Cerebral Palsy

Cerebral Palsy

Cerebral palsy  is a disease that causes disturbances in muscles, movement, and body coordination. This condition can occur during pregnancy, during labor, or in the first year after birth.

Symptoms of cerebral palsy or cerebral palsy are very diverse. At its most severe level, cerebral palsy can cause paralysis. Sufferers may need special equipment to be able to move. This disease can even cause the sufferer to be unable to walk so that it requires lifelong treatment.

The brain damage in cerebral palsy is permanent and cannot be cured. However, there are treatments that can be done to help improve the function of the nerves that regulate the movement of the body's muscles. The disease will also not get worse, but some of the symptoms may change over time.

Causes of Cerebral Palsy

Cerebral palsy  or brain paralysis is caused by impaired brain development in children, which causes movement and posture disturbances. In addition, this condition can also cause intelligence disorders.

Cerebral palsy usually occurs during pregnancy, but can also occur during delivery, or the first few years after the child is born.

It is not known exactly what causes this developmental disorder, but this condition is thought to be triggered by a number of factors:

Disorders during pregnancy

Cerebral palsy is most often caused by impaired brain development while the child is still in the womb. This condition is caused by:

  • Changes in genes that have a role in brain development
  • Infections during pregnancy that transmit to the fetus, such as chickenpox,  rubella , syphilis, herpes, zika, toxoplasmosis, and  cytomegalovirus infections
  • Impaired blood flow to the fetal brain
  • Rhesus blood group differences between mother and baby

Postpartum disorders

Brain damage in cerebral palsy can also be caused by several factors that occur during or after the baby is born, namely:

  • Lack of oxygen supply to the baby's brain ( asphyxia ) during labor
  • Breech birth, which is born with the feet out first
  • Jaundice ( kernicterus )
  • Inflammation of the baby's brain (encephalitis) or lining of the brain (meningitis).
  • Severe head injury, for example in the case of shaken baby syndrome or due to an accident

Risk factors for cerebral palsy

There are several factors that can increase the baby's risk of developing cerebral palsy , namely:

  • The birth of twins or more, especially if one baby survives and the other baby dies at birth
  • Low baby weight at birth , which is less than 2.5 kilograms
  • Premature birth, which is born at less than 37 weeks of gestation
  • Bad habits in the mother during pregnancy, such as smoking, consuming alcoholic beverages , or using drugs

Symptoms of Cerebral Palsy

Cerebral palsy is a disease that causes disturbances in the brain and nervous system functions, such as movement, intellect, hearing, vision, and speech. In children or infants affected by  cerebral palsy , a number of symptoms that can arise include:

Movement and coordination

Symptoms of cerebral palsy related to movement and coordination are:

  • Tendency to use one side of the body, such as dragging one leg when crawling, or reaching for something with only one hand
  • Difficulty making precise movements, for example when picking up an object
  • An abnormal gait, such as on tiptoe, crossed like scissors, or with legs wide apart
  • Muscles that are stiff or even very weak
  • Joints that are stiff and do not open fully (joint contractures)
  • Tremors of the face, arms, or other body parts
  • Uncontrolled writhing movements

Ability to speak and eat

Disorders of the muscles around the face due to cerebral palsy can cause sufferers to have difficulty speaking and eating. Symptoms that may be seen as a result of this condition are:

  • Speech disorder ( dysarthria )
  • Difficulty swallowing (dysphagia)
  • Difficulty sucking and chewing
  • Constantly drooling

Growth and development

People with cerebral palsy generally experience disturbances in their growth and development. Symptoms that may appear include:

  • Inhibited growth of limbs so that their size will be smaller than normal size
  • Delayed development of motor skills, such as sitting, rolling over, or crawling
  • Learning disorders
  • Intellect disorder

Nervous system

Damage to the brain can result in disorders of the nervous system, such as:

  • Seizures (epilepsy)
  • Impaired vision
  • Hearing disorders
  • Unresponsive to touch or pain
  • Mental health conditions, such as emotional and behavioral disorders
  • Inability to hold back urination (urinary incontinence)

Cerebral palsy symptoms can be mild to severe. The types of symptoms that appear depend on the part of the brain that is affected. These symptoms usually appear in the first 2 years of a child's age and can be permanent.

When to see a doctor

Check with your doctor if you find signs or symptoms of cerebral palsy in your child. Disorders of child development need to be diagnosed and treated immediately so that the child's quality of life can improve.

Diagnosis of Cerebral Palsy

Doctors can suspect a child has  cerebral palsy if there are a number of symptoms that have been mentioned previously. The doctor will also talk to the patient and perform a physical exam to test his hearing and vision.

