Cerebral palsy ( CP ) is a group of permanent motion disorders that appear in early childhood. Signs and symptoms vary among people. Often, symptoms include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, sight, hearing, swallowing and speaking. Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children their age. Other symptoms may include seizures and problems with thought or reasoning, one of which occurs in about a third of people with CP. Although the symptoms can be more noticeable during the first few years of life, the underlying problems do not worsen over time.
Cerebral palsy is caused by abnormal development or damage to parts of the brain that control movement, balance and posture. Most often, problems occur during pregnancy; However, they can also occur during labor or shortly after birth. Often, the cause is unknown. Risk factors include premature birth, becoming twins, certain infections during pregnancy such as toxoplasmosis or rubella, methylmercury exposure during pregnancy, difficult delivery and head trauma during the first few years of life, among others. About 2% of cases are believed to be caused by inherited genetic causes. A number of sub-types are classified according to the specific problem that exists. For example, those who have stiff muscles have spastic cerebral palsy, those with poor coordination have ataxic cerebral palsy and those with stretched movements have athetoid cerebral palsy. The diagnosis is based on the child's development over time. Blood tests and medical imaging can be used to rule out other possible causes.
CP can be partially prevented through maternal immunization and efforts to prevent head injuries in children such as through increased safety. There is no cure for CP; however, care, medication and supportive surgery can help many individuals. This may include physical therapy, occupational therapy and speech therapy. Drugs such as diazepam, baclofen and botulinum toxin can help relax the stiff muscles. Surgery may include elongating the muscles and cutting off the overactive nerves. Often, external braces and other auxiliary technologies are helpful. Some affected children can achieve normal adult life with proper care. While alternative medicine is often used, there is no evidence to support its use.
Cerebral palsy is the most common motion disorder in children. This occurs in about 2.1 per 1,000 live births. Cerebral palsy has been documented throughout history, with the first known description to occur in the work of Hippocrates in the 5th century BC. Extensive study of this condition began in the 19th century by William John Little, after a spastic diplegia called "Small Disease". William Osler first named it "cerebral palsy" from Germany zerebrale KinderlÃÆ'¤hmung (brain childhood paralysis). A number of potential treatments are being examined, including stem cell therapy. However, further research is needed to determine whether it is effective and safe.
Video Cerebral palsy
Signs and symptoms
Cerebral palsy is defined as "a group of permanent disorders of movement and posture development, leading to activity limitations, associated with non-progressive disorder occurring in the fetus's brain or developing baby." While motion problems are a major feature of CP, difficulties with thinking, learning, feelings, communication and behavior often occur together, with 28% experiencing epilepsy, 58% having difficulty with communication, at least 42% having problems with their vision, and 23-56 % have learning disabilities. Muscle contractions in people with cerebral palsy are generally considered to arise from overactivation.
Cerebral palsy is characterized by smooth muscle, reflexes, or motor development and coordination. Neurological lesions are primary and permanent whereas orthopedic manifestations are secondary and progressive. In cerebral palsy the unequal growth between the muscle-tendon unit and the bone eventually leads to bone and joint deformity. The first deformity is dynamic. Over time, deformity tends to be static, and joint contractures develop. Deformity in generalized and static deformities in specific (joint contractures) leads to an increase in gait difficulty in tip-toeing gait, due to the tightness of the Achilles tendon, and scissoring action, due to the tightness of the hip adductor. This gait pattern is the most common gait disorder in children with cerebral palsy. However, the orthopedic manifestations of cerebral palsy vary. The effects of cerebral palsy fall on the continuum of motor dysfunction, which can range from a slight awkwardness on the light end of the spectrum to extremely severe disturbance so that they make coordinated movements nearly impossible on the other end of the spectrum. Although most people with CP have problems with increased muscle tone, some have normal or low muscle tone. High muscle tone can be caused by spasticity or dystonia.
Babies born with severe cerebral palsy often have irregular postures; their bodies may be very floppy or very stiff. Birth defects, such as curvature of the spine, small jawbone, or small head sometimes occur simultaneously with CP. Symptoms may appear or change as the child gets older. Babies born with cerebral palsy are not immediately present with symptoms. Classically, CP becomes clear when the baby reaches the stage of development at 6 to 9 months and begins to mobilize, where use of limb, asymmetry, or motor developmental delay is seen.
Drooling is common in children with cerebral palsy, which can have various impacts including social rejection, speech disorders, damage to clothing and books, and mouth infections. It can also cause choking.
An average of 55.5% of people with cerebral palsy experience lower urinary tract symptoms, more frequent storage problems than urinary problems. Those with urinary problems and pelvic overactivity may worsen as adults and have upper urinary tract dysfunction.
Children with CP may also have sensory processing problems
Language
Speech and language disorders are common in people with cerebral palsy. The incidence of dysarthria is estimated to range from 31% to 88%, and about a quarter of people with CP are non-verbal. Speech problems are associated with poor respiratory control, laryngeal and velopharyngeal dysfunction, and oral articulation disorders caused by limited movement of the facial-mouth muscles. There are three main types of dysarthria in cerebral palsy: seizures, diskinetik (athetosis), and ataxicity.
The early use of augmentative and alternative communication systems can help the child develop his oral speaking skills. The overall language delay is associated with the problem of cognition, deafness, and learned helplessness. Children with cerebral palsy are at risk of helpless learning and passive communicators, initiating small communication. Early intervention with these clients, and their parents, often targets situations in which children communicate with others so they learn that they can control people and objects in their environment through this communication, including making choices, decisions, and mistakes.
