Some insights on cerebral palsy that we need to know: An expert interview

Some insights on cerebral palsy that we need to know: An expert interview
Cerebral palsy is a non-progressive neurological disorder that occurs in the developing foetal or infant brain leading to abnormal posture and movement. In simple terms, Cerebral means brain and Palsy means partial or total loss of ability to move a part of a body i.e. a problem with the brain causing loss of ability in the muscles in one or more parts of the body. Cerebral palsy is being caused by several factors and the prevention of the same is being more vital since the therapy towards it is really a challenging one. This article covers a live interview with Ms. Sangeetha Thanappan, Paediatric Physiotherapist who is actively working on the ailment of cerebral palsy sufferers in Vijaya Health Centre, Vadapalani and this short note aims to create more public awareness towards the research.

What are the causes for cerebral palsy?
Causes for cerebral palsy can be analysed in simplified manner in terms of high risk factors in prenatal, natal and postnatal period. High risk factors in prenatal period includes maternal age (age of mother before 18 or over 35 years), infections in mother, malnutrition, diabetes, hypertension, high parity, etc. High risk factors in natal period includes period of delivery, such as preterm - prematurity and post-term - meconium aspiration, and type of delivery, such as assisted vaginal delivery - vacuum assisted delivery and forceps delivery, and emergency lower section caesarean section. High risk factors in postnatal period includes hypoxia, apnea, acquired infections before six months of life, migration deficits (midline shifts of the hemispheres), suffocation, heavy metal encephalopathy, persistent seizures, meningitis, degenerative disorders of the brain, cerebral atrophy, etc.

What are the effects of cerebral palsy in normal life?
Cerebral palsy has varied impact in the day-to-day life of the child, depending on the impairment range from mild to severe. Restriction of physical mobility is the major impact. Approximately two-thirds of patients with CP have associated with mental impairment. Again severity of retardation decides the person’s personal life, participation in family life, social life, etc. There are persons with cerebral palsy who lead a near normal life which is attributed to the well managed condition, and also the impairments due to brain damage would be mild. More severe cases are extremely restricted physically and intellectually and are dependent on their caretaker to a greater extent even for their activities of daily living e.g. transportation, self-care, education, employment, etc.

Is it genetic?
Till date, for cerebral palsy, neither a specific gene has been identified nor has an inheritance pattern been figured out. Hence, it is not grouped under genetic diseases. But some researchers believe there exists a small contribution by genes too, especially SERPINE1.

Can we cure cerebral palsy? If yes, to what extent?
Cerebral palsy cannot be cured. It can only be managed because the damage occurring in the developing brain is irreversible. But fortunately by the advent of advanced medical techniques and therapeutic approaches the quality of life of the affected people has been greatly improved.

Is cerebral palsy preventable?
Yes. Effective obstetric care during prenatal period can rule out intrapartum causes of cerebral palsy, such as foetal acidosis pH<7.0, malnutrition and toxaemia (pre-eclampsia) to a greater extent. Interventions that prolong gestation period or those which decrease the risk of preterm delivery also will help in preventing incidence of cerebral palsy. Also, malpractices like administration of steroids to preterm infants in order to decrease the risk of certain pulmonary complications increase the chances of cerebral palsy. Hence, limiting such treatments would reduce the risk of cerebral palsy.

Is it more prevalent?
As per a recent review of 49 related studies, overall prevalence of cerebral palsy was 2.11 per 1000 live births. Also, prevalence of cerebral palsy attributed to prematurity (children born before 28 weeks of gestation) was the highest (111.80 per 1000 live births).

Are there any other disorders associated with cerebral palsy?
Intellectual disability, seizure disorders, hearing impairment, visual impairment, speech and language disorders, spinal deformities, drooling and sensory and perceptual disorders are possibly associated with cerebral palsy.

What is the common view of our society on those challenged personalities?
Most of the times, person with disabilities is being neglected in various sectors of the society. Although the recent decades have seen many changes in the society in regard to acceptance of individuals with disabilities, still there does prevail to some extent, an attitude that the persons with disabilities are incapable of being meaningful contributors to the society. This issue needs more clarity and awareness on the community side to make people see the abilities of the exceptional persons and how to make the best use of it.

