Thursday, May 5, 2016

About Cerebral Palsy Spasticity

About Cerebral Palsy Spasticity

Cerebral Palsy (CP)

Cerebral palsy affects movement and posture and is caused by brain damage before, during, or after birth. The brain damage underlying CP cannot be reversed and produces life-long disabilities. Despite remarkable medical advances, the incidence of cerebral palsy has not decreased, with one out of 500 children being afflicted with the disorder.

Treatment of cerebral palsy varies with the age of patients and many options are available. It is important for parents and patients to consult with their treatment team, which includes a physical therapist, pediatrician, rehabilitation medicine specialist, neurologist, neurosurgeon and orthopedic surgeon.

Cause of Spasticity

Spasticity refers to increased tone, or tension, in a muscle. Normally, muscles must have enough tone to maintain posture or movement against the force of gravity while at the same time providing flexibility and speed of movement.

The command to tense, or increase muscle tone, goes to the spinal cord via nerves from the muscle itself. Since these nerves tell the spinal cord just how much tone the muscle has, they are called "sensory nerve fibers." The command to be flexible, or reduce muscle tone, comes to the spinal cord from nerves in the brain. These two commands must be well coordinated in the spinal cord for muscles to work smoothly and easily while maintaining strength.

In a person with cerebral palsy, damage to the brain has occurred. For reasons that are still unclear, the damage tends to be in the area of the brain that controls muscle tone and movement of the arms and legs. The brain of the individual with cerebral palsy is therefore unable to influence the amount of flexibility a muscle should have. The command from the muscle itself dominates the spinal cord and, as a result, the muscle is too tense, or spastic.

Prevalence of Spasticity 

Approximately 80 out of 100 patients with cerebral palsy have varying degrees of spasticity. Spasticity can be associated with diplegic, quadriplegic or hemiplegic cerebral palsy. Spasticity can be evident during the first year of life in relatively severe CP, but most often it is detected later. It is important to note that once spasticity has developed with cerebral palsy, it never resolves spontaneously.

Effects of Spasticity

There is no way in which spasticity is of benefit to children or adults with CP. Spasticity adversely affects muscles and joints of the extremities, causing abnormal movements, and is especially harmful in growing children. The known adverse effects of spasticity include:

  • Inhibition of movement
  • Inhibition of longitudinal muscle growth
  • Inhibition of protein synthesis in muscle cells
  • Limited stretching of muscles in daily activities
  • Development of muscle and joint deformities
  • Patients with cerebral palsy do not have deformities of the extremities at birth but develop them over time. Spasticity of muscles, along with the limitations on stretching and use of muscles in daily activities, is a major cause of deformities.

Current Treatments for Cerebral Palsy Spasticity

Currently, oral medication, Botox (botulinum A toxin) injection, baclofen infusion, orthopedic surgery, selective dorsal rhizotomy surgery, physical therapy, and braces are employed to treat CP spasticity and related problems.

Oral medications, such as valium and baclofen, are still tried, but the consensus is that they do not reduce spasticity.

Injections of Botox into muscles have been used widely in recent years. Botox weakens muscles for up to 3-4 months after injection, reducing spasticity in a limited group of muscles. Most important, the effect is only temporary. Side effects appear to be minimal.

Baclofen infusion, using a pump implanted in the abdominal wall, is clearly effective in reducing spasticity in spinal cord injury and can also reduce CP spasticity. However, baclofen infusion is not effective permanently; when it is stopped, spasticity recurs. Also, the baclofen infusion carries risks of overdose, meningitis, and other complications that may require repeated hospitalization, and since it has been used for CP for only several years, long-term consequences are not known.

Orthopedic operations, including muscle release and tendon-lengthening procedures, are also used to treat deformities associated with spastic cerebral palsy. Orthopaedic surgery improves range of motion of the joints and makes it easier for children to move the lower extremities. A major side effect is permanent muscle weakness and resulting abnormal postures and deformities. Also, orthopaedic surgery does not reduce spasticity directly but treats only the consequences of spasticity.

Wednesday, August 14, 2013

Cerebral Palsy Prevention

Cerebral Palsy Prevention

Often the cause of cerebral palsy is not known, and nothing can be done to prevent it. However, some important causes of cerebral palsy can be prevented in many cases, including premature birth, low birth weight, infections, and head injuries.

* Seek appropriate prenatal care as early as possible in the pregnancy. Many women schedule a prepregnancy visit so they can be properly prepared for a healthy pregnancy. Appropriate care is available from physicians, physician assistants, nurse practitioners, and certified nurse-midwives.

* Avoid using cigarettes, alcohol, and illicit drugs during pregnancy: these increase your risk of premature delivery.

* Rubella (measles) during pregnancy or early in life is a cause of cerebral palsy. Testing for rubella immunity before you become pregnant allows you to be immunized, which protects both you and your baby from contracting this potentially devastating illness.

* Appropriate prenatal care includes testing for Rh factor. Rh incompatibility is easily treated but can cause brain damage and other problems if untreated.

* Routine vaccinations of babies can prevent serious infections such as meningitis that can lead to cerebral palsy.

* Make sure your child is restrained in a properly installed car seat and wears a helmet when riding on a bicycle.