Skeleton
In order for bones to reach their normal shape and size, they require the pressure of the normal muscles. People with cerebral palsy are at risk of low bone mineral density. The bone shaft is often thin (gracile), and becomes thinner during growth. When compared with the thin shaft (diaphyses), the centers (metaphysical) often appear quite enlarged (bulging). Because more than normal joint compression is caused by muscle imbalance, articular cartilage may develop atrophy, leading to a narrow joint space. Depending on the level of flexibility, a person with CP may exhibit various angular joint deformities. Because the vertebral body needs a vertical gravity loading force to thrive, abnormal flexibility and gait may inhibit proper and complete bone and skeletal development. People with CP tend to be shorter than the average person because their bones are not allowed to grow to the fullest. Sometimes the bones grow at different lengths, so the person may have one leg longer than the other.
Children with CP are susceptible to low trauma fractures, especially children with higher levels of GMFCS who can not walk. This further affects the mobility, strength, pain experience of the child, and can lead to suspicion of school or suspected child suspicion. These children generally have broken bones in the legs, while unaffected children generally break their hands in the context of sporting activities.
Hip dislocation and equinus ankle or planter flexion deformity are the two most common abnormalities among children with cerebral palsy. In addition, hip and knee flexion deformities may occur. In addition, long bone torsional deformities such as femur and tibia are encountered among others. Children may develop scoliosis before age 10 - the estimated prevalence of scoliosis in children with CP is between 21% and 64%. Higher damage rates in GMFCS are associated with scoliosis and pelvic dislocation. Scoliosis can be corrected surgically, but CP makes surgical complications more likely, even with better techniques. Hip migration can be managed by soft-tissue procedures such as muscle release of the adapter. The continued degree of pelvic migration or dislocation can be managed by a broader procedure such as femoral and pelvic corrective osteotomy. Both soft and bone tissue procedures aim to prevent hip dislocations in the early phase or aim at hip detention and anatomical restoration in the final phase of the disease. Equinus deformity is managed by conservative methods especially when dynamic. If the abnormality remains/static occurs then the operation becomes mandatory.
The acceleration of growth during puberty can make walking more difficult.
Pain and sleep
Pain is common and can occur due to an inherent deficit associated with the condition, along with many of the procedures that children normally face. When children with cerebral palsy are in pain, they experience worse muscle spasms. Pain associated with stiff or short muscles, abnormal posture, stiff joints, unsuitable orthoses, etc. Hip migration or dislocation is a recognizable source of pain in CP children and especially in adolescent populations. However, adequate scores and scale of pain in CP children remain challenging. There is also a high likelihood of chronic sleep disturbance due to physical and environmental factors. Children with cerebral palsy have a much higher rate of sleep disturbance than children who develop typically. Infants with cerebral palsy who have stiffness problems may cry more and are more difficult to put to sleep than infants who are not disabled, or "floppy" babies may be lethargic. Chronic pain is less recognizable in children with cerebral palsy, although 3 in 4 children develop cerebral palsy pain.
Eating
Due to sensoric and motor disturbances. those with CP may have difficulty preparing food, holding equipment, or chewing and swallowing, infants with CP may not be able to suck, swallow or chew. Gastro-oesophageal reflux is common in children with CP. Children with CP may have too little or too much sensitivity around and in the mouth. A poor balance when sitting, lack of control over the head, mouth, and body, is unable to bend the hips enough to allow the arm to stretch forward to reach and hold food or equipment, and lack of hand-eye coordination can make eating difficult. Eating difficulties associated with higher GMFCS levels. Dental problems can also cause difficulty eating. Pneumonia is also common where feeding difficulties exist, which are caused by undetected aspiration of food or fluids. Finger crashing, as required to pick up a tool, is more often damaged than manual dexterity, as it is necessary to spoon the food onto a plate. Grip strength disturbances are less common.
Children with severe cerebral palsy, especially with oropharyngeal problems, are at risk of malnutrition. The Triceps skin fold test has been found to be a very reliable indicator of malnutrition in children with cerebral palsy.
Related interruptions
Associated disorders include "intellectual disability, seizures, muscle contractures, abnormal walking, osteoporosis, communication disorders, malnutrition, sleep disturbances, and mental health disorders, such as depression and anxiety." In addition to this, "gastrointestinal functional abnormalities that cause intestinal obstruction, vomiting, and constipation" may also occur. Adults with cerebral palsy may suffer from "ischemic heart disease, cerebrovascular disease, cancer, and trauma" more than the unaffected population. Obesity in people with cerebral palsy or a more severe assessment of the Motoric Function Classification System is particularly regarded as a risk factor for multimorbidity. Other medical problems can be misinterpreted as symptoms of cerebral palsy, so it can not be handled properly.
Related conditions may include apraxia, dysarthria or other communication disorders, sensory impairment, urinary incontinence, fecal incontinence, or behavioral disorders.
Handling of seizures is more difficult in people with CP because seizures are often longer.
Related disorders that occur in conjunction with cerebral palsy may be more disabling than motor function problems.
Maps Cerebral palsy
Cause
Cerebral palsy is caused by abnormal development or damage that occurs in the developing brain. This damage can occur during pregnancy, labor, first month of life, or more rarely in early childhood. Structural problems in the brain are seen in 80% of cases, most commonly in white matter. More than three-quarters of cases are believed to stem from problems that occur during pregnancy. Most children born with cerebral palsy have more than one risk factor associated with CP.
While in certain cases there are no identifiable causes, typical causes include problems in intrauterine development (eg exposure to radiation, infection, fetal growth restriction), brain hypoxia (thrombotic events, placental conditions), birth trauma during labor and delivery, and complications around birth or during childhood.
In African birth asphyxia, high bilirubin levels, and infections in newborns from the central nervous system are the main causes. Many CP cases in Africa can be prevented with better available resources.
