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.