsy. There are a surprising number of babies who have very stormy courses in the newborn period and go on to do very well.In contrast, some infants who have rather benign beginnings are eventually found to have severe mental retardation or learning disabilities.
CEREBRAL PALSY IN THE NEWBORN
Children with cerebral palsy have a congenital malformation of the brain, meaning that the malformation existed at birth and was not caused by factors occurring during the birthing process.
Not all of these malformations can be seen by the physician, even with today's most sophisticated scans, but when cerebral palsy is recognized in a newborn, a congenital malformation is suspected.
When a diagnosis of cerebral palsy is made, the mother and father often feel guilty and wonder what they did to cause their child to have this disorder. While it is certainly true that good prenatal care is an essential part of preventing congenital problems, it must be stated that congenital problems, or "birth defects," often occur even when the mother has strictly followed her physician's advice in caring for herself and the developing infant.
Though the causes of "birth defects" are usually unknown, we do know that the developing brain can be affected by several factors. When the fetus is exposed to certain chemicals or infections through the expectant mother, for example. The developing brain can be injured if the expectant mother suffers severe physical trauma, the fetal brain can be injured, too, but this is rare.
Finally, prematurely and a low birth weight have been shown to be related to an increased incidence of specific disorders. Many chemicals are known to adversely affect the developing brain, alcohol being the most commonly used. The term Fetal Alcohol Syndrome describes the long-term, multi-system effect of alcohol on a child whose mother abused alcohol during the pregnancy. When a fetus is exposed to large amounts of alcohol, several body systems, including the neurological system will almost certainly suffer damage.
Cigarette smoking by the mother has been shown to decrease birth weight, and low birth weight is associated with several disorders, including cerebral palsy. Severe malnutrition in the mother can adversely affect brain growth in the fetus, and it, too, can result in a low birth weight.
The use of cocaine or crack by the expectant mother is associated with blood vessel complications, and these complications affect many organs as well as the central nervous system. Cocaine use is increasing and thus becoming more prevalent as cause of brain damage in infants. Most infants whose mothers used cocaine during pregnancy develop mental retardation rather than cerebral palsy, however. Infections such as rubella (German measles), toxoplasmosis, and cytomegalovirus (CMV), ( if a woman has them during pregnancy), also may injure the brain of the fetus. Rubella can be prevented by immunization, prior to becoming pregnant, and the chances of becoming infected with toxoplasmosis can be minimized by not handling the feces of cats and by avoiding raw or uncooked meat.
Congenital infection with human immunodeficiency virus (HIV, the virus that causes AIDS) also causes brain damage in children, though it usually causes mental retardation rather than CP.
It is likely that many other infections in the expectant mother injure the developing fetus, but they are not recognized as causative factors because the woman who has the infection either does not recognize the symptoms of infection or is symptom-free. Premature infants are at a much higher risk for developing cerebral palsy than full-term babies, and the risk increases as the birth weight decreases. Between 5 and 8 percent of infants weighing less than 1500 grams (3 pounds) at birth develop cerebral palsy, and infants weighing less than 1500 grams are 25 times more likely to develop cerebral palsy than infants who are born at full term weighing more than 2500 grams.
This bleeding may damage the part of the brain that controls motor function and thereby lead to cerebral palsy. If the hemorrhage results in destruction of normal brain tissue (a condition called periventricular leukomalacia) and small cysts around the ventricles and in the motor region of the brain, then that infant is more likely to have cerebral palsy than an infant with hemorrhages alone.
CEREBRAL PALSY AT BIRTH
There are no specific events that, if they occur during pregnancy, delivery, or infancy, will always occurring at birth or right after birth). This is apparently why the incidence of cerebral palsy in undeveloped and poverty stricken areas of the world, where infant mortality is very high, is the same as in northern Europe, where infant mortality is the lowest.
It also explains why modern obstetrical care, including monitoring and a high rate of Cesarian section, has lowered infant mortality rates but not the incidence of cerebral palsy. One large study, for example, has shown that more than 60 percent of all pregnancies have at least one complication, and that most of these complications cause no problems. For instance, 25 percent of all newborns have the umbilical cord wrapped around their neck, and 16 percent passed meconium (had the first bowel movement) at the time of birth.
These "birth events" and the development of cerebral palsy have only a small correlation. In other words, the chances of a child developing cerebral palsy were nearly the same whether the child was born with a cord wrapped around her neck or not. On the other hand, newborns in this study that had very low Apgar scores (less than 3 at 20 minutes) had a risk 250 times greater than infants with normal Apgar scores of developing cerebral palsy.