Premature birth
Between 40% and 50% of all children with cerebral palsy are born prematurely. Most of these cases (75-90%) are believed to be caused by problems that occur around the time of birth, often just after birth. Babies with multiple births are also more likely than single-born babies to have CP. They are also more likely to be born with low birth weight.
In those born with a weight between 1 kg and 1.5 kg CP occurred at 6%. Among those born before the 28th week of pregnancy it occurred at 11%. Genetic factors are believed to play an important role in prematurity and cerebral palsy in general. Whereas in those born between 34 and 37 weeks the risk was 0.4% (three times normal).
Conditional babies
In infants born to risk factors include problems with placenta, birth defects, low birth weight, meconium breathing to the lungs, delivery requiring either the use of instruments or emergency caesarean section, birth asphyxia, seizures only after birth, respiratory distress syndrome, sugar low blood, and infections in infants.
In 2013, it is unclear how many roles born of asphyxia play a role. It is unclear whether placental size plays a role. By 2015 it is evident that in countries benefiting, most cases of cerebral palsy in neonatus terms or short-term have an explanation other than asphyxia.
Genetics
Approximately 2% of all CP cases are inherited, with decarboxylase-1 glutamate becoming one of the enzymes that may be involved. Most cases inherited are autosomal recessive.
Early Childhood
After birth, other causes include toxic, severe jaundice, lead poisoning, physical brain injury, stroke, rough head trauma, incidents involving hypoxia to the brain (such as near drowning), and encephalitis or meningitis.
More
Mother infections, even those that are not easily detected, can increase the risk of triple the child developing cerebral palsy. Infection of the fetal membrane known as chorioamnionitis increases the risk.
Intrauterine and neonatal (many of which are contagious) increase the risk.
It has been hypothesized that some cases of cerebral palsy are caused by death in early identical twin pregnancies.
Incompatibility of Rh blood type can cause the mother's immune system to attack the baby's red blood cells.
Diagnosis
The diagnosis of cerebral palsy has historically depended on the history and physical examination of a person. The assessment of a general movement, involving spontaneous measurements of movement among those less than four months, seems most accurate. The more severely affected children are more likely to be noticed and diagnosed beforehand. Abnormal muscle tone, delayed motor development and persistence of primitive reflexes are the main early symptoms of CP. Symptoms and diagnosis usually occur at age 2, although people with milder forms of cerebral palsy may be over 5 years old, if not in adulthood, when finally diagnosed. This is a developmental defect.
Once a person is diagnosed with cerebral palsy, further diagnostic tests are optional. Neuroimaging with CT or MRI is justified when a person's cerebral palsy causes have not yet formed. MRI is preferred over CT, due to diagnostic and safety outcomes. When not abnormal, neuroimaging research can suggest early damage time. CT or MRI are also able to reveal treatable conditions, such as hydrocephalus, porensefali, arteriovenous malformations, subdural and hygroma hematomas, and verminal tumors (some studies suggest 5-22% of time). In addition, abnormal neuroimaging studies show a high likelihood of related conditions, such as epilepsy and intellectual disability. There is a small risk associated with childhood sedatives to take a clear MRI.
The age at which CP is diagnosed is important, but there is disagreement about what age is best to make the diagnosis. CP was previously diagnosed correctly, the better the chances to provide children with physical and educational help, but there may be a greater possibility that CP will be confused with other problems, especially if the child is 18 months or younger. Babies may have temporary problems with muscle tone or control that can be confused with CP, which is permanent. Metabolic or tumor disorders in the nervous system may seem like CP; Metabolic disorders, in particular, can produce brain problems that look like CP on MRI. Disorders that worsen the white matter in the brain and the problems that cause seizures and weakness in the legs, may be mistaken for CP if they first appear early in life. However, this disorder worsens over time, and CP does not (although it may change in character). In infancy it may not be possible to distinguish between them. In the UK, being unable to sit independently at 8 months is considered a clinical sign for further monitoring. Fragile X syndrome (causes of autism and intellectual disability) and general intellectual disability should also be ruled out. Specialist cerebral palsy John McLaughlin recommends waiting until the child is 36 months before making a diagnosis, because at that age, the motor capacity is easier to assess.
Classification
CP is classified by type of motor damage from limbs or organs, and by the limitation of activity that may be performed by the affected person. The Gross Motor Function Classification System is Expanded and Revised and the Manual Classification System is used to describe mobility and manual agility in people with cerebral palsy, and recently the Communications Function Classification System, and the Food and Drinking Classification System has been proposed to explain the functions that. There are three major CP classifications by motor disorders: spastic, ataxia, and athetoid/diskinetik. In addition, there is a mixed type that shows a combination of features of other types. This classification reflects areas of the damaged brain.
Cerebral palsy is also classified according to the topographic distribution of muscle flexibility. This method classifies children as diplegic, (bilateral involvement with greater leg involvement than arm involvement), hemiplegia (unilateral involvement), or quadriplegic (bilateral involvement with arm involvement equal to or greater than foot involvement).
Spastic
Spastic cerebral palsy, or cerebral palsy where flexibility (excision of muscles) is exclusively exclusive or almost exclusive exclusion, by far the most common type of cerebral palsy, occurs in up to 70% of all cases. People with CP type are hypertonic and have what is essentially a disorder of neuromuscular mobility (not hypotonia or paralysis) derived from top motor neuron lesions in the brain as well as the corticospinal tract or motor cortex. This damage impairs the ability of some nerve receptors in the spine to receive gamma -Asminobutyric acid correctly, causing hyponia in muscles characterized by damaged nerves.
