CEREBRAL PALSY SERVICES

Comprehensive Evaluations

Although many individuals with CP are highly intelligent and can excel academically, there are some that can have associated developmental problems such as language impairment, learning difficulties, or intellectual disabilities. Many observers will falsely misinterpret abnormal movements or speech difficulties as cognitive impairment, or cause teachers and others to underestimate intellectual ability.  For this reason, formal neuropsychological testing is crucial to understand an individual’s cognitive and intellectual strengths and weaknesses for curriculum and vocational planning.

Individualized Treatment

Many individuals with CP can benefit from therapies such as occupational, speech, feeding and physical therapy, and need close neurological and neurodevelopmental monitoring. The management of CP entails assessing for identifiable or potentially treatable causes of CP, including genetic, metabolic, neurotransmitter and other disorders. Assessing and treating associated disorders, such as epilepsy, is essential.  Thus, an individual with CP should have various neurodiagnostic and laboratory testing, such as blood and urine tests for genetic, metabolic and other disorders; imaging of the brain (magnetic resonance imaging [MRI]); dense array electroencephalography (dEEG); and in select cases, examination of the cerebrospinal fluid (CSF). When physical and occupational therapies are insufficient to control spasticity, there are other options, such as medications or localized injections (e.g. Botox). In extreme cases, there are orthopedic or neurosurgical approaches that can be helpful.

Other problems that can be associated with CP include gastroesophageal reflux, feeding difficulties, constipation, hearing impairment, visual problems, epilepsy (seizures), hydrocephalus, scoliosis, joint contractures and other orthopedic concerns, dental problems, bladder control issues and sleep disorders. Furthermore, there are some children and adults with CP who have severe behavioral and neuropsychiatric disorders and problems.

About CP

Cerebral palsy (CP) is a term used often to describe those who have abnormalities of body movement, balance and posture occurring from abnormal neurological processes. Historically, CP was attributed to a brain injury occurring during labor and delivery, but modern research has found that only a very small number of individuals with CP have experienced a brain injury during labor and delivery. Rather, the mechanism(s) that causes CP occurs more frequently during prenatal life as the fetus develops, from infections, abnormalities of the placenta, fetal stroke, genetic abnormalities, developmental abnormalities of the fetal brain, trauma to the mother, premature delivery, and other causes, or after birth from inborn metabolic disorders, epilepsy, neurotransmitter disorders, and more.

CP is a subset of the “static encephalopathies”: abnormalities of the brain that are felt to be “fixed” and not progressive. However, there are progressive neurological disorders that can mimic CP, and if individuals with CP do not receive appropriate therapies, they can progress and regress over time. The approach to managing difficulties associated with cerebral palsy is multimodal with the goal to manage motor difficulties and potential associated medical, educational and social difficulties.

Signs and Symptoms

Children with cerebral palsy can be delayed in meeting their developmental milestones (rolling over, sitting, walking, etc.).  Those with cerebral palsy can be hypotonic (i.e., floppy, low in tone), spastic (e.g., tight in arms and legs), dystonic (rigid/ twisting quality to tightness) or have abnormal or excess movements (such as overshooting when trying to reach). CP is divided into different types:

  • Spastic (pyramidal): increased tone (i.e. resistance to passive [movement done by someone other than the individual] extension of a limb, classically releasing at the very end of the movement, known as “clasp-knife” release). There can often be low tone of the trunk and poor head control. This type of CP is further categorized as:
    • Diplegic/diparesis (although “-plegic” is commonly used, referring to paralysis, “-paresis” is more appropriate, referring to weakness): affecting primarily the legs.
    • Quadriplegic/quadriparesis: affecting all four extremities and the entire body.
    • Hemiplegic/hemiparesis: affecting one side of the body, usually face/arm or leg, or all three.
  • Dyskinetic (extrapyramidal): causes abnormalities of coordination of movements, often with abnormalities of tone. This type of CP is further categorized as:
    • Athetoid: uncontrollable slow and writhing movements that can involve any parts of the body, including face, mouth and tongue.
    • Ataxic: causing problems with balance and coordination, particularly an unsteady gait (walking).
  • Hypotonic: low tone of the trunk and extremities with increased deep tendon reflexes.
  • Mixed: a combination of the different type of CP.

For further comprehensive information regarding Cerebral Palsy, see the following :
Cerebral Palsy Resource Guide

Emedicinehealth Article on Cerebral Palsy

Emedicine.Medscape Article on Cerebral Palsy

 

Other Useful References:

The NINDS Cerebral Palsy Information Page

Ashwal S, Russman BS, Blasco A, et al. “Practice Parameter: Diagnostic assessment of the child with cerebral palsy: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society,” Neurology 2004; 62: 852-863.

“Using information they obtained from my son’s medical history, learning and thinking styles, and specialized brain and genetic testing, the CNNH team was able to “think outside the box” and prescribe a comprehensive treatment plan that really works, both at home and in school!”

— Jaime C.

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