Four Current Issues Related to the Treatment of Cerebral Palsy and its Impacts

Cerebral Palsy
Student Full Name
Institutional Affiliation
Course Full Title
Instructor Full Name
Due Date
Cerebral Palsy
Abstract
Cerebral palsy is a common neurological disorder among children with prevalence estimates ranging from 1 to nearly 4 per 1,000 children. People with cerebral palsy have movement and posture problems, and in some instances, suffer from seizures, some level of intellectual disability, joint problems, or sensory losses. This diagnostic research paper will provide an overview of the disorder including a description of the condition, current treatment methods, incidence rates, and demographics. It will also outline the functional limitations of cerebral palsy and rehabilitation strategies for the patient before conducting a review of two websites containing information on the neurological disorder. Finally, the diagnostic research paper will discuss four current issues related to the treatment of cerebral palsy along with their impacts.
Overview of Medical Knowledge
Cerebral palsy is described as a group of neurodevelopmental disorders that affect both developmental and motor skills. Therefore, it is not a defined, distinct disease category but a collective term including etiologically dissimilar symptoms that vary with age. As a medical term, cerebral palsy was used for the first time in the mid-1880s by William Little, an English orthopedic surgeon, after associating neonatal hypoxia with muscle spasticity and resulting musculoskeletal deformities (Sadowska et al., 2020). The definition of cerebral palsy has been constantly changed throughout the years, including neurological disorders caused by heterogeneous underlying genetic variants.
Cerebral palsy is caused by non-progressive disturbances, abnormality, or lesion in the maturing infant or fetal brain. The diagnosis of the medical condition is mainly founded on posture and motor function disorders that begin showing at early childhood and continue until the end of life. Breathing, swallowing, and speech muscles may also be involved together with intellectual disabilities and seizures. These disorders are non-progressive but vary with age. The motor disorders of cerebral palsy usually correlate with disturbances of perception, cognition, sensation, communication, and seizure or behavior disorder (Torpy, 2010). Cerebral palsy does not include neurological disorders of the spinal cord or the muscles such as muscular dystrophies, myelomeningocele, or spinal muscular atrophy, which also have similar symptoms. It is critical to identify the primary cause of cerebral palsy syndrome, particularly in instances of metabolic or genetic disorders that have particular disease-alleviating treatment. An accurate diagnosis of the metabolic or genetic disorder has considerable effects on the likelihood of treatment, genetic counseling, and correct prognosis.
While the pathophysiology of cerebral palsy is still unclear, certain events during a child's neural development have been determined as risk factors. Some of the gestational, fetal, postnatal, or maternal factors that increase the likelihood of cerebral palsy include brain injury, prematurity and post-maturity, abnormal brain development, cerebral leukomalacia, preventricular-intraventricular hemorrhage, infection of the mother during pregnancy (including cytomegalovirus or rubella), mother and fetus having discordant blood proteins, inadequate blood or oxygen flow to the fetus brain, genetic and congenital disabilities, severe jaundice in the infant, head trauma, cerebral infections or inflammations, hypoperfusion injuries (Gulati & Sondhi, 2017). There are three main types of cerebral palsy: spastic, dyskinetic, and ataxic. Spastic cerebral palsy is characterized by stiff and tight muscles that prevent normal movement. Dyskinetic cerebral palsy is categorized by stiffening muscles when activated, resulting in atypical limb poses, including writhing movements. Ataxic cerebral palsy is classified by poor balance and coordination.
Other forms of the neurological condition are choreiform (recurrent purposeless limb movements), rigid (occurrence of hypertonicity without muscle spasticity, hyperreflexia, and clonus), hypotonic (normal deep tendon reflexes accompanied by low muscle tone), and mixed (cerebral palsy of more than one type with little to no head/neck control). Physiologically, the medical disorder can be split into spastic type (cerebral palsy that affects the corticospinal tracts) and extrapyramidal type (cerebral palsy that affects other areas of the maturing brain). The latter includes dyskinetic, ataxic, choreiform, rigid, and hypotonic. Cerebral palsy is the most widespread motor disability in childhood, where the most recent population-based studies put prevalence rates between 1 and 4 per 1,000 children. According to a 2010 report by CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network, about 3 in 1,000 children has the condition. Nearly 500,000 children and 264,000 adults have cerebral palsy. Around 8,000 to 10,000 infants are diagnosed with neurological disorders every year. Cerebral palsy is more common in boys than girls: boys (3.6 per 1,000 infants) and girls (2.5 per 1,000 infants). Spastic cerebral palsy is most common, comprising 61% to 76.9% of all cases, dyskinetic 2.6%, ataxic 2.4%, hypotonic 2.6%, and mixed 15.4% (CDC, 2018).
The medical condition is highest in black children than in other ethnic groups: black (3.9 per 1,000 infants), white (2.7 per 1,000 infants), Hispanic (2.4 per 1,000 infants), and Asians (1.3 per 1,000 infants). Approximately 58% of all children diagnosed with cerebral palsy can walk independently, 11% can walk independently but with the aid of mobility devices, whereas 31% are entirely unable to walk and require wheelchairs (Birth Injury Help Center, 2019). Cerebral palsy becomes evident once the baby reaches the age of six to nine months and begins demonstrating preferential use of limbs, asymmetrical motor development, gross motor developmental delay, extreme mobilization. Unlike other comorbidities, these growth delays or primitive reflexes are endemic. However, a formal examination involving physical examination, simple to complex tests, and medical history of both the mother and child are required to ascertain that the symptoms are indeed cerebral palsy.
Some standard tests used to rule out other comorbidities are brain scans (both MRI and cranial ultrasound may be performed to identify areas of abnormal development or damage in the brain), electroencephalogram (EEG) test (to diagnose abnormal brain wave patterns caused by epilepsy, over and above, blood, urine, and skin tests (to determine metabolic or genetic problems). In mature children, the symptomatology of the neurological disorder is quite diverse, although unsteady gait, spasticities, balance issues, involuntary movements, and spasms are common. Cerebral palsy is often associated with mild to severe learning disabilities, visual impairment, malnutrition, and associated conditions like obesity, under-nutrition, gastroesophageal reflux, osteopenia, and hydrocephalus. About 60% of children with neurological disorders are diagnosed with one or several co-occurring disabilities at around eight years old (Agarwal & Verma, 2012). Owing to the heterogeneous nature of cerebral palsy, a personalized approach to treatment is critical even if the condition cannot be cured.
A multidisciplinary plan of care including physical, speech, and occupational therapy; orthopedics; orthotics; pediatrics; nutrition; and social work has been found to help maximize the child’s potential activities at different stages of development. Other treatment options include surgery, medications, and assistive devices. Medications to reduce muscle tightness and enhance functional abilities, manage complications, and treat pain associated with cerebral palsy symptoms include muscle and nerve injections and oral muscle relaxants. The physician may recommend Botox injections or another agent every three months to tighten various muscles and even drooling. Drugs like diazepam, baclofen, Valium, Zanaflex, and Dantrium can help with muscle relaxation. Baclofen is sometimes pumped into the spinal cord intravenously (Mayo Clinic, 2016). Other medications may be necessary for co-occurring disorders such as feeding and nutrition, osteoporosis, seizure, vision and hearing loss, sleep difficulties, bladder incontinence, and mental health conditions.
Surgical procedures may be necessary to reduce muscle tightness and correct bone deformities brought about by spasticity. Orthopedic surgery may be performed to correct severe contractures or abnormalities in the bones or joints, especially the spine, limbs, and hips. Surgical lengthening or shortening of the muscles or repositioning tendons affected by contractures can help improve mobility or reduce pain. The surgical procedures can make it easier for the patient to use assistive devices such as crutches or braces. In some rare cases, the only way to alleviate cerebral palsy symptoms is by cutting the nerves causing spastic muscles through a procedure known as selective dorsal rhizotomy (Agarwal & Verma, 2012). This surgical procedure helps reduce pain and muscle tautness, although it can result in numbness. As the child diagnosed with cerebral palsy continues to grow, his or her healthcare needs change. Therefore, regular evaluation and treatment of those symptoms common among adults with neurological conditions are critical. These include dental problems, heart and lung disease, seizures, fatigue, vision and hearing loss, mental health issues, orthopedic problems, and muscle tone issues.
Functional Limitations and Rehabilitation Strategies
Various dysfunctions are associated with effects of cerebral palsy, notably cognitive issues, which range from mild to severe disabilities in learning, reasoning, and gaining knowledge through thoughts, experiences, and senses. Some of the most common signs of cognitive dysfunction among children include difficulty speaking and responding to others; challenges learning to read and count; issues with sensory stimulation; delayed language development; and emotional instability, including anger outbursts, depression, and anxiety. Physical dysfunctions include preferential use of limbs, asymmetrical motor development, gross motor developmental delay, extreme mobilization, unsteady gait, spasticities, balance issues, involuntary movements, and spasms. Since sensory processing is a neurobiological process, the neurodevelopmental disorder adversely impacts the patient’s ability to register and modulate sensory information.
Children experience various sensory inputs in a limited way due to damaged muscle tone, damaged muscle tone, asymmetrical posture, and incorrect postural adjustments and movement patterns (Jovellar-Isiegas et al., 2020). One motor function disability relates to communication issues: patients with cerebral palsy cannot coordinate their tongue and mouth muscles as required for speech or saliva control. Several patients are also incapable of coordinating their breathing to support speech understandably or controlling their mouth muscles to prevent saliva loss (also referred to as sialorrhoea or drooling), and loss of tongue and mouth muscle control results in eating and drinking challenges. Others suffer gastroesophageal reflux and have to be fed through a feeding tube.
Due to the inability to deliver an appropriate and adapted response to environmental demands, persons with cerebral palsy are incapable of performing daily living activities or participating in meaningful occupations. Sensory processing dysfunction has been linked to behavioral self-regulation problems, including hyperactivity, obstinacy, anxiety, rage, and other strong emotional responses (Brossard-Racine et al., 2012). Cognitive deficiencies increase the likelihood of atypical social interaction, poor social information problems, limited social adjustment. Motor impairments and intellectual disabilities may result in the child developing low self-esteem, anxiety, depression, social anxiety, and shyness. It is also common for patients with cerebral palsy to have hearing and vision impairments.
Patients with cerebral palsy and their families face u...