Compared with other types of CP, and especially compared with hypotonic or paralytic mobility defects, CP spastic is usually more easily handled by affected people, and medical care can be performed on many orthopedics and neurologists throughout life. In any form of spastic CP, the clonus of the affected limb (s) may occasionally occur, as well as muscle spasms resulting from pain or stress from the stiffness experienced. Flexibility can and usually causes the onset of muscle stress symptoms such as arthritis and tendinitis, especially in ambulatory individuals in their mid-20s and early 30s. Occupational therapy and physical therapy regimens assisted stretching, strengthening, functional tasks, or physical activity and targeted exercise are usually the primary means of keeping a well-managed spastic CP. If there is too much flexibility for people to handle, other treatments may be considered, such as antispasmodic drugs, botulinum toxins, baclofen, or even neurosurgery known as selective dorsal rhizotomies (which eliminate flexibility by reducing the excitatory nerve response in the nerves that cause it).
Ataxic
Cerebral palsy is observed in about 5-10% of all cases of cerebral palsy, making it most commonly occurring cerebral palsy. Cerebral palsy ataxia is caused by damage to the cerebellar structure. Due to damage to the cerebellum, which is important for coordinating muscle movement and balance, patients with cerebral cerebral ataxia experience problems in coordination, particularly in the arms, legs and torso. Ataxic cerebral palsy is known to decrease muscle tone. The most common manifestation of ataxic cerebral palsy is tremor intent (action), which is especially noticeable when making proper movements, such as tying a shoelace or writing with a pencil. These symptoms worsen as the movement continues, causing the hand to vibrate. As the hand gets closer to completing the intended task, the vibration gets stronger which makes it harder to complete.
Athetoid
Atetoid cerebral palsy (sometimes abbreviated ADCP) is mainly associated with damage to the basal ganglia in the form of lesions that occur during brain development due to bilirubin encephalopathy and hypoxia-ischemic brain injury. ADCP is characterized by hyponia and hypotonia, due to the inability of the affected individual to control the muscles. ADCP clinical diagnosis usually occurs within 18 months of birth and is primarily based on motor function and neuroimaging techniques. Athetoid cerebral palsy dyskinetic is a non-spastic, extrapyramidal form of cerebral palsy. Cerebral palsy can be cleverly divided into two distinct groups; choreoathetoid and distonik. The chorio-athetotik CP is characterized by the most involuntary movements found on the face and extremities. Dystonic ADCP is characterized by a slow and strong contraction, which can occur locally or cover the entire body.
Mixed
The mixture of cerebral palsy has athetoid, ataxic and spastic CP symptoms appearing simultaneously, each with varying degrees, and both with and without symptoms respectively. CP mixtures are the most difficult to treat because they are very heterogeneous and sometimes unpredictable in their symptoms and development over a lifetime.
Prevention
Because the causes of CP vary, prevention interventions have been investigated.
Electronic fetal monitoring does not help prevent CP, and by 2014 the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada have acknowledged that there is no long-term benefit of electronic fetal monitoring. Prior to this, electronic fetal monitoring was widely used to support obstetric litigation.
In those at risk for preliminary labor, magnesium sulfate appears to reduce the risk of cerebral palsy. It is unclear whether it helps those born in the long run. In those at high risk of preterm labor, a review found that moderate to moderate CP was reduced by administration of magnesium sulphate, and that adverse effects on infants from magnesium sulfate were not significant. Mothers who receive magnesium sulfate may experience side effects such as respiratory depression and nausea. However, guidelines for the use of magnesium sulphate in mothers at risk for preterm labor are not followed. Caffeine is used to treat premature apnea and reduce the risk of cerebral palsy in premature infants, but there are also concerns about long-term negative effects. A moderate level of evidence has been shown to give antibiotics to women during preterm labor when their water is not broken is associated with an increased risk of cerebral palsy in children. In addition, allowing premature birth to continue rather than trying to delay birth also has moderate levels of evidence for an increased risk of cerebral palsy in children. Corticosteroids are sometimes taken by pregnant women who expect premature birth to provide nerve shields in their infants. Taking corticosteroids during pregnancy is shown to have no significant correlation with developing cerebral palsy at preterm delivery.
Cooling high-risk babies soon after birth can reduce disability, but this may only be useful for some form of brain damage that causes CP.
Management
Over time, approaches to CP management have shifted from narrow attempts to fix individual physical problems - such as spasticity in certain extremities - to make such care part of a larger goal of maximizing people's freedom and community involvement. Many childhood therapies are aimed at improving gait and walking. About 60% of people with CP can walk independently or with help in adulthood. However, the basic evidence for the effectiveness of intervention programs that reflect the philosophy of independence has not been caught: effective interventions for body structure and function have strong evidence base, but less evidence for effective interventions targeted towards participation, environment, or personal. factors. There is also no good evidence to suggest that effective interventions at body-specific levels will result in an increase in activity levels, or vice versa. Although such cross-over benefits may occur, not enough high-quality research has been done to demonstrate it.
Since cerebral palsy has "varying degrees of severity and complexity" throughout life, it can be considered a collection of conditions for management purposes. A multidisciplinary approach to management of cerebral palsy is recommended, with a focus on "maximizing individual function, choice and independence" in accordance with the International Classification of Function, Disability and Health. The team may include pediatricians, health visitors, social workers, physiotherapists, orthopedists, speech and language therapists, occupational therapists, a teacher specializing in helping blind children, an educational psychologist, an orthopedic surgeon, an expert nerves and neurosurgeons.
Various forms of therapy are available for people living with cerebral palsy as well as caregivers and parents. Treatment may include one or more of the following: physical therapy; work related to therapy; speech therapy; water therapy; drugs to control seizures, relieve pain, or relax muscle spasms (eg benzodiazepines); surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic tools; rolling walker; and communication aids such as computers with synthesized sound syntheses. A Cochrane review published in 2004 found trends toward the benefits of speech and language therapy for children with cerebral palsy, but noted the need for high-quality research. A systematic review of 2013 found that many therapies used to treat CP had no good evidence base; treatment with the best evidence are drugs (anticonvulsants, botulinum toxins, bisphosphonates, diazepam), therapies (bimanual training, casting, constricted induction therapy, context-focused therapy, fitness training, goal-directed training, hip supervision , home program, occupational therapy after botulinum toxin, pressure treatment) and surgery. Surgical interventions in CP children mainly include orthopedic and neurosurgical surgery (selective dorsal rhizotomy).
