Does your baby’s head fall backward when you pick them up? Or perhaps their limbs are rather stiff when you’re handling them?
As they grow older, do they seem to be slower than their peers to reach milestones like rolling, sitting and crawling?
These may be the early signs of children with Cerebral Palsy.
Cerebral Palsy (CP) is a neurological disorder caused by a brain injury or malformation that occurs while the child’s brain is under development.
This type of injury is ‘non-progressive’, meaning that it happened during one moment, and does not get worse over time. The injury (or malformation) may have been in the womb, during birth, or immediately after birth.
It’s a lifelong condition that affects the communication between the brain and the muscles, causing a permanent state of weakness, abnormal movements, and coordination issues.
CP occurs in 1-3 out of every 1000 babies born (about 0.15% to 0.3%) and is more likely to occur in babies who are born premature as well as babies of low birth weight.
To understand what’s happening in these children, we need to understand a bit more about how the brain works.
As we all know, the brain is one of the largest and most complex organs in the human body. It’s running hundreds and thousands of simultaneous processes that range from managing temperature, to running other organs, to processing jokes. This complexity is both the brain’s strength and weakness, and a lot can go wrong.
The brain has several zones, including:
The Cerebrum is the largest part of the brain and makes up the right and left hemispheres. It’s the part of the brain responsible for processing sensory information, such as sight and sound; and it’s also responsible for planning motor activity, emotion, and memory.
The Cerebrum has a lot of functions!
Coating the surface of the Cerebrum and the Cerebellum is the Cerebral Cortex.
This is the wrinkly layer of tissues that is seen on the brain. It’s divided into four lobes of the brain: the frontal lobe, parietal lobe, occipital lobe, and temporal lobe, which are each responsible for processing different types of sensory information and are also involved in the synthesis of movements.
The Cerebellum is located under the Cerebrum. It plays an important role in coordinating muscle movements, maintaining posture and balance. You can see that while the Cerebrum focused on the big picture, the Cerebellum keeps the muscles functioning correctly. Without your cerebellum, you would find it difficult to stand upright, keep your balance or even to move around.
The Brainstem acts as a relay center that connects the cerebrum and cerebellum to the spinal cord. This ‘tiny yet mighty’ part of the brain is in charge of all the functions your body needs to stay alive, like breathing, digesting food, regulating your heart rate and body temperature as well as coughing and swallowing.
As the name implies, most cases of Cerebral Palsy affect the Cerebral Cortex.
This means that CP can permanently affect body movement and muscle coordination, making it the most common motor disability in childhood.
Now that We’re familiar with the major components of the brain, it will be easier to understand the different types of Cerebral Palsy and how it can affect your child.
There are four main types of Cerebral Palsy, with each type creating abnormalities in different parts of the brain, and resulting in different symptoms.
Spastic Cerebral Palsy is the most common type, and is caused by damage to the Motor Cortex of the brain.
In this type of CP, there is an abnormal increase in muscle tone which often results in difficulty controlling movements due to tight muscles and rigid joints.
Spastic CP contains three more catgeories:
Dyskinetic can be roughly translated to: “Involuntary movements”.
This type of CP is characterized by slow and involuntary writhing or jerky movements of the limbs. Hyperactivity in the facial and tongue muscles also makes it difficult to eat and speak. It’s a particularly difficult type to live with as it has a big psychological and social impact as well.
This type of CP also includes Athetoid (Slow, writhing movements of the hands and fingers), Choreoathetoid (Shoulders, Hips, and Face), and Dystonic cerebral palsies (Repetitive Movements and Unnatural, fixed Postures).
Ataxic Cerebral Palsy is the least common type of CP. While other CP mostly occurs due to the Cerebral Cortex, this type occurs from damage to the Cerebellum.
This affects balance and depth perception. Children with ataxic Cerebral Palsy will often have poor coordination and walk with an unsteady gait. They have difficulty with quick or precise movements, such as writing or buttoning a shirt, or a hard time controlling voluntary movement such as reaching for a book.
Mixed Cerebral Palsy is when a child has a mixture of 2 of the above types.
It’s usually a result of damage to many parts of the brain. The most common combination is Spastic CP (Tight Muscles and Joints/Paralysis) and Dyskinetic CP (Involuntary Movements).
Besides having movement and posture issues, children with Cerebral Palsy may also have problems such as cognitive impairment, seizures, impaired vision, hearing loss, speech disorders and malnutrition, depending on which parts of the brain have been injured.
You could say that in some cases, Cerebral Palsy is just one part of a larger injury.
It goes without saying that it can affect a child’s quality of life tremendously. As parents, you will probably have a myriad of questions and concerns, and worry what the future holds for your child.
But the good news is that early intervention can make a big difference!
On a brighter note, CP is not a progressive disease. This means that it does not get worse over time. In many instances, CP can improve with a variety of treatments and therapies. These treatments focus on minimizing deformities and maximizing your child’s capability at home and in the community.
Once the diagnosis is made and the type of CP is determined, a team of health care professionals will work with you and your child to build an appropriate plan. This plan is focused on helping your child grow and develop to their full potential.
As CP is a neurological condition, this team of professionals will come from a range of disciplines, with each profession focusing on their particular specialty. This team usually comprises of your Doctor, your Physiotherapist, and often various other specialists such as Podiatrists (foot and shoe specialists).
Here at Body in Common, we are Physiotherapists, so our specialty is in working with movement, coordination, posture, muscle length, and the physical symptoms that make up CP.
Physiotherapy rehabilitation will usually commence as soon as the diagnosis is made as it’s the cornerstone of all CP treatments.
Strength and resistance training, along with stretching exercises can help in improving muscle strength, balance, and motor skills as well as to prevent contractures (muscles getting stuck in position).
Physiotherapists also work closing with Podiatrists (foot specialists) to provide ‘Gait training’. This training uses special orthotics (shoe modifications) to learn to walk more naturally and improve their movement.
Clinical Pilates is a specialist field of Physiotherapy. While traditional physiotherapy uses a lot of hands-on movements and treatments, Clinical Pilates is focused on creