Cerebral Palsy Of Children

The term "cerebral palsy" decrease the condition of a
heterogeneous group of patients whose CNS has been damaged
in utero, at birth, or in early life. The resulting
physical and mental defects may not be fully evident for
several years. 

About 0.5% of patients admitted to pediatric hospitals have
cerebral palsy, often with a history of abnormal labor;
birth trauma, neonatal asphyxia, or jaundice. However, it
is not always possible to determine whether pathologic
changes have resulted from developmental defects,
intrauterine cerebral degeneration, birth trauma, metabolic
abnormality, or infection. 

In severe cases, symptoms are evident from birth, with
vomiting, irritability, and difficult in nursing. The
infants may be small, with delicate physiques. They are
susceptible to infections and may succumb early in infancy.
In milder cases, motor difficulty may not be apparent until
the child fails to perform the expected acts at certain
months. Thus, he/she may not sit up a t 6 months or begin
to talk and walk at 1 year. About 25% of patents have
convulsions. Athetoid movements usually do not appear until
the second or third year. 

Cases have been divided into three groups -- spastic,
atoxic, and athethoid -- depending on whether the cortex,
the cerebellum, or the basal ganglia is affected most
severely. Mixtures are the rule. Spastic weakness, usually
symmetrical, is the most common manifestation, and the legs
are involved more than the arms. A "scissors gait" is
characteristic; exaggerated tendon reflexes are present. In
the mild form, there may be only exaggeration of tendon
reflexes, and slight contractures of the calf muscles
leading to talipes equinovarus. The most severe cases have
marked spasticity of all extremities. Involuntary movements
or cerebellar signs may predominate, or may accompany the
spasticity. 

About 70% of cases show apparent mental retardation. This
often appears to be more sere than it actually is, due to
difficulties in self-expression. 

The treatment depends on the extent and type of
involvement. Mild cases nay proceed through a fairly normal
life. For the moderately affected child, muscle
reeducation, speech training and corrective orthopedic
procedures should be used. A careful evaluation of
mentality is advisable, since many patients with cerebral
palsy are brighter than they appear, slowness often being
due to their physical handicap. Special courses of study
and vocational guidance to fit individual capability are of
great benefit. 

The assistance of psychiatrists and psychologists is of
value in the mental and emotional development of the child
and in helping the parents to adjust to the problems
presented by the child's difficulties. Community health
agencies and lay health organizations, such as the United
Cerebral Palsy Association, can help the parents in their
search for rehabilitation, educational, and social
opportunities for the child.