Prognosis
CP is not a progressive disorder (ie, brain damage does not deteriorate), but the symptoms can become more severe over time. A person with the disorder may slightly improve during childhood if he receives extensive treatment, but once the bones and muscles become more established, orthopedic surgery may be necessary. People with CP can have varying degrees of cognitive impairment or none at all. The full intellectual potential of a child born with CP will often not be known until the child starts school. People with CP are more likely to have learning disorders, but have normal intelligence. The intellectual level among people with CP varies from genius to intellectual disability, as is the case in the general population, and experts have stated that it is important not to underestimate one's ability with CP and to give them every opportunity to learn.
The ability to live independently with CP varies greatly, depending in part on the severity of each individual's damage and partly on everyone's ability to manage his own logistics of life. Some individuals with CP need a personal assistant service for all activities of everyday life. Others just need help with certain activities, and others do not need physical help. But regardless of the severity of a person's physical disorder, one's ability to live independently often depends primarily on one's capacity to manage the physical reality of his life independently. In some cases, people with CP recruit, hire, and manage personal care assistant staff (PCAs). PCAs facilitate the independence of their employers by assisting them with their daily personal needs in a way that enables them to maintain control over their lives.
Puberty in young adults with cerebral palsy may become prematurely or delayed. Delayed puberty is considered a consequence of nutritional deficiency. There is currently no evidence that CP affects fertility, although some secondary symptoms have been shown to affect sexual desire and performance. Adults with CP were less likely to get routine reproductive health checks in 2005. Gynecological examination may have to be done under anesthesia because of flexibility, and equipment is often inaccessible. Breast self-examination may be difficult, so a partner or caregiver may have to do it. Women with CP reported higher levels of spasticity and urinary incontinence during menstruation in a study. Men with CP had a higher cryptorchidism rate at 21 years of age.
CP can significantly reduce a person's life expectancy, depending on the severity of their condition and the quality of care provided. 5-10% of children with CP die in childhood, especially where seizures and intellectual disabilities also affect children. The ability to negotiate, roll over, and feed themselves has been linked to an increase in life expectancy. Although there are many variations in the way CP affects people, it has been found that "independent independent motor functional ability is a very powerful determinant of life expectancy". According to the Australian Bureau of Statistics, in 2014, 104 Australians die of cerebral palsy. The most common cause of death in CP is related to respiratory causes, but in middle age cardiovascular problems and neoplastic disorders become more prominent.
Self-care
For many children with CP, parents are deeply involved in self-care activities. Self-care activities, such as bathing, dressing, grooming, can be difficult for children with CP as self-care mainly depends on the use of upper limbs. For those living with CP, impaired upper limb function affects nearly 50% of children and is considered a major factor contributing to decreased activity and participation. Because the hands are used for many self-care tasks, sensory and motor disturbances make daily self-care more difficult. Motor problems cause more problems than sensory disturbances. The most common damage is the dexterity of the fingers, which is the ability to manipulate small objects with radii. Compared to other defects, people with cerebral palsy generally need more help with daily tasks.
Productivity
The effects of sensory, motor and cognitive impairments affect self-care work in children with CP and productivity work. Productivity may include, but is not limited to, schools, employment, domestic work or contributing to society.
Play is included as a productive job because it is often the main activity for children. If playing becomes difficult because of defects, like CP, this can cause problems for the child. These difficulties can affect a child's self-esteem. In addition, the sensory and motor problems experienced by children with CP affect how children interact with their environment, including the environment and others. Physical limitations not only affect the ability of children to play, the limitations felt by caregivers and playmates also affect children's play activities. Some disabled children spend more time playing alone. When disability prevents children from playing, there may be social, emotional and psychological problems that can lead to increased dependence on others, less motivation and poor social skills.
At school, students are asked to complete many tasks and activities, many of which involve handwriting. Many children with CP have the capacity to learn and write in the school environment. However, students with CP may find it difficult to keep up with school handwriting demands and their writing may be difficult to read. In addition, writing may take longer and requires greater effort on the part of students. Factors related to handwriting include postural stability, sensory and perceptual ability of the hand, and stationery pressures.
Speech disorders can be seen in children with CP depending on the severity of brain damage. Communication in school environments is important because communicating with peers and teachers is part of "school experience" and promotes social interaction. Problems with language or motor dysfunction can cause disparagement of students' intelligence. In short, children with CP may experience difficulties in school, such as hand-written difficulties, school activities, orally communicating and social interaction.
Spare time
Recreational activities can have some positive effects on physical health, mental health, life satisfaction and psychological growth for people with physical disabilities such as CP. Commonly identified benefits are stress reduction, development of coping skills, friendship, fun, relaxation and a positive effect on life satisfaction. In addition, for children with CP, spare time seems to increase the adjustment to live with disabilities.
Convenience can be divided into structured (formal) and unstructured (informal) activities. Children and adolescents with CP engage in less physical activity than their peers. Children with CP are primarily involved in physical activity through therapy aimed at managing their CP, or through organized exercise for persons with disabilities. It is difficult to maintain behavioral changes in terms of increased physical activity of children with CP. Gender, manual dexterity, child preference, cognitive impairment and epilepsy are found to affect recreational activities of children, with manual dexterity associated with more recreational activities. Although leisure time is important for children with CP, they may have difficulty engaging in recreational activities due to social and physical barriers.
