CEREBRAL PALSY Cerebral palsy (CP) is a disorder that affects muscle tone, movement, and motor skills (the

ability to move in a coordinated and purposeful way). Cerebral palsy can also lead to other health issues, including vision, hearing, and speech problems, and learning disabilities. CP is usually caused by brain damage that occurs before or during a childs birth, or during the first 3 to 5 years of a childs life. There is no cure for CP, but treatment, therapy, special equipment, and, in some cases, surgery can help a child who is living with the condition. What Is Cerebral Palsy? Cerebral palsy is one of the most common congenital (existing before birth or at birth) disorders of childhood. About 500,000 children and adults of all ages in the United States have the condition. The three types of CP are:

1. Spastic cerebral palsy causes stiffness and movement difficulties 2. Athetoid cerebral palsy leads to involuntary and uncontrolled movements 3. Ataxic cerebral palsy causes a disturbed sense of balance and depth perception
Cerebral palsy affects muscle control and coordination, so even simple movements like standing still are difficult. Other vital functions that also involve motor skills and muscles such as breathing, bladder and bowel control, eating, and learning are also affected when a child has CP. Cerebral palsy does not get worse over time. Causes of Cerebral Palsy: The exact causes of most cases of CP are unknown, but many are the result of problems during pregnancy in which the brain is either damaged or doesn't develop normally. This can be due to infections, maternal health problems, or something else that interferes with oxygen reaching the fetal brain. Problems during labor and delivery can cause CP in some cases. Premature babies particularly those who weigh less than 3.3 pounds (1,510 grams) have a higher risk of CP than babies that are carried full-term, as are other low birth weight babies and multiple births, such as twins and triplets. Brain damage in infancy or early childhood can also lead to CP. A baby or toddler might suffer this damage because of lead poisoning, bacterial meningitis, malnutrition, being shaken as an infant (shaken baby syndrome), or being in a car accident while not properly restrained. Diagnosing Cerebral Palsy: CP may be diagnosed very early in an infant known to be at risk for developing the condition because of premature birth or other health problems. Doctors, such as pediatricians and developmental and neurological specialists, usually follow these kids closely from birth so that they can identify and address any developmental delays or problems with muscle function that might indicate CP. In a baby carried to term with no other obvious risk factors for CP, it may be difficult to diagnose the disorder in the first year of life. Often doctors arent able to diagnose CP until they see a delay in normal developmental milestones such as reaching for toys by 4 months or sitting up by 7 months which can be signs of CP. Abnormal muscle tone, poorly coordinated movements, and the persistence of infant reflexes beyond the age at which they are expected to disappear can also be signs. If these developmental milestones are only mildly delayed, the diagnosis of CP may not be made until the child is a toddler. Preventing Cerebral Palsy: In many cases the causes of CP are unknown, so theres no way to prevent it. But if youre having a baby, you can take steps to ensure a healthy pregnancy and carry the baby to term, thus lowering the risk that your baby will have CP. Before becoming pregnant, its important to maintain a healthy diet and make sure that any medical problems are managed properly. As soon as you know youre pregnant, proper prenatal medical care is vital. Controlling diabetes, anemia, hypertension, and nutritional deficiencies during pregnancy can help prevent some premature births and, as a result, some cases of cerebral palsy. Once your baby is born, you can lower the risk of brain damage, which could lead to CP. Never shake an infant, as this can lead to shaken baby syndrome and brain damage. If youre riding in a car, make sure your baby is properly strapped into an infant car seat thats correctly installed if an accident occurs, the baby will be as protected as possible. Be aware of lead exposure in your house, as lead poisoning can lead to brain damage. How Cerebral Palsy Affects Development: Children with CP have varying degrees of physical disability. Some have only mild impairment, while others are severely affected. Associated medical problems may include visual impairment or blindness, hearing loss, food aspiration (the sucking of food or fluid into the lungs), gastro-esophageal reflux (spitting up), speech problems, drooling, tooth decay, sleep disorders, osteoporosis (weak, brittle bones), and

behavior problems. Seizures, speech and communication problems, and mental retardation are also common among kids with CP. Many have problems that may require ongoing therapy and devices such as braces or wheelchairs. Treatment of Cerebral Palsy: Currently there's no cure for cerebral palsy, but if your child is diagnosed with it, a variety of resources and therapies can provide help and improve the quality of your childs life. Therapies can help kids with CP achieve maximum potential in growth and development. As soon as CP is diagnosed, a child can begin therapy for movement, learning, speech, hearing, and social and emotional development. In addition, medication, surgery, and braces can help improve muscle function. Surgery can help repair dislocated hips and scoliosis (curvature of the spine), which are common problems associated with CP. Severe muscle spasticity can sometimes be helped with medication. DR. ALIM AKHTAR BHUIYAN
CONSULTANT NEUROLOGIST, APOLLO HOSPITALS, DHAKA (Ex-Associate Professor of Neurology , Bangladesh Medical College , Dhaka ; Ex-Consultant Neurologist, Veterans Administration Hospital ,New York, U.S.A.)