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Cerebral Palsy FAQ:
Brachial Plexus FAQ:
The term Cerebral palsy is used to describe a group of disorders affecting body movements and muscle coordination. These disorders are caused by brain damage sustained just before, during, or shortly after birth. Cerebral palsy is a permanent condition, not a progressive disease.
What Are the Main Types of Cerebral Palsy?
There are three main types of cerebral palsy, depending on the location and extent of brain damage involved:
In some cases an individual displays symptoms of more than one category, which is called mixed cerebral palsy.
Cerebral palsy is usually diagnosed before the age of three. An infant with cerebral palsy may display an abnormally limp or rigid posture. Spastic muscles characterize some cases of cerebral palsy, while in others the muscles are unusually slack. Certain early reflexes that are present in newborns, but normally disappear within several weeks, remain for much longer in children affected by cerebral palsy. Babies with cerebral palsy are typically slow to reach developmental milestones, such as sitting, crawling, and walking. Their sense of balance may be impaired, and certain children may have fits or seizures. Such children may also demonstrate atypical behavior, either by crying and fussing excessively or by showing very little emotion.
Spastic cerebral palsy is the most common form occurring form of the condition. The term "spastic" refers to one who is prone to spasms, which are involuntary contractions of muscles. Spastic cerebral palsy is characterized by tight muscle tone, which results in rigid and jerky movements. Those affected by this condition may have difficulty changing positions and performing other basic movements.
Athetoid cerebral palsy causes fluctuations in muscle tone throughout the entire body. Individuals afflicted with this condition sometimes make unintentional or uncontrolled movements that can be either slow and contorting or fast and erratic. Athetoid CP usually affects the entire body.
Ataxic cerebral palsy is characterized by slack muscle tone and impaired coordination and balance. Individuals with this condition generally appear very shaky and unsteady. People with ataxic cerebral palsy may walk unsteadily because of poor balance.
There are many possible causes of cerebral palsy. It is not always clear what caused the brain damage in the first place, but some possibilities include:
- Health problems of the mother
- Hypoxia (lack of oxygen)
- Birth injuries from complications
- Premature delivery
- Jaundice (excessive bilirubin)
One of the most important causes of cerebral palsy during the birth process is an insufficient amount of oxygen reaching the newborn or fetal brain. Many times when there is a lack of oxygen, the doctors and nurses should be able to identify fetal distress by interpreting the fetal monitor strip correctly. If the doctor fails to do a C-Section, or to do it quickly, the child will lose oxygen and develop cerebral palsy or brain damage. Doctors are trained to identify risk factors for cerebral palsy, and may be held responsible if these dangers are neglected.
Cerebral palsy treatment largely depends on the type and pattern of the condition that is present in a given individual. It is important to note that, because cerebral palsy cannot be cured, the goal of treatment is to help patients function at the highest level possible. To achieve this goal, there are a number of different therapy approaches, including:
- Physical Therapy
- Speech and Language Therapy
- Drug Therapy
- Occupational Therapy
- Surgery
Shoulder dystocia is a delivery in which additional maneuvers are needed to free the fetal shoulder from obstruction. To alleviate shoulder dystocia the medical staff should initiate a series of maneuvers. These maneuvers should result in the release of the shoulder and aid delivery of the baby. Sometimes damage is done to the network of nerves running from the spinal cord to the arm.
The brachial plexus is a system of nerves connecting the spinal cord to the shoulder, arm, and hand. Brachial plexus injury is most commonly caused during a childbirth involving shoulder dystocia. There are different degrees of brachial plexus injury, depending on how severely the region is stretched, including:
- Neurapraxia
- Neuroma
- Rupture
- Avulsion
Erb's palsy is a condition that affects the mobility and function of the arms. Typically Erb's palsy results from injuries sustained during difficult births. When a delivery involves shoulder dystocia, the fetus may suffer a brachial plexus injury, which means that the nerves connected to the affected arm are damaged.
An infant with Erb's palsy will usually have one arm that does not move, except perhaps the fingers. The arm may hang straight down at the baby's side, possibly turned in slightly. A bent wrist and straight fingers are also typical for an infant with this injury.
Klumpke's palsy is a rare injury that paralyzes the hand muscles and finger flexors. This condition occurs when nerves in the lower brachial plexus are injured. Due to the nature of brachial plexus injuries and the location of the nerves involved, it is extremely rare to have an isolated case of Klumpke's palsy. Usually Klumpke's palsy will coincide with Erb's palsy, an injury referred to as complete or global brachial plexus palsy.
A baby with Klumpke's palsy may be able to move the large muscles in the affected arm, but the finger flexors and hand muscles are paralyzed. More often, Klumpke's palsy will manifest with Erb's palsy, resulting in the complete impairment of the affected arm.
The nerves of the brachial plexus can oftentimes recover from injuries such as Erb's palsy, particularly if the damage is not severe. Sometimes the nerves do not fully reattach at their original motor and sensory targets, and surgical repair is required. There are also a number of additional surgeries that can be performed to improve the function of the arm if the nerves never fully recover. Unfortunately, some patients will be impaired for the rest of their lives. It is important to help children keep joints limber to avoid contracture. Children can be taught to adapt in order to minimize deficits and maximize capabilities.
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