Participation and obstacles
Participation is involvement in life situations and daily activities. Participation includes self-care domain, productivity and convenience. In fact, communication, mobility, education, home life, recreation and social relations require participation and an indicator of the extent to which a child functions in its environment. Barriers can exist on three levels: micro, meso and macro. First, the barriers at the micro level involve the person. Barriers at the micro level include physical limitations of children (motor, sensory and cognitive disorders) or their subjective feelings about their ability to participate. For example, a child may not participate in group activities because of lack of confidence. Second, obstacles at the meso level include family and society. This may include a person's negative attitude toward disability or lack of support within the family or in the community. One of the main reasons for this limited support seems to be the result of a lack of awareness and knowledge of the child's ability to engage in activities despite his disabilities. Third, macro-level barriers incorporate systems and policies that do not exist or hinder children with CP. These may be environmental barriers to participation such as architectural barriers, lack of relevant aids technology and transportation difficulties due to limited wheelchair access or public transport that can accommodate children with CP. For example, buildings without elevators will prevent children from accessing the higher floors.
A 2013 review states that the result for adults with cerebral palsy without intellectual disabilities in 2000 is that "60-80% complete secondary school, 14-25% complete college, up to 61% independent living in the community, 25-55% work in competitive, and 14-28% engage in long-term relationships with partners or have established families ". Adults with cerebral palsy may not seek physical therapy because of transportation problems, financial restrictions and practitioners do not feel like they know enough about cerebral palsy to take people with CP as clients.
A study of young adults (18-34) about the transition into adulthood found that their concerns were physical health care and understanding of their bodies, able to navigate and use services and support successfully, and deal with prejudices. The feeling of being "thrust into adulthood" is common in this study.
Aging
Children with CP may not succeed in transitioning using adult services because they are not referred to one at the time of entering the age of 18, and may reduce their use of the service. Because children with cerebral palsy are often told that it is a non-progressive disease, they may be unprepared for a greater effect of the aging process as they enter their 30s. Young adults with cerebral palsy have aging problems that adults may experience "in the future". 25% or more adults with cerebral palsy who can walk have increasing difficulty walking with age. The risk of chronic diseases, such as obesity, is also higher among adults with cerebral palsy than the general population. Common problems include increased pain, reduced flexibility, increased seizures and contractures, post-malfunction syndrome, and raises issues with balance. Increased fatigue is also a problem. When maturity and cerebral palsy are discussed, in 2011, it is not discussed in terms of different stages of adulthood.
As they do in childhood, adults with psychosocial experiences of cerebral palsy are associated with their CP, especially the need for social support, self-acceptance, and acceptance by others. Workplace accommodations may be needed to improve the continual work for adults with CP as they get older. Rehabilitation or social programs that include Salutogenesis can increase the potential for coping with adults with CP as they age.
Epidemiology
Cerebral palsy occurs in about 2.1 per 1,000 live births. In those born with lower interest rates at 1 per 1000 live births. Prices look similar in both developing and developed countries. In a population may be more common in the poor. This figure is higher in men than in women; in Europe it is 1.3 times more common in men. Variations in reported incidence or prevalence rates in different geographic areas in industrialized countries are estimated to be caused by differences in the criteria used for inclusion and exclusion. When these differences are taken into account in comparing two or more registers of patients with cerebral palsy (eg, the extent to which children with mild cerebral palsy are included), prevalence rates converge to an average level of 2: 1000.
There was a "moderate, but significant" increase in CP prevalence between the 1970s and 1990s. This is thought to be due to the low birth weight of the baby and the increased survival rate of these infants. The increased survival rates of infants with CP in the 1970s and 80s indirectly may be attributed to the rights movement of people with disabilities that challenge the perspective around the value of the baby with disabilities, as well as the Baby Doe Act.
In 2005, progress in the care of pregnant women and their babies did not result in a significant reduction in CP. This is generally associated with medical advances in areas related to premature baby care (which results in greater survival rates). Only the introduction of quality medical care to sites with inadequate medical care has shown a decline. Incidence of CP increases with very low preterm or infant infants regardless of the quality of care. By 2016, there are suggestions that both incidence and severity are declining slightly - more research is needed to find out if this is significant, and if so, which interventions are effective.
The prevalence of cerebral palsy is best calculated around the school entry age of about 6 years, the prevalence in the US is estimated to be 2.4 out of 1,000 children.
History
Cerebral palsy has affected humans since antiquity. An ornate cemetery marker dating from around the 15th to 14th century BC shows a figure with one small leg and using crutches, probably due to cerebral palsy. The earliest physical evidence of this condition comes from the mummy of Siptah, an Egyptian Pharaoh who ruled from about 1196 to 1190 BC and died in about 20 years. The presence of cerebral palsy has been suspected because of his legs and hand are deformed.
The ancient Greek medical literature addresses the paralysis and weakness of the arms and legs; modern word palsy comes from the ancient Greek word ???????? or ?????? , which means paralysis or paresis respectively. The works of Hippocrates school (460-c.370Ã, BCE), and the manuscripts of the Sacred Scour in particular, describe a group of problems that fit so well with the modern understanding of cerebral palsy. The Roman Emperor Claudius (10 BC - AD 54) was alleged to have a CP, since the historical record depicts him having some physical problems in line with the condition. Medical historians began to suspect and found CP's portrayal in many later works of art. Some paintings from the 16th century and then show individuals with problems consistent with it, such as the 1642 Jusepe de Ribera painting The Clubfoot .