Sunday, March 4, 2012

Cerebral Palsy

Cerebral Palsy

Cerebral palsy is a group of disorders that affect a person's ability to move and to maintain balance and posture. The disorders appear in the first few years of life. Usually they do not get worse over time. People with cerebral palsy may have difficulty walking. They may also have trouble with tasks such as writing or using scissors. Some have other medical conditions, including seizure disorders or mental impairment.

Cerebral palsy happens when the areas of the brain that control movement and posture do not develop correctly or get damaged. Early signs of cerebral palsy usually appear before 3 years of age. Babies with cerebral palsy are often slow to roll over, sit, crawl, smile or walk. Some babies are born with cerebral palsy; others get it after they are born.

There is no cure for cerebral palsy, but treatment can improve the lives of those who have it. Treatment includes medicines, braces, and physical, occupational and speech therapy.

Saturday, February 18, 2012

Cerebral Palsy: Intracranial Hemorrhage (IVH)

Cerebral Palsy: Intracranial Hemorrhage (IVH)

Hemorrhaging inside the brain, clinically referred to as intracranial hemorrhage (IVH), can damage or kill areas of the brain crucial to development and motor function. When this happens, resulting impairment — as well as the severity of impairment — is dependent upon the location and degree of damage. The hemorrhage can be arterial or venous.

    Arterial bleeding results in additional loss of oxygen to tissue as arteries carry oxygenated blood to the heart.
    Venous bleeding is internal hemorrhages affecting the veins that return blood to the heart. Arterial hemorrhages are harder to control than venous.

Hemorrhaging is bleeding. When bleeding is isolated in a particular organ or tissue, localized swelling, known as a hematoma, can occur. A hematoma can damage and kill surrounding tissue by compressing the tissue or reducing its blood supply. Clotting mechanisms or swelling that block blood supply will eventually stop a hematoma.
Cerebral Palsy.

Thursday, February 16, 2012

Cerebral Pasly : Hypoxic-Ischemic Encephalopathy (HIE) or Intrapartum Asphyxia

Cerebral Pasly : Hypoxic-Ischemic Encephalopathy (HIE) or Intrapartum Asphyxia

Hypoxic-ischemic encephalopathy (HIE) is the brain injury caused by asphyxia – also commonly known as oxygen deprivation. The newborn’s body can compensate for brief periods of depleted oxygen, but if the asphyxia lasts too long, brain tissue is destroyed. Hypoxic-ischemic encephalopathy due to fetal or neonatal asphyxia is a leading cause of death or severe impairment among infants. Such impairment can include epilepsy, developmental delay, motor impairment, neurodevelopmental delay, and cognitive impairment. Usually, the severity of impairment cannot be determined until a child is three to four years old.

Asphyxia was long thought to be the cause of cerebral palsy, but two studies have shown that only 9% of cases are a direct result of asphyxia. In the remaining 91% of cases, factors such as premature birth, complications of birth or problems immediately following birth cause cerebral palsy. In some cases, cause cannot be definitively determined.

Tuesday, February 14, 2012

Cerebral Palsy: Cerebral Dysgenesis

Cerebral Palsy: Cerebral Dysgenesis

Cerebral dysgenesis is abnormal brain development, also known as brain malformation, which differs from the other three causes of cerebral palsy which involve brain injury. Brain malformation is the result of:

    a brain that did not fully develop
    a brain that grew abnormally
    a brain that experienced incomplete division
    a brain that developed with incomplete organization

Billions of cells, and various types of cells, continuously form and move to distinct locations during brain development; skull development is occurring, as well.

Any event that interrupts brain development can result in malformed or missing areas of the brain. This can result in loss of brain function. Brain malformation can vary in severity; defects of greater severity lead to one, or a combination of, conditions such as epilepsy, cerebral palsy, intellectual impairment, and sensory impairment.

Sunday, February 12, 2012

Cerebral Palsy: Periventricular Leukomalacia (PVL)

Cerebral Palsy: Periventricular Leukomalacia (PVL)

Periventricular leukomalacia (PVL) is a type of brain damage that involves the periventricular white matter of the brain. Damage to white matter results in the death and decay of injured cells, leaving empty areas in the brain — called lateral ventricles, which fill with fluid (a condition called leukomalacia).

The brain primarily consists of white matter and gray matter. Gray matter has neural cell bodies, which can initiate nerve impulses, while white matter transports impulses between gray matter cells. The periventricular white matter that surrounds two horseshoe shaped cavities in the brain is primarily responsible for the transmission of nerve impulses that control motor function. Damage in this area can result in spasticity and intellectual impairment.

Myelin is an integral component of white matter that coats and essentially insulates cell pathways, promoting speedy transmission of nerve impulses. Damage to myelin slows and impedes nerve transmission, possibly impairing brain function.

Approximately 60-100% of infants with periventricular leukomalacia are diagnosed with cerebral palsy. Four to 26% of premature infants placed in neonatal intensive care units have cerebral palsy. In severe cases, postmortem examinations have discovered that 75% of premature infants who died shortly after birth had periventricular leukomalacia.

Experts believe intrauterine infections are the underlying factor for periventricular leukomalacia. Membranes around the fetus are affected by the release of toxins, which travel through amniotic fluid to selectively injure areas of the developing brain. These toxins can also cause premature rupture of the membranes and premature birth.
cerebral-palsy-four-types-of-brain damage