Further information about cerebral palsy
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The purpose of this information sheet is to
give an overview of what cerebral palsy is and the different types of cp. It is
intended to explore the subject in greater detail than its companion factsheet,
An Introduction to Cerebral Palsy, but still using simple language.
If you or someone close to you has cerebral
palsy and you require further clarification of any terms used in connection with
cerebral palsy – which
may or may not be mentioned in this factsheet –
please refer to our
Glossary of Terms factsheet or contact a relevant
health professional such as your physiotherapist or consultant.
What is cerebral palsy?
Cerebral palsy is a very diverse and complex
condition, which ranges from very mild to severe, with no two people being
affected in precisely the same way.
There has never been a simple explanation of
what cerebral palsy is. In 1984 P. Scrutton wrote, “The almost infinite
variety (and the lack of a common language to describe this variety
accurately) makes learning about it very difficult indeed.” (1)
Cerebral palsy does not have a clear-cut
single cause; it is not a specific condition – unlike Down’s Syndrome for
example, which is an identifiable chromosomal disorder.
In cerebral palsy the brain impairment is
non-progressive i.e. it does not get worse or improve. However, the effects
on the body may become more (or less) obvious as time goes by. Cerebral palsy,
therefore, is a general term for a wide range of non-progressive cerebral
(brain) disorders, which result in some sort of movement impairment and which
become apparent during early childhood.
A Definition
Cerebral palsy can be defined as “a
persistent (but not unchanging) disorder of movement and posture, as the result
of one or more non-progressive abnormalities in the brain, before its growth and
development are complete. Other clinical signs may be present as well.”
(Cerebral Palsy: Problems and Practice, Griffiths M., Clegg M. (eds). Human
Horizons Series ISBN 0-285-65071-8)
Explanation of this definition
·
Cerebral...
means that the cause of the difficulties is in the brain – not in the muscles
themselves.
·
Palsy...
literally means paralysis.
·
Persistent...
means that the effects of the brain impairment, on the person’s movement and
posture, do not go away. Therefore, cerebral palsy is present throughout the
person’s life.
·
Not unchanging...
whilst the condition will always remain, movement patterns may change. This will
occur as the baby/child develops and/or as a result of therapeutic intervention,
for example, physiotherapy.
The
characteristics of the motor disorder, the
way the person is affected and muscle tone may alter significantly, particularly
during the early years of life. In the first few months any potential
difficulties may not be immediately obvious. It is possible for some signs not
to show until the child is between 12 and 18 months or older.
·
‘Disorder of movement
and posture’... refers to
the difficulties a person may have in co-ordinating their muscles to produce and
control the movement required - i.e. a ‘motor control’ disorder. This may lead
to being unable to position the body correctly, or in the desired way, for
example, when walking, sitting or whilst in bed.
·
Non-progressive...
refers to the fact that the brain impairment does not recover or deteriorate;
the impairment is static.
·
Abnormality...
means that the part(s) of the brain concerned with ‘motor control’ were damaged
and/or have not developed in the usual way.
(The word ‘lesion’ is sometimes used to denote
that an organ or tissue –
the brain, in this instance – has been damaged and
is not functioning correctly.)
The dysfunction of the motor control part(s)
of the brain is present ‘before the brain’s growth and development are
complete’.
This means the impairment occurred during
pregnancy, birth or early childhood – before the brain’s growth and development
has reached a certain level of maturity. The following quote explains further
how age may influence diagnosis:
“Insults to the brain that occur after eight
years of age result in neurological impairments reminiscent of those observed in
adults; similar insults prior to three years of age (including during the
prenatal period), result in neurological impairments and motor outcomes
– such as cerebral palsy –
that are characteristic of injury to the immature brain. From three to eight,
mixed patterns of neurological impairment are observed. An arbitrary upper age
limit of five or six years has been suggested for assigning the diagnosis of
cerebral palsy; however, in practice, the determination is typically made on a
case by case basis.” (2)
Growing babies and children have to learn to
use many other muscles besides those concerned with the co-ordination and
movement of arms, legs, trunk and so on. For example, the brain ‘learns’ how to
position and focus the eyes, make noises and sounds, chew food, control the
muscles used when going to the toilet and those used for breathing. Therefore,
there may also be difficulties for some children in these areas of function.
In addition, because other areas of the brain
may also have been affected there is a possibility of ‘associated’ or ‘related’
difficulties such as sensory or perceptual impairment. Other associated
difficulties may include learning difficulties or epilepsy (seizures).
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