The modern understanding of CP as a result of problems in the brain began in the early decade of the 1800s with a number of publications on brain disorders by Johann Christian Reil, Claude Fran秧ois Lallemand and Philippe Pinel. Then the doctors used this study to connect problems in the brain with specific symptoms. British surgeon William John Little (1810-1894) was the first to study CP extensively. In his doctoral thesis he states that CP is the result of problems around the time of birth. He then identified difficult labor, premature birth and perinatal asphyxia, particularly as a risk factor. The shape of CP spastic diplegia is known as Little disease. At around this time, a German surgeon also worked on cerebral palsy, and distinguished it from polio. In the 1880s, the English neuroscientist William Gower built Little's work by linking paralysis to newborns with difficult births. He named the problem of "birth paralysis" and classified birth into two types: peripheral and cerebral.
Working in Pennsylvania in the 1880s, Canadian-born physician William Osler (1849-1919) reviewed dozens of CP cases to classify further disturbances by the spot of the problem on the body and by underlying causes. Osler made a further observation that binds the problem around the time of delivery with CP, and concludes that the problems that cause bleeding in the brain are likely the main culprits. Osler also suspected polioencephalitis as the cause of infection. Through the 1890s, scientists generally confused CP with polio.
Before moving to a psychiatrist, Austrian neurologist Sigmund Freud (1856-1939) made further improvements to the classification of the disorder. He produced a system that is still in use today. Freud's system divides the causes of disorders into problems at birth, problems that develop during birth, and problems after birth. Freud also makes a rough correlation between the location of problems within the brain and the location of the affected limbs on the body, and documenting various types of motion impairment.
At the beginning of the 20th century, the attention of the medical community generally turned from CP until orthopedic surgeon Winthrop Phelps became the first physician to treat the disorder. He sees CP from a musculoskeletal perspective rather than a neurological one. Phelps developed surgical techniques for surgery on muscles to overcome problems such as flexibility and muscle stiffness. Physical rehabilitation practitioners Hungary AndrÃÆ'¡s Pet? developing a system to teach children with CP how to walk and perform other basic movements. The Pet System became the basis for conductive education, widely used for children with CP today. Through the remaining decades, physical therapy for CP has evolved, and has become a core component of the CP management program.
In 1997, Robert Palisano et al. introduced the Motor Function Classification System (GMFCS) as an improvement over previous rough assessment of either mild, moderate or severe limits. The limitations of GMFCS are based on the abilities observed in certain basic mobility skills such as sitting, standing and walking, and considering the degree of dependence on aids such as a wheelchair or pedestrian. GMFCS was further revised and expanded in 2007.
Society and culture
Economic impact
It is difficult to directly compare the cost and cost-effectiveness of interventions to prevent cerebral palsy or the cost of interventions to manage CP. Access Economics has released a report on the economic impact of cerebral palsy in Australia. The report found that, in 2007, the financial cost of cerebral palsy (CP) in Australia was $ AUS 1.47 billion or 0.14% of GDP. This:
- $ AUS 1.03 billion (69.9%) is lost productivity due to lower employment, absenteeism and premature death of Australians with CP
- $ AUS 141 million (9.6%) is the DWL of the transfer including welfare payments and forgotten taxes
- $ AUS 131 million (9.0%) is other indirect costs such as direct programming, housekeeping and home modifications, as well as funeral funeral transfers
- $ AUS 129 million (8.8%) is the value of informal care for people with CP
- $ AUS 40 million (2.8%) is direct health system expenditure
The value of lost welfare (disability and premature death) is $ AUS 2.4 billion further.
In terms of per capita, this means a financial cost of $ 43,431 per person per year with CP per year. Including lost welfare, costs more than $ 115,000 per person per year.
Individuals with CP bear 37% of the financial costs, and their families and friends bear 6% more. The federal government accounts for about a third (33%) of the financial costs (mainly through lost tax revenues and welfare payments). State governments bear under 1% of the cost, while employers bear 5% and the rest of the community bears the remaining 19%. If the burden of disease (loss of welfare) is included, the individual bears 76% of the cost.
The average lifetime cost for people with CP in the US is $ US921,000 per individual, including lost income.
In the United States many countries allow Medicaid recipients to use their Medicaid funds to rent their own PCA, rather than forcing them to use institutional or managed care.
In India, a government-sponsored program called "NIRAMAYA" for the medical care of children with neurological and muscular disorders has proven to be a remedial economic measure for people with disabilities. It has been shown that people with mental or physical defects can weaken weaken living a better life if they have financial independence.
Use of the term
The term palsy in modern languages ​​refers to motion impairment, but the root word "palsy" technically means "paralysis", although it is not used as such in the sense of cerebral palsy. The use of "palsy" in terms of cerebral palsy makes it important to note that the actual paraplegic disorder is not cerebral palsy, - meaning that the condition of tetraplegia, originating from a spinal injury or traumatic brain injury. , do not be confused with quadriplegia seizures, which are not, and tardive dyskinesia should be confused with dyskinetic cerebral palsy or the (paralytic) "diplegia" condition with spastic diplegia. In fact, at the beginning of the 21st century some doctors have become so sad at the improper use of these terms that they have used a new naming scheme rather than trying to reclaim the classics; one example of this evolution is the increasing use of the term bilateral flexibility to refer to spastic diplegia . Such doctors even quite often argue that the term "new" is technically more clinically accurate than the term defined.
Many people prefer to be called disabled (first person language) than disability. "Cerebral Palsy: A Guide for Care" at the University of Delaware offers the following guidelines:
Disorders are appropriate terms to be used to define deviations from normal, such as not being able to make muscle movements or not being able to control unwanted movements. Defect is a term used to define a limitation in the ability to perform the normal activities of everyday life that can be done by a person of the same age. For example, a three-year-old child who can not walk has a disability because a normal three-year-old can walk on his or her own. A disabled child or an adult is a person who, due to disability, can not achieve a normal role in a society commensurate with his or her age and socio-cultural environment. For example, a sixteen-year-old child who can not prepare his own food or take care of his own toilet or cleanliness needs to be handicapped. On the other hand, a sixteen-year-old boy who can walk only with the help of crutches but who attend regular school and is fully independent in daily life activities is flawed but not disabled. All disabled people are distracted, and all disabled people are disabled, but someone can be distracted and need not be disabled, and someone can be disabled flawlessly.
