Cerebral palsy (CP)

Cerebral palsy

What causes cerebral palsy

We do not know the causes of most cases of cerebral palsy. We are not able to determine what factors cause cerebral palsy in cases of congenital palsy.We do know that the children at highest risk for developing cerebral palsy are premature infants, very young infants who do not cry within the first 5 minutes after birth, children who need a cue for more than 4 weeks, and those who have a cerebral hemorrhage.Seizures in the newborn also increase the risk of CP.There is no combination of factors that always leads to CP.Even a very young premature infant has more than a 90 percent chance of not developing CP. There are a very large number of babies who have a difficult birth or a difficult postnatal period,but develop very well.There are also children who did not have any particular problems at birth,but then develop severe mental retardation.

Cerebral palsy in the newborn

Many children with cerebral palsy have congenital brain damage, indicating that the disability exists before birth and is not caused by factors during the birth process.Not all malformations can be seen by a doctor, even with modern diagnostic methods.When a diagnosis of cerebral palsy is made, parents often feel guilty and wonder if they somehow caused their child’s condition.It is true,that good prenatal care is an essential part of preventing congenital problems.It should be known that quite often birth defects occur even when the mother has strictly followed the doctor’s advice and has taken good care of herself and the developing fetus. It should be known that the main causes of fetal brain damage are the effects on the pregnant woman of certain chemicals and infections.The developing brain can also be damaged by severe physical trauma or systemic alcohol intake.Smoking by the pregnant woman often leads to a decrease in the birth weight of the baby,which is directly associated with cerebral palsy. The use of drugs such as cocaine, for example, directly damages the fetal brain.Infections such as rubiola, toxoplasmosis, cytomegalovirus,AIDS lead directly to fetal harm. Between 5 and 8% of children weighing less than 1500 grams develop cerebral palsy.This is 25 times more than children weighing more than 2500 grams.

Cerebral palsy from the birth process

It should be noted that there is not much difference in the percentage of children with cerebral palsy in countries where there is a higher infant mortality rate compared to countries where there is a lower rate. Even in northern European countries, where special care for the pregnant woman, including constant monitoring and frequent caesarean sections, has reduced infant mortality to a minimum, but not cerebral palsy. A common cause of cerebral palsy is severe asphyxia during the birthing process caused by a wrapped umbilical cord, meconium or others. However, it should be immediately noted that half of children with severe asphyxia do not develop cerebral palsy. Recent research shows that only 9 percent of children with cerebral palsy have birth asphyxia as a direct cause . Even Sigmund Freud believed that cerebral palsy occurs before birth, not during the birth process. This view of his was ignored in the first half of the century, but recent research suggests that he was right. Nevertheless, the birth process can be traumatic for the child and the trauma caused by it can in some cases lead to cerebral palsy.

Cerebral palsy in the infant and child

What can cause cerebral palsy in the young child is again asphyxia. This can be caused by choking on small objects such as toys or small pieces of food,liquids and also by poisoning. The brain can be damaged by physical traumatization – by a blow to the head. One form of childhood disability is ‘shaken baby syndrome’, where the baby rocks too hard and constantly to be soothed. Severe infections such as meningitis or encephalitis can lead to cerebral palsy in this age group.

How cerebral palsy is diagnosed

It is the GP who should be the first to notice the child’s developmental delay in some of the skills such as grasping toys, sitting, crawling, walking. Abnormal muscle tone, movements and reflexes should be noted, as well as the persistence of the newborn’s reflexes for a prolonged period of time.Making a definitive diagnosis of cerebral palsy is not an easy job, especially before the child’s first birthday.The diagnosis is usually made worldwide around the 18th month on average and later. Fortunately, in my hospital, the premature infant ward, headed by Dr. Petrov and his wonderful micropediatricians, has a section for newborns with neurological abnormalities, where Dr. Piskova, using Professor Voita’s method of special diagnosis, can identify early abnormalities in a baby’s neurological development.

