Deformities in CP

In CP the neurological lesion is primary and permanent while orthopaedic manifestations are secondary and progressive. At first deformities are dynamic, over time they become fixed.

Deformities can cause increasing difficulties in walking patterns and ambulation.

• Tip toeing gait ( due to tightness of Achilles tendon)
• Scissoring gait( due to tightness of hip adductors)
• Crouch gait ( due to hamstring tightness)
• Hip dislocation and ankle equines or plantar flexion deformity are very commonly found in CP individuals.
• Hip Surveillance with a paediatric orthopaedic surgeon at regular intervals
• Torsional deformities of long bones such as femur and tibia are seen.
• Scoliosis may develop in children before the age of 10 estimated. Prevalence between 21% & 64%.
• In general higher levels of severity of CP are associated with Scoliosis and hip dislocation. ( Hip and Spine surveillance is very essential )

Eating (Feeding difficulties) (Malnutrition in CP Children)

• Due to sensory / motor impairments, those with CP may difficulty in chewing and Swallowing.
• An infant with CP may have difficulty in Sucking, Swallowing or Chewing.
• Gastro – oesophageal reflux is common in children with CP.
• Children with CP may have too little or too much sensitivity around & in the month.
• Self feeding is difficult due to
  • Lack of head, month & trunk control
  • Lack of hand – eye co-ordination
  • Not able to bend hip enough to reach forward to grasp food or utensils.
  • Poor fine finger dexterity & poor grip strength.

There are associated dental problems.

There is a risk of Pneumonia caused by undetected aspiration of food or liquids. Hence CP children have risk of under nutrition.

Language and Communication Disorder

• Speech and language disorders are common in people with CP.
• Incidence [ 31% to 88% ]
• Speech problems are due to :
  • Poor respiratory control
  • Laryngeal and velopharyngeal dysfunction
• Oral articulation disorders are due to :
  • Restricted movement in the oral- Facial muscles.

Overall language problems are associated with problems of cognition, deafness and learned helplessness.

Children with CP tend to become passive communicators, initiating little communications

Suggested is :

• Early intervention with children & their parents
• Early use of augmentative and alternative communication systems

Associated Disorder

Associated disorders intellectual disabilities, seizures, muscle contractures, abnormal gait, osteoporosis, communication disorders, mal nutrition, sleep disorders, depression and anxiety.

Management

The approach to CP management is a holistic approach, shifting from narrow attempts to treat medical problems to aiming for a larger goal of maximizing the persons & independence and community participation

The above philosophy is reflected in our multi disciplinary approach for cerebral palsy management, in line with the international classification of functioning, disability and health’s goal (ICF)

The team includes a paediatrician, a paediatric orthopedic surgeon, paediatric neurologist,a developmental paediatrician, a physiotherapist , an occupational therapist, speech therapist, an orthotist, a special educators, a psychology counsellor.

Prognosis

The brain damage is non-progressive but the symptoms can become more severe over time.

The ability to live independently with CP varies widely, depending partly on the severity of the capability of each person to self-manage logistics of life.

For many children with CP, parents are heavily involved in self- care activities like bathing, dressing, grooming, eating where primarily upper limbs are involved. Almost 50% children with CP have impaired upper limb function, involving sensory & motor impairements, most common being ability to manipulate small objects with fingers.

Productivity

• Productivity include school, work, household chores or contributing to the community
• Play becomes difficult, affecting the child’s self esteems
• The sensory – motor problems of CP child affect how he interacts with the surrounding environment and people
• The inability of child’s caregivers and playmates to understand his problems. Also limit his play activities. Which leads to less motivation and poor social skills.
• Children with CP spend more time playing by themselves
• There is a need to create accessible play spaces for Cp children
• In school, factors related to hand writing challenges include postural instability, sensory and perceptional disabilities of hand writing tool pressure
• Additionally there may be difficulties in carrying out school activities, communicating verbally and interacting socially

Leisure

• Limitation in carrying out leisure activities due to social and physical barriers.
• Have limitations in participating in sports, visiting social gathering and public places due to inaccessibility of these places.

Participation and barriers

• Participation includes self care, productivity and leisure
• Barriers can exist on 3 levels.Meso Level : Includes negative attitudes of family and community towards disability and ultimately poor support from them. The limited support appears to be the result of lack of awareness of the medical problem and knowledge regarding the child’s 9 existing inherent ) potential to engage in activities
  • Micro Level : Child’s physical limitations
  • Meso Level : Includes negative attitudes of family and community towards disability and ultimately poor support from them. The limited support appears to be the result of lack of awareness of the medical problem and knowledge regarding the child’s 9 existing inherent ) potential to engage in activities
• Adults with CP may not seek physical therapy due to transport issues, financial restrictions