The term "seizure" shows the attribute of pliability in the spastic CP type. In 1952, a British charity called The Spastics Society was formed. The term "spastics" is used by charities as a term for people with CP. The word "seizure" has since been used extensively as a common insult for people with disabilities, which by some people is considered very offensive. They are also often used to insult the able-bodied people when they seem too uncoordinated, anxious, or unskilled in sports. Charity changed its name to Scope in 1994. In the United States the word spaz has the same usage as an insult, but it is generally unrelated to CP.
Media
Maverick documentary filmmaker Kazuo Hara criticized the customs and customs of Japanese society in the sentimental portrait of an adult with cerebral palsy in his 1972 film Goodbye CP (Sayonara CP). Focusing on how people with cerebral palsy are generally ignored or ignored in Japan, Hara challenges her community taboo about physical disability. Using a deliberately loud style, with rough black-and-white photography and an unynchronized voice, Hara brings sharp realism to the subject.
Spandan (2012), a film by Vegitha Reddy and Aman Tripathi, investigating the dilemma of a parent whose child has cerebral palsy. While films made with children with special needs as central characters have been tried before, parents' difficulties deal with the stigma associated with the condition and so are handled at Spandan . In one of the songs from Spandan "cha chaal chaal tu bala" more than 50 CP children have acted. The famous classical singer Devaki Pandit has cast his voice on a song written by Prof. Jayant Dhupkar and composed by National Film Award winner Isaac Thomas Kottukapally.
My Left Foot (1989) is a drama film directed by Jim Sheridan and stars Daniel Day-Lewis. It tells the true story of Christy Brown, an Irish born with cerebral palsy, who can only control his left leg. Christy Brown grew up in poor families, working class, and became a writer and artist. It won the Academy Award for Best Actor (Daniel Day-Lewis) and Best Actress in Supporting Role (Brenda Fricker). It was also nominated for Best Director, Best Picture and Best Writing, Scenario Based on Material from Other Media. It also won the New York Film Critics Circle Award for Best Film for 1989.
Call the Midwife (2012-) has featured two episodes with actor Colin Young, who he himself suffers from cerebral palsy, plays characters with similar defects. The storyline focuses on the separation of people with disabilities in Britain in the 1950s, as well as romantic relationships between people with disabilities.
Micah Fowler, an American actor with CP, starred in the sitcom ABC Speechless (2016-), who explored the serious and funny challenges a family faces with a teenager with CP.
Important case
- Josh Blue, winner of NBC's Last Comic Standing season, whose acting revolves around his CP. Blue is also on the 2004 US Paralympic football team.
- Jason Benetti, the Play-by-play announcer for ESPN, Fox Sports, Westwood One and Time Warner includes soccer, baseball, lacrosse, hockey, and basketball. Since 2016, he is also a television-by-play broadcaster for the Chicago White Sox home game.
- Jack Carroll, British comedian and runner-up in the seventh season of
- Abbey Curran, the American beauty queen who represented Iowa at Miss USA 2008 and was the first contestant with a competing inability.
- Geri Jewell has a regular role in the prime-time series The Facts of Life . She has roles in Sesame Street , 21 Jump Street , The Young and the Restless and Deadwood .
- Francesca Martinez, English stand-up comedian and actress. Harold Elwood Yuker, a psychologist and educator at Hofstra University, Distinguished Professor of Psychology and founding director of the Center for Attitudes toward People with Disabilities, is widely recognized as a critique of the tendency of some disabled people to keep to themselves. The motto is The most important thing for anyone with a disability is to learn to get along in an undisturbed world.
- Evan O'Hanlon, Australian Paralympian, the fastest athlete with cerebral palsy in the world.
- Arun Shourie's son, Aditya, about whom he wrote the book Did He Know Mother's Heart
- Maysoon Zayid, "Palestinian Muslim maiden with cerebral palsy, from New Jersey", who is an actress, comedian and stand-alone activist. Zayid has been a resident of Cliffside Park, New Jersey. He is considered one of the first female Muslim comedians in America and the first person ever to appear in Palestine and Jordan.
- RJ Mitte, an American actor best known for his role as Walter White Jr. in Breaking Bad . He is also a celebrity ambassador for United Cerebral Palsy.
- Zach Anner, an American comedian, actor, and writer. She has a television series on OWN OWNY OWN called Rollin 'With Zach and is a writer if at Your Birth Not Working.
- Kaine, a member of the popular hip-hop duo of Atlanta, Georgia, The Ying Yang Twins, has a mild form of cerebral palsy that makes her weak.
- Hannah Cockroft is a British wheelchair athlete specializing in running distances in the T34 classification. He holds the Paralympic and world record for 100 meters, 200 meters and 400 meters in his classification.
Litigation
Because of the false perception that cerebral palsy is largely due to trauma during birth, in 2005, 60% of obstetric litigation was about cerebral palsy, which Alastair MacLennan, Professor of Obstetrics and Gynecology at the University of Adelaide, considers as the cause of the exodus. of his profession. In the second half of the 20th century, obstetric litigation about the causes of cerebral palsy became more common, leading to the practiced defensive treatment.
See also
- Caregiver stress
- Classification of cerebral palsy sport - explains the classification of disability sport for cerebral palsy.
- Inclusive recreation
- Quality of life (health care)
Source of the article : Wikipedia
0 Comments