Cerebral Palsy: Causes, Prevention, Treatment

Published: 2021-09-11 18:20:09
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Category: Illness, Medicine

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The human body skeletal has adapted allowing them to have the aid from levers and erected spines, enabling them to place the center of mass over a narrow base of support i.e. the feet. Another adaption being the muscles in the legs allow humans to control the action of the foot whilst maintaining balance and having over leg raised whilst walking. Larger muscles in the hips keep the upper body erected. If humans didn’t have any of these functions, it would show weakened gait and thus indicate disorders such as Cerebral palsy.
Cerebral Palsy (CP) is a non-progressive syndrome which causes disability within children, causing problem with their posture and motor impairment. The prevalence of the disorder is 1-2/1000 live births, the risk is higher with the decreasing gestational age of birth for the newborn children. CP is caused by the altercations in the nervous system due to the pre-, peri- and postnatal stages before the development of the fetus is complete. The disorder causes activity limitations, attributed to the non-progressive disturbances that occur as a result of the damage to the developing brain of the fetus/newborn, potentially having an impact and effect on the sensation, perception, cognition communication and behavioral skills of the infant. Motor control issues are due to the disturbance by the excessive coactivation of antagonist muscles, spasticity, secondary musculoskeletal malformation dyskinesia, hyperreflexia, retained development reactions, alongside paresis and defective programming. Spasticity can be a big challenge for those with CP as it can cause serve issues such as preventing certain motor functions, may cause pain, prevent or disturb sleep, and can cause serious complications. Spasticity is defined as a velocity dependent increased resistance to passive muscle activity associated with the upper motor neuron paralysis. Spasticity in children is very high as 70% of children with CP suffer from spasticity. Gross motor skills are involved in the movement and the coordination of the arms and legs, an individual with CP will be limited within the movement of certain limbs. Individuals with CP tend to walk on their tip toes and have hip and knee flexion. This occurs as the individual will try to shift the center of gravity close to the body via the individual to tiptoe, thus causing a “scissoring” effect. This is due to the sparsity of the medial hamstrings and increased femoral anteversion. Shortening and stiffening of the soft tissue cause joint resistance to stretching and preventing normal movement. Although people who suffer from CP can live a normal life, they can find that within the age range of 20-40 years old their muscles will start to deteriorate causing and increases risk of developing cardiovascular diseases due to the lack of physical activity. Mortality records indicated that those with CP have a 2 to 3-fold increase in coronary artery disease. The lack of exercise is due to the limitation of movement caused by the disorder. Recently research has focused on medical technology to improve the mobility of children who suffer from CP.
The technology focuses on the assessment and treatment of the disorder, an individual suffering from CP can never be cured, however, using technology can help in aiding the individual to live a normal life but it can never cure them. Current medical technology for assessment and treatment for cerebral palsy Gait analysis allows the assessment of the specific pathologies of the patient. Gait analysis provides information regarding the gait deviation and gives a better understanding of the deviations. It also gives an overview of the evaluation of the effects of the treatment provided to the individual. It helps clinicians narrow down the type of gait an individual has, thus providing more information about the way their muscles and joints are moving and how they may possibly be aligned. Gait analysis has four directions in which it calculates the positioning and movement of the body, the four directions are; kinematics (the body movement without the analysis of forces), kinetics (the body movement and forces together), energy consumption (oximetry measurements) and neuromuscular activity (EMG analysis). This information provided by the four directions shows the effect on the biomechanics and helps identify the dysfunction. The kinematic analysis reveals the movement of the body and thus providing the information on the energy consumed whilst conducting the activity. Children with CP tend to show a higher energy consumption whilst walking. Individual children with spasticity can show that they use the weight shift of their upper body to compensate for the weakness in the muscles surrounding the hip which then results in an increased usage of their pelvic excursions. Thus, providing information to the clinicians regarding the positioning of the muscles and the joints and how they work together, this helps with prognosis and allows them to access the best option for treatment for the individual. The usage of botulinum toxin for temporary relief of spasticity, the toxin provides a focal, muscle control for those weakened muscles.
Spasticity commonly arises within the early stages of the child’s life, therefore recommendations for this treatment to being is usually when the child is 2-6 years of age, when their gait and muscle movement has developed but remain flexible, thus allowing change. Molenaers et al (2006), demonstrated that the treatment with botulinum toxin can delay and reduce the changes of the child of having surgery, provided that the child starts the treatment when the gait is flexible. When the correct dosage of botulinum toxin injections is given it has shown to improve movement patterns and improve fine motor functions within the child, thus given them a better quality of life. However, botulinum toxin is a potent poison and if not prescribed and given correctly it can cause great harm. The toxin does relax muscles thus giving the individual an increased level of movement and muscle control, yet if the child shows any signs of respiration problems the dosage should be reduced or treatment should be halted. This is due to the toxin acting as a neuromuscular blockade through the inhibition of the neurotransmitter acetylcholine, the wrong dosage and the placement of the injection can cause respiratory failure by paralyzing the muscles within the chest. Surgery has been a popular treatment for those who have been diagnosed with CP. Orthopaedic surgery has been used on children for the treatment and correction for the fixed contracture of their joints. This could be due to rational problems effecting their walking, a curvature of their spine causing issues with them sitting or dislocation of the joints. There are four different types of orthopaedic surgery, musculotendinous lengthening, tendon transfer, osteotomies and arthrodesis. Musculotendinous lengthening is when the joint is lengthened by using a “z” type fashion, tendon transfer is to reposition the muscle that is spastic giving it a different function.
Osteotomies is surgery that requires cutting and removing sections or alternating sections of the bone, and arthrodesis is the fusion of the joints to place the joint in an optimum position. Young children’s bones have the ability to recover and adjust to change, thus having surgery at such a young age may appear excessive however in the child’s future it is shown to have more benefits. Surgery helps in the management of CP via the improvement of mobility, posture and the physical alignment to the joints and bones it also prevents future complications and deformities. Recent studies have shown that researchers are using gaming technology as a treatment for an adolescent with spastic CP. Virtual reality allows the individual to create an interactive simulation that allows the participant to interact with the environment through the movement of their body through a 3D space. Using gaming technology shows an increasing amount of energy expenditure thus translating it into increased habitual physical activity. This has a greater effect on the individual then traditional therapies as this form of rehabilitation allows them to explore their creative side and shows them that they can perform certain activities as they have the physical capacity to do so. Utilizing virtual reality gaming gives the potential to increase the free-living physical activity and improve the body composition of the children, whereas a child diagnosed with CP would not have access to this type of understanding when one to one treatment is provided. Children with CP suffer from the motor and cognitive disabilities, by using virtual reality it allows the child to access different motor skills and gives them the ability to research new limits. Virtual reality gaming gives the patient the independence of learning and practicing themselves, as they can play and practice in their own space with freedom.
Delivering training at home ensures that the child can have an intensive and long-lasting training in comparison to training that is normally provided within small groups, thus giving them a more one to one training. Deutsch et al (2008), showed that by using a gaming console with children diagnosed with CP showed to improve the visual-perceptual processing, postural control and functional mobility in the individual. A significant improvement in the children was shown by using personal and customized training, as they focused more and aided in the recovery of stability which was demonstrated by reducing the center of pressure area within them. Shumway-Cook et al (2003), showed that this improvement was still present 30 days following the completion of their training. Thus, showing that the interaction provided by the virtual gaming aids in the mobility of the children and allows them to use their motor and cognitive skills.

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