To further confirm the diagnosis, the doctor will suggest further tests, such as:

  • Blood tests, to rule out the possibility that the symptoms are caused by another condition or disease
  • Scans with MRI , CT scan, and ultrasound, to see areas of the brain that are damaged or develop abnormally
  • Electroencephalography ( EEG ), to see the brain's electrical activity with the help of a special tool connected to the scalp

After confirming the diagnosis of cerebral palsy , the doctor can perform other tests to detect disturbances in intelligence, posture and development. Tests are also done to check for disturbances in speech, seeing, hearing, and movement.

Cerebral Palsy Treatment

Until now there is no treatment that can cure  cerebral palsy . However, there are methods that can be used to improve the patient's ability to function independently. Commonly used treatment methods are:

Drugs

Medications are used to relieve pain or relax stiff muscles to make it easier for the patient to move. The type of drug used depends on the extent of the stiff muscle.

In muscle stiffness that only occurs in certain areas of the body, doctors can give Botox injections every 3 months. Botox can also be used to treat drooling. As for muscle stiffness that occurs throughout the body, your doctor may prescribe diazepam, dantrolene,  baclofen , or tizanidine.

Therapy

Apart from drugs, therapy is also needed to treat the symptoms of cerebral palsy , including:

  • Physiotherapy
    Children's physiotherapy aims to improve movement abilities and muscle strength, and prevent contractures (shortening of muscles that restrict movement).
  • Occupational
    therapy Occupational therapy aims to help patients overcome difficulties in performing daily activities, such as sitting, walking, bathing, or dressing. This therapy will be very helpful in increasing muscle strength, as well as increasing the patient's confidence and independence.
  • Speech therapy Speech therapy is intended for cerebral palsy
    patients  who experience problems communicating with others. This therapy will train children to repeat words and improve their ability to say words.

Operation

Surgical procedures are needed if muscle stiffness causes abnormalities in the bones. The aim is to improve the ability of the sufferer's body movement. Examples of these operations are:

  • Orthopedic surgery
    This procedure aims to return the bones and joints to their correct position. Orthopedic surgery can also lengthen muscles and tendons that are too short due to contractures, so that the patient's mobility is improved.
  • Selective dorsal rhizotomy (SDR)
    SDR is performed when other procedures are unable to overcome muscle pain and stiffness. This procedure is performed by cutting one of the sensory nerves in the spinal cord.

In patients who have difficulty swallowing ( dysphagia ), the doctor will advise the patient to eat soft and soft foods while exercising the swallowing muscles with physiotherapy. However, if the dysphagia experienced is severe, the doctor will recommend the installation of a feeding tube ( nasogastric tube ).

In patients who are constantly drooling, the doctor will perform surgery to direct the flow of saliva to the back of the mouth so it doesn't keep dripping out.

Complications of Cerebral Palsy

Cerebral palsy that lasts in the long term can cause the following complications:

  • muscle stiffness
  • Muscle wasting (atrophy)
  • Bone inflammation ( osteoarthritis )
  • Curvature of the spine (scoliosis)
  • Low bone density (osteoporosis)
  • Lung disease, such as aspiration pneumonia
  • Lack of nutrition due to difficulty swallowing food
  • Pressure sores ( decubitus ulcers )
  • Bladder infection
  • Skin damage
  • Sleep disturbance
  • Constipation

Cerebral palsy in adult patients

Even though it doesn't get worse, cerebral palsy in adults can cause several new problems for sufferers. For example, people with cerebral palsy need 3–5 times more energy to carry out daily activities.

In addition, sufferers are also at risk of developing degenerative diseases more quickly due to muscle stiffness, or excessive use of muscles, bones and joints.

Other conditions that can occur include:

  • Premature aging
  • Post-impairment syndrome
  • Prolonged (chronic) pain
  • Mental disorders, such as depression

Prevention of Cerebral Palsy

In many cases, the cause of cerebral palsy cannot be fully known, especially in cerebral palsy caused by genetic disorders. Therefore, not much prevention can be done.

However, to reduce the risk of brain development disorders that can trigger cerebral palsy , there are several preventive measures that can be taken before and during pregnancy, as well as after delivery. Some of these efforts are:

  • Carry out overall pregnancy planning, such as undergoing the MMR vaccination , and adopting a healthy lifestyle, such as maintaining an ideal body weight, eating nutritious foods, and exercising regularly
  • Have regular pregnancy checkups
  • Obey traffic rules to avoid accidents while driving
  • Avoid smoking and consuming alcoholic beverages, especially during pregnancy
  • Do not abuse drugs
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