Cerebral palsy is a debilitating disease, affecting several individuals across the world. This article highlights all essential information that is pivotal to locating the symptoms and understanding the diagnosis and treatment procedure for cerebral palsy.

Cerebral palsy (CP) is an ailment concerned with the difficulties in the movement of a person, which also affects their ability to maintain balance. In most cases, CP is diagnosed mostly in childhood and is related to functionalities in the brain.

In general terms, it is concerned with the abnormal development of the brain or any brain damage that disturbs the concerned person's capacity to move limbs and control muscle movement.

Generally, the type of cerebral palsy a patient is affected with is determined by the body's movement. In addition, a concerning part of the brain helps doctors detect the nature of the movement disorder, which can be classified into the following:

• Dyskinetic Cerebral Palsy: Normally, people or children affected with dyskinetic cerebral palsy are concerned with the problems of body movements. The problems have mainly occurred in limbs, making doing basic activities like sitting and walking impossible. Dyskinetic cerebral palsy includes athetoid, choreoathetosis, and dystonic movement disorder.
• Spastic Cerebral Palsy: The majority of people with cerebral palsy are affected by this type. Individuals facing this movement disorder encounter stiffness in a muscle that leads to chronic difficulties in movement. Furthermore, spastic cerebral palsy consists of three different kinds:
  • Hemiparesis or spastic hemiplegia
  • Diparesis or spastic diplegia
  • Quadriparesis or spastic quadriplegia

In this case, the treatment for cerebral palsy is conducted based on which part of a body is affected.

• Ataxic Cerebral Palsy: Children or adults affected with Ataxic CP encounters issues in maintaining balance and coordination. Getting disbalance while walking or initiating swift movement that requires control and a specific amount of balance are common symptoms of this type of CP.
• Mixed Cerebral Palsy: A patient is diagnosed and treated for mixed cerebral palsy when a doctor can detect more than one type of symptom of CP. Hence, spastic-dyskinetic CP is the most general case of mixed movement disorder affecting individuals.

The primary and pivotal symptoms of cerebral palsy include problems with movements, coordination and development of the overall body growth of a baby. An early signs of cerebral palsy are commonly detected during the first 2 to 3 years include:

• Delays in developmental growth, like problems in sitting or walking
• Restlessness or clumsy movement of bodies
• Hypotonia – stiffness or floppiness
• Uncontrollable body movements
• Hand tremors

In addition to this, there are lists of other common symptoms of cerebral palsy that are identified among infants based on their age:

Infants Younger Than 6 Months of Age

• Head lags when picked up or lying on his back
• Floppiness
• Feeling of stiffness
• Tendency to overextend his back and neck whenever the baby is cradled in the arms

Infants Older Than 6 Months of Age

• Unable to roll over in any of the direction
• Face difficulty in bringing her hands jointly
• Problems reaching her mouth with her hand

Babies Older Than 10 Months of Age

• Crawls one-sidedly while dragging with one leg and hand and pushing off with the opposite leg and hand.
• Hops on his knees; however unable to crawl on all the four legs

Additionally, the severity of this disease's symptoms depends on a child's other body condition and affects different parts of the body.

Most children having a condition of cerebral palsy are born with the condition known as congenital cerebral palsy. Generally cerebral palsy is caused due to the damage or abnormal development of parts of a child's brain. This may occur while a baby is still in a mother's womb or during or shortly after birth.

Let us discuss the most known origin of cerebral palsy, which affects the development of a baby's brain before birth.

• Periventricular Leukomalacia (PVL): PVL is a situation that refers to the damage in the white matter of a baby's brain. The white matter in the brain sends the signal to the entire brain and other parts of the body. When this part of the brain undergoes any injury, it breaches the connection between the brain and body, related to control movement.

A fetus's brain is susceptible to damage between 26 and 34 weeks of pregnancy. However, this damage can occur at any time during pregnancy.

• Abnormal Development of Brain: Any disturbances in the natural growth of the brain development of a fetus can lead to abnormalities. These abnormal occurrences are responsible for the tampered transmission of instructions in the brain. Generally, common reasons for abnormal development of the brain of a fetus  are infections, genetic mutations, fever, or trauma.

• Shortage of Oxygen in the Brain: The lack of sufficient oxygen in the brain for a prolonged period can lead to acute damage and the emergence of cerebral palsy. In addition, an occurrence of extremely low blood pressure in a mother, damage in the placenta, or issues in the umbilical cord can accelerate low blood pressure in a mother. Mostly, excessive trauma or damage to an infant's head during the delivery causes an acute shortage of oxygen.

• Bleeding inside the Brain: One of the consequential reasons for cerebral palsy is when a fetus undergoes a stroke. The cause of stroke in a foetus is mostly due to the blocked or broken blood vessels of the brain. Mostly, when a baby is suffering from blood clotting or heart defects in a mother's womb, it leads to a bleeding brain. In addition, sometimes, the abnormal formation of blood vessels or sickle cell disease can increase the chances of such an issue.

Apart from the above-mentioned cause, cerebral palsy can occur during or shortly after the baby’s delivery. Here are the potential causes of cerebral palsy in this scenario:

• Any difficulty in delivery leading to the scarcity of oxygen temporarily triggers cerebral palsy. This situation is asphyxiation.
• Cerebral palsy can occur due to infection, mostly meningitis or encephalitis.

In addition to all the above-mentioned factors, a sudden stroke or fall in the blood glucose level also instigates the chances of cerebral palsy in babies.

The prevention of cerebral palsy becomes easy when there is proper awareness of the risk factors. Here are the common risk factors that are pivotal to keep in mind:

1. Excessive low birth weight in children
2. A premature birth procedure mostly includes children born before the completion of the 37th week of pregnancy. As per Centers for Disease Control and Prevention, a newborn taking birth before the 32nd week of pregnancy has a higher possibility of cerebral palsy.
3. There is always a higher risk for cerebral palsy in case of multiple births of twins or triplets. This chance may increase if the baby's twin dies before the delivery or right after that.
4. Risk factors are high when children are born through infertility treatment or assisted reproductive technology.
5. Infections during the span of pregnancy can lead to cerebral palsy through the increase of proteins called cytokines. Cytokines are spread in the brain and blood of a fetus, causing inflammation and, subsequently, brain damage.
6. In addition to the points mentioned above, fever, jaundice, and kernicterus affecting mothers or newborns can also lead to cerebral palsy. Sometimes, bacterial infections in mothers affecting the placenta or fetal membranes damage the growth of the brain.

Furthermore, through different medical histories and a physicians' research, complications in birth like placenta detachment, uterine rupture, issues in umbilical cords and mothers bearing thyroid or heart problems increase the risk factor for cerebral palsy in newborns to a great extent.

It is always recommendable if the parents notice any abnormal or uncontrollable body movements of the child to consult with a specialised doctor. Generally, to obtain a clear vision that the child is facing cerebral palsy, the doctors perform a plethora of examinations and tests.

During the initial stage, the diagnosis of cerebral palsy begins with familiarising the child's medical history and progress. Upon detecting prominent symptoms of cerebral palsy, the practitioner tries to find out any occurrence of accidents or complications during pregnancy or delivery.

Finally, the conduction of an assessment of a child's body movement and learning potential lets the doctor carry out the following tests:

1. Brain Scans: The detection of cerebral palsy is mostly done through cranial ultrasound scan, MRI scan, and a CT scan. A cranial ultrasound scan involves a device that passes sound waves to the top part of the child's brain, which offers a clear image of the brain. Similarly, an MRI or CT scan is when a scanner uses magnetic fields and radioactive waves or X-rays to provide an image of the brain.
2. Tests and Examination: Specialised doctors conduct other examinations like Electroencephalogram (EEG), Electromyogram (EMG), and different blood tests.

• An electroencephalogram is a procedure to record the activity of the brain. This is a painless process where small sensors are attached to the scalp, which helps identify electrical signals the brain produces.
• An electromyogram is an examination to analyse the condition of the nerve cells that control them. This helps detect any muscle dysfunction or issues in signal transmission.

To prescribe remedies and start with the treatment of cerebral palsy, it is pivotal to detect the problems through the necessary test.

Once a clear indication of cerebral palsy is present in a child, healthcare professionals offer care plans that provide adequate relief. However, depending on health condition of a child, a concerned doctor can prescribe following treatment procedures:

1.  Occupational Therapy: Occupational therapy is one of the most effective treatments for cerebral palsy that helps elevate a child's self-esteem and confidence. In this procedure, an expert advises and guides the child with basic activities that require complex physical movements.

In addition, for the treatment of CP in adults, doctors recommend most of them to live independently, like doing basic chores, getting a job, learning technological skills, etc. This greatly affects an individual's mind-set positively and increases their confidence.

1. Speech and Language Therapy: Speech and language therapy is concerned with exercises that improve the communication skills of the affected individual. In this treatment, an alternative method of communication, like sign language or communicating through pictures, was taught.

In addition, therapists provide young children with devices that have contain pictures of daily objects. It helps them to communicate their needs and preferences.

1. Physiotherapy: Based on symptoms and diagnosis of cerebral palsy, a doctor will advise the patient to opt for physiotherapy. This treatment method includes exercises that help to improve physical movement. The primary objectives of physiotherapy are to improve movement and enhance muscle strength.

Furthermore, this includes the prevention of muscle shortening and contracture to a great extent. Based on the condition of a patient, a specialised physician will prescribe different physical aids like an arm or leg braces for supporting limbs.

Apart from the therapies, other treatment options for cerebral palsy include medications and surgical processes that are offered depending on the patient's condition.

Medications

Doctors offer medicines that work to lessen muscle tightness, making it function smoothly and without any complications. Here is the most prescribed list of medication for cerebral palsy:

1. Relaxants for Oral Muscles: Relaxants that are often prescribed are baclofen, tizanidine (Zanaflex), dantrolene (Dantrium) or diazepam (Valium).
2. Injections: Doctors may prescribe injections like onabotulinumtoxinA (Botox) to promote firmness and tightness in a specific muscle. Generally, this type of medication includes side effects like pain in the spot where the medicine has been injected, mild fever, etc. In addition to this, botox injections are also prescribed to salivary glands to control drooling.

Surgical Procedures

In some severe cases, healthcare personnel may prescribe surgical procedures to make any corrections on bone abnormalities. These procedures include the following:

• Selective Dorsal Rhizotomy: This procedure, also known as cutting nerve fibres, is performed by doctors in severe conditions. The doctors cut a specific spastic muscle that eliminates the tightness, thereby reducing pain and complications.
• Orthopaedic Surgery: Depending on the degree of bone deformities in children, doctors can recommend surgeries on bones. These surgeries help in lengthening the muscles, showing improvement in the patient's mobility.

In addition to this, depending on the severity of the condition, doctors may prescribe pain management methods to offer fast relief.

In addition to the above mentioned treatment methods, there are some remedies available to combat the feeding and drooling problems.

1. Remedies for Feeding Difficulty

In case of people having difficulties swallowing food undergoes the following treatment which includes:

• A speech and language therapist shows techniques describing how to swallow food and related exercises.
• Sorting food plans and making dietary changes which include chewing soft or liquid foods, etc.
• In case of extreme difficulties in swallowing food, doctors may prescribe a feeding tube in many cases. This feeding tube is generally passed into the stomach through the nose.

Like difficulties in swallowing food, drooling is also common for people with cerebral palsy. Again, this does not include any critical effect; however, the continuous saliva can cause irritation to the skin around the mouth area.

2. Remedies for Drooling

The following are the treatments for excessive drooling that a doctor may prescribe post the diagnosis of cerebral palsy:

• A doctor may recommend or prescribe anticholinergic medicines that come in tablets or skin patches. This medicine is concerned with the reduction of saliva production.
• In case of excessive saliva production, doctors prescribe botulinum toxin injections to many patients.
• Specialised doctors can go ahead and prescribe surgery to control the production of saliva and redirect saliva glands.

In some cases of CP, a specialised physician may prescribe surgical procedures to impart comparative relief. Surgeries can help restore the curvature of the spine and treat problems related to the control bladder.

Though the exact causes of congenital CP are still unknown, however; there are certain measures considerations that lead to healthy pregnancy development. Here are the certain prerequisites that need to be followed before conceiving:

• Maintaining a healthy and balanced lifestyle before pregnancy
• Being vaccinated for specific diseases like chickenpox and rubella can be detrimental to the growth of the fetus. Pregnant mothers must take these vaccinations before conceiving.

In addition to following the factors mentioned above, there are certainly other measures to follow during the span of pregnancy:

• Taking necessary and regular prenatal care is crucial for the smooth development of a foetus and a mother's overall health.
• Washing hands with soap quite often prevents the chances of infections caused due to viruses.
• Consider taking a flu shot to reduce the chances of getting the flu, as this would offer the utmost protection to an unborn baby.
• Proper care is necessary if there is disparity between the blood type and Rh between a baby and mother, as this may lead to jaundice or kernicterus.
• Take early consultation from your physician for all the risks involved in preterm delivery.

Those mentioned above are the basic factors that are crucial to consider before and during pregnancy to initiate smooth and risk-free delivery of a new-born.

It is pivotal to approach a specialised doctor for prompt remedies and diagnosis of cerebral palsy. The guardians must recognise certain symptoms like consecutive unawareness or abnormal body movements. Abnormalities in body movements can include stiffness in muscles, unbalanced coordination, and chewing or swallowing issues.

If there is an identification of these signs or symptoms for a prolonged period, then it is certain that an individual requires medical attention.

Cerebral palsy if not detected on time or non-receiving of proper treatment can lead to tampering of intellectual abilities and unusual physical sensations. However, with patience and proper care, a great amount of ailment can be overcome. Moreover, with an advancement of medical science and availability of quality expert consultations, the treatment result for CP can reach a level of optimism.