What's the influence of cerebral palsy on children's development?
Children with cerebral palsy have varying degrees of physical disability and may also have associated medical problems such as seizures, speech or communication problems, and mental retardation. Much of a child's normal intellectual, physical, and social development occurs through play and exploration of the environment. The ability to reach for and grasp objects, to move about, to explore the properties of toys, and to communicate with others are all central activities in
the child's growth. cerebral palsy may restrict a child's ability to engage in these activities, and therefore prevent the acquisition of motor skills, knowledge of the world, and social competence. The family can do much to overcome these restrictions by adapting the child's environment to meet his or her needs and providing challenges within the child's abilities to accomplish. The advice and direction of an occupational therapist can be critical to promoting normal development of the child with cerebral palsy.
Spasticity, muscle coordination, ataxia, and scoliosis are all significant impairments that affect the posture and mobility of a person with cerebral palsy. The physical therapist works with the family to maximize the child's ability to move affected limbs, to develop normal motor patterns, and to maintain posture. Spasticity causes muscles to shorten, joints to tighten, and postures to change.
Ataxia, or lack of balance control, is another factor affecting mobility. Physical therapy is an important tool to help the child with cerebral palsy maximize balance. Coordination can be worsened if one member of a muscle pair is overly strong; bracing or surgical transfer of the muscle to a less overpowering position may help.
Scoliosis, or spine curvature, can develop when the muscles that hold the spine in place become either weak or spastic. In either case, an imbalance of forces pulls the vertebrae (bones making up the spinal column) out of alignment. This can cause pain, as well as interfere with normal posture and internal organ function. Scoliosis may be treated with a trunk brace. If this proves unsuccessful, spinal fusion surgery may be needed to join the vertebrae together, which keeps the spine straight.
Seizures occur in 30-50% of children with cerebral palsy. Seizures may be restricted to one limb (focal) or generalized. Grand mal seizures are the most common type of generalized seizure for people with CP. Seizures may be treated with drugs, most commonly carbamazepine (Tegretol) or ethosuximide (Zarontin).
Mental retardation which is sometimes referred to as developmental delay, is often associated with cerebral palsy. Up to 50% of patients with CP are mentally retarded. Certain features are, however, more likely to be associated with significant mental retardation in the patient with cerebral palsy. These include extensive damage occurring on both sides of the brain, microcephaly (small head size), a documented genetic disorder, and a documented prenatal infection.
Children with cerebral palsy may not be able to feed easily, because of poor coordination of the tongue and mouth muscles, or inability to hold and move utensils independently. The person may not take in adequate nutrition for full growth and development, worsening the results of the disorder.
Children with moderate-to-severe cerebral palsy, especially those with spastic quadriplegia, often experience failure to grow or thrive—infants fail to gain weight normally; young children may be abnormally short; and teenagers may be short for their age and may have slow sexual development. These phenomena may be caused by a combination of poor nutrition and damage to the brain centers that control growth.
Drooling, dental caries (cavities), and gum disease are more common in people with cerebral palsy than in the general population, partly because of lowered coordination and increased muscle tightness in the mouth and jaw. Each of these can be prevented to some degree, either through behavioral changes alone or in combination with drug therapy. Constipation is more common as well, and may be treated through dietary changes, or with enemas or suppositories when necessary.