Whether X-rays or other tests help in making the diagnosis

The diagnosis of cerebral palsy cannot be made on the basis of an X-ray or blood test. Transfontanal ultrasonography, MRI and CT scans can detect early some changes in the brain that may be the cause of cerebral palsy, but they also cannot give a definitive and firm diagnosis of cerebral palsy.

What types of cerebral palsy there are

CP can be classified by the type of motor problem /such as spastic or athetoid CP/ or by the body parts involved /hemiplegia, diplegia or quadriplegia/. Spasticity represents the inability of muscles to relax, while athetosis represents the inability to control muscle movement. Hemiplegia involves one arm and one leg on the same side of the body, while diplegia involves both legs. Quadriplegia affects all four limbs as well as the trunk and neck muscles. The motor imbalance of children varies greatly from child to child, so the condition can be divided into many subgroups. There are also the terms paraplegia, double hemiplegia, triplegia and even pentaplegia, which are also based on the number of body parts affected. All of these classifications support communications on CP issues. The words severe, moderate and mild can also be used in combination with the anatomical and motor classifications / severe spastic diplegia – for example / but they are subjective words and vary depending on the opinion of the person using them.

What is the prognosis for a child with cerebral palsy

The first question parents usually ask when this diagnosis is made is, “Will he be able to walk?” Predicting for a young child with CP what he or she will and will not do is very difficult, especially if the child is less than a year old. In a two-year-old, it can already be determined whether it is hemiplegia, diplegia or quadriplegia. At a later age, even more general conclusions can be drawn, such as a child who could not sit up at 4 and walk at 8 will never be able to walk independently / however I have had cases where I have been able to help children walk at 10 and 11.
This should include, in addition to motor development, the development of the child’s intellectual function and mental abilities, because very often mental retardation in children can impede functional development.

How aggressive should treatment be in the sick newborn

This is also a frequently asked question by parents of a sick child. It is my opinion that the disease should be attacked with all strength and means, and every sign of weakness and intransigence should be regarded as weakness and yielding to the disease. From the very beginning, both the child’s personal physician and a well-coordinated team of pediatrician-neurologist, psychologist, special educator, and a well-trained and well-meaning rehabilitation therapist should be involved in the treatment. The child must be under the care of this team at all times. An important moment in the treatment is when the child meets his or her orthopaedic surgeon.This is the person who enables him or her to walk if he or she has not walked before, and to improve the gait if he or she walks but with a bad gait.

What realistic goals can be set for a child with cerebral palsy

When considering and discussing the future of a child with CP, this should be done with a combination of optimism and realism. To quote a colleague of mine from the US, who gives the following example: parents of a 3-year-old child with cerebral palsy hope and wish that the child will graduate from high school, college, law school, enter politics and then become President of the United States.Some of these goals, he says, are completely realistic, while others are far from reality.
My opinion is that the main goals that should be set by both the parents and the treatment team should be first physical independence, second social responsibility and third emotional maturity.These are the three goals from which both the treatment process and the child’s life and self-control should be woven.

What medical problems are associated with cerebral palsy

The most common problems associated with cerebral palsy are epilepsy, mental retardation, learning disability, attention deficit associated with hyperactivity. The main problems, however, are problems with impaired gait as well as acquired subluxation of the hip joints.

What Dr. Yanakiev can do for your child

A child affected by cerebral palsy must be rehabilitated from birth and, when his or her mind and age allow, self-rehabilitate. It should be trained by special educators, stand under the supervision of the personal doctor, neurologist and psychologist. However, if, despite all efforts, the child cannot walk by the age of 2.5-3 years or has a poor gait by the age of 5-6 years, and also has a deviation in position in grasping with the hands, he should meet with me. Since 1990. To date, I have performed hundreds of surgical interventions in the fight against this insidious disease of cerebral palsy, which have enabled several dozen children from Kozloduy to Kardzhali and from Sofia to Varna and Burgas to pass or significantly improve their gait. The surgeries I apply are applied in the world practice by leading orthopedists. They are the same ones that would do you in Osaka, Munich or Chicago. In general, operations are aimed at overcoming contractures and spasticity of the affected muscles, and also to restore the shape of the injured limb.

Source: biberonbg.com

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