1. Dissemination of information on disability related issues and developing solutions by awareness creation.
2. Providing guidance and support to the persons with disabilities in order to help them to become meaningful contributors to the society and thereby enabling them to live with a sense of self-esteem and confidence. 3. Bringing into limelight the success stories of persons with disabilities; thereby, changing the thoughts and attitudes of the society positively towards the differently abled persons.
4. Removing lifestyle barriers in the society (e.g. architectural barriers), providing the differently abled persons a maximal access to places around.
5. Working towards inclusion.

Note: The concept of an inclusive community means that communities adapt their structures and procedures to facilitate the inclusion of persons with disabilities rather than expecting them to change to fit in with existing arrangements.

What are the steps usually taken to cure the same?
There is a vital need for early identification and early intervention of children with cerebral palsy in order to get best results. Before the abnormal patterns of posture and movement are established, maximal positive outcomes are expected by therapeutic procedures. Apart from that, there is no as such stagewise classification in the management of cerebral palsy. Based on the motor handicap and the child’s needs, management is carried over in a multidisciplinary approach.

In various growing stages of a child, when we can sense the disability usually?
A typical pattern of development in the infants suggests the presence of some neurological impairment. But it is up to the parents to sense the impairment as the earliest. Specific screening methods, such as reflex testing, muscle tone assessment, etc. are performed by the specialists to confirm the presence of neurological impairment. High risk infants are advised for routine screening by specialists to monitor the pattern of development of the child.

What are the problems usually associated with the treatment?
There is absolute denial from at least more than 50% of the parents when they are informed of the diagnosis. Even after so many tests being done, at times when specific diagnosis is not found, the questions of parents with so much agony like “Why my child has encountered with cerebral palsy?”, “Will he be normally growing up?” etc. cannot possibly be answered. Sometimes, professionals handling them may show an awkward response to the child’s behaviour during the treatment period.

What are the supports required from the family to improve the conditions of preventing and managing cerebral palsy?
1. Episodes of seizures making the child more weak and causing regression in gained abilities.
2. Regularity in therapeutic sessions and proper follow up which is commonly a problem attributed to either distance from home to centres, financial status, family support or psychological trauma and depression of the parents.
3. Availability of resources, be it institution based, community based or home based management.

How can medications and drugs manage the children with cerebral palsy?
There are some medications which are prescribed as drug, some can help in preventing the symptoms and some can address complications that arise secondary to primary impairment. Drugs generally prescribed for cerebral palsy are Anticholinergics (uncontrolled body movements), Anticonvulsants (seizure medications), Antidepressants (depression medications), Antispastic (muscle relaxers), Anti-inflammatories (pain management) and Stool softeners.

What are the supports required from the health practitioners in terms of prevention of cerebral palsy?
Failure to find out risk factors and treat them during pregnancy leads to higher incidence of cerebral palsy. Best quality obstetric and neonatal care will eventually lead to better newborn health and reduction in cerebral palsy cases. Once the baby is born, health practitioners have a vital responsibility of educating mothers regarding rearing the child with utmost caution preventing infections from environment in the first few months of life which has highest risk of reaching the brain.

What is the responsibility of mothers in the prevention of cerebral palsy - prenatal and postnatal?
1. Should follow through routine prenatal care
2. Should take precautions for long-term illnesses, such as diabetes, thyroid problems, etc.
3. Should manage essential vitamin levels
4. Avoid exposure to radiations
5. Avoid alcohol consumption
6. Avoid cigarette smoking
7. Avoid unsupervised drug intake
8. Keen supervision and good care of the newborn especially by preventing head injuries using safety rails on bed
9. Keep the child off from highly crowded places that are potential to transmit infections especially during the first few months of life.

What kind of activities government can take in prevention of cerebral palsy like conditions?
1. Funding awareness campaigns
2. Enforcing health related laws
3. Research funding
4. Regulating the available health benefits to reach the public appropriately

The article intended to project certain views on cerebral palsy. Any united activity with precaution, support and treating with care may find solutions for the upcoming and existing problems related with cerebral palsy.
How to cite this article:
Selvakumar Krishnamoorthy. Some insights on cerebral palsy that we need to know: An expert interview. BioLim O-Media. 10 June, 2017. 5(6).
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