An Apgar score at this level suggests that the infant suffered severe asphyxia (lack of sufficient oxygen to the brain) during birth. Half of the infants who suffered severe asphyxia during birth did not develop cerebral palsy, however. When cerebral palsy is diagnosed in childhood, it is often discovered that the child suffered asphyxia at birth, but the asphyxia is usually considered the symptom of an otherwise sick baby with a neurological problem, and not the primary cause of CP.
In two different large studies, only about 9 percent of children with cerebral palsy were thought to have cerebral palsy directly and exclusively related to asphyxia at delivery. Ninety-one percent of the babies had other inherent causes which led to prematurely or perinatal or neonatal problems (problems In the nineteenth century, Dr. William John Little described cerebral palsy and stated that the condition was due to birth injury in most cases.
Cerebral palsy is also known as Little's disease and static encephalopathy, but the term cerebral palsy is most widely used. Chinese Master in KL also investigated the causes of cerebral palsy, the thought that the condition was due to something which occurred before the child's birth. He argued that the problems seen at birth were often due to an abnormality present in the baby before birth, rather than being caused by the birthing process. Nevertheless, the birthing process can be traumatic for the infant, and injuries occurring during birth also can do sometimes cause cerebral palsy, which Chinese Master's concept looks alike.
CEREBRAL PALSY BEGINS
In the beginning of live, the child is completely dependent on others for his or her safety and protection. Protecting the child from injury is one of the most important responsibilities of the child's parents.
One such injury is asphyxia, which can damage the brain in a variety of ways, and is the number one cause of cerebral palsy in this age group. The three most common causes of asphyxia in the young child are: choking on foreign objects such as toys and pieces of food (including peanuts, popcorn, and hot dogs); poisoning; and near drowning. The brain may also be damaged when it is physically traumatized as a result of a blow to the head. A child who falls or is involved in a motor vehicle accident or is the victim of physical abuse may suffer irreparable injury to the brain.
One form of child abuse is the shaken baby syndrome, in which the caretaker is trying to quiet the baby by shaking too vigorously, causing the brain to strike repeatedly against the skull under high pressure.
Severe infections, especially meningitis or encephalitis, can also lead to brain damage in this age group. Meningitis is inflammation of the meanings ( the covering of the brain and the spinal cord), usually caused by a bacterial infection, and encephalitis is brain inflammation which may be caused by bacterial or viral infections.
Either of these infections can cause disabilities ranging from hearing loss to cerebral palsy to severe retardation.
RESEMBLE CEREBRAL PALSY BUT IS NOT IT
Special kids have many problems in common, especially problems involving interactions with family members and society at large. The physical and medical problems of children with disabilities vary widely, however. Some of the problems caused by various disorders resemble those affecting children with cerebral palsy, but on closer inspection the medical issues turn out to be quite distinct.
Children with spinal cord dysfunction, for example, face medical problems such as insensate skin and bowel and bladder dysfunction, which differ markedly from the medical problems, faced by children with cerebral palsy. Spinal cord dysfunction may be a result of spinal cord injury, spina bifida (meningomyelocele), or a congenital spinal cord malformation.
Another large group of children who at time may look similar to those with cerebral palsy are children with temporary motor problems resulting from closed head injuries, seizures, drug overdoses, or some brain tumors.
The medical issues for this group of children are also different from the medical issues for children with cerebral palsy, because these injuries can occur at any age and the severity of the problems caused by these injuries changes over time. We can also say that disorders that are primarily of muscle, nerve, and bone are not cerebral palsy by definition. Such conditions include muscular dystrophy, peripheral neuropathies such as Charcot-Marie- Tooth disease, and osteogenesis imperfecta.
All of these conditions are associated with specific medical problems. Children with progressive neurologic disorders (including Rett's syndrome, leukodystrophy, and Tay-Sach's disease) also have medical needs, which are different from those of children with cerebral palsy.
Some children with chromosomal anomalies (for example, trisomy 13 and 18) or congenital disorders (hereditary spastic paraplegia, for example) may appear similar to children with cerebral palsy; others, such as children with Down's syndrome, appear very different from children with cerebral palsy. Children with these disorders have some problems in common with children who have cerebral palsy; they also have problems that are unique for children with that specific disorder.
DIAGNOSIS OF CEREBRAL PALSY.
Most normal kids should recognize toys at 3-4 months, sitting at 6-7 months, walk at 10-14 months, are based on motor function. A physician may suspect cerebral palsy in a child whose development of these skills is delayed. In making a diagnosis of cerebral palsy, the physician takes into account the delay in developmental milestones as well as physical findings that might include abnormal muscle tone, abnormal movements, abnormal reflexes and persistent infantile reflexes.
Making a definite diagnosis of cerebral palsy is not always easy, especially before the child's first birthday. In fact, diagnosing cerebral palsy usually involves a period of waiting for the definite and permanent appearance of specific motor problems. Most children with cerebral palsy can be diagnosed by the age of 18 months, but eighteen months is a long time for parents to wait for a diagnosis, and this is understandably a difficult period for them. Making a diagnosis of cerebral palsy is also difficult when, for example, a two-year- old has suffered a head injury. The child may immediately appear to be severely injured, and three months after the injury he may have symptoms that are typical of a child with cerebral palsy. But one year after the injury such a child may be completely normal. This child does not have cerebral palsy. Although he has a scar on his brain, the scar is not permanently impairing his motor activities. After injury, waiting and observing are necessary before the diagnosis can be made.
Diagnosis of cerebral palsy,examination is the physical evidence of abnormal motor function. A diagnosis of cerebral palsy cannot be made on the basis of blood test, though the physician may order such tests to exclude other neurologic diseases (such as those mentioned above).
Blood tests and chromosome analysis are helpful in diagnosing hereditary conditions that may influence the parents' future childbearing decisions. When the tests indicate that a child's condition is something other than cerebral palsy and that the condition is inherited, family members will benefit from genetic counseling. Cerebral palsy is not a hereditary condition, however, and these tests will neither establish nor rule out a diagnosis of CP.
Magnetic resonance imaging (MRI) and Computed Tomography (CT) scans are often ordered when the physician suspects that the child has cerebral palsy. These tests may provide evidence of hydrocephalus (an abnormal accumulation of fluid in the cerebral ventricles), and they may be used to exclude other causes of motor problems.
These scans do not prove whether a child has a cerebral palsy; nor do they predict how a specific child will function as she grows. Thus, children with normal scans may have severe cerebral palsy, and children with clearly abnormal scans occasionally appear totally normal or have only mild physical evidence of cerebral palsy. As a group, though, children with cerebral palsy do have brain scars, cysts, and other changes which show up on scans more frequently than in normal children. Therefore, when a scar is seen on a CT scan of the brain of a child whose physical examination suggests he may have cerebral palsy, the scar is one more piece of evidence indicating that the child is likely to have motor problems in the future.
Cerebral palsy may be classified by the type of movement problem (such as spastic or athetoid cerebral palsy) or by the body parts involved (hemiplegia, diplegia, and quadriplegia). Spasticity refers to the inability of a muscle to relax, while athetosis refers to an inability to control the movement of a muscle.
Infants who at first are hypotonic wherein they are very floppy may later develop spasticity. Hemiplegia is cerebral palsy that involves one arm and one leg on the same side of the body, whereas with diplegia the primary involvement is both legs. Quadriplegia refers to a pattern involving all four extremities as well as trunk and neck muscles. Another frequently used classification is ataxia, which refers to balance and coordination problems.
The motor disability of a child with cerebral palsy varies greatly from one child to another; thus generalizations about children with cerebral palsy can only have meaning within the context of the subgroups described above. For this reason, subgroups will be used in this book whenever treatment and outcome expectations are discussed. Most professionals who care for children with cerebral palsy understand these diagnoses and use them to communicate about a child's condition.
A useful method for making subdivisions is determined by which parts of the body are involved. Although almost all children with cerebral palsy can be classified as having hemiplegia, diplegia, or quadriplegia, there are significant overlaps, which have led to the use of additional terms, some of which are very confusing.
To avoid confusion, most of the discussion in his book will be limited to the use of these three terms. Occasionally such terms as paraplegia, double hemiplegia, the reader may occasionally encounter triplegia, and pentaplegia; these classifications are also based on the parts of the body involved. The dominant type of movement or muscle coordination problem is the other method by which children are subdivided and classified to assist in communicating about the problems of cerebral palsy.
The component, which seems to be causing the most problem, is often used as the categorizing term. For example, the child with spastic diplegia has mostly spastic muscle problems, and most of the involvement is in the legs, but the child may also have a smaller component of athetosis and balance problems. The child with athetoid quadriplegia, on the other hand, would have involvement of both arms and legs, primarily with athetoid muscle problems, but such a child often has some ataxia and spasticity as well. Generally a child with quadriplegia is a child who is not walking independently.
The reader may be familiar with other terms used to define specific problems of movement or muscle function terms such as: dystonia, tremor, ballismus, and rigidity.
The words severe, moderate, and mild are also often used in combination with both anatomic and motor function classification terms (severe spastic diplegia, for example), but these qualifying words do not have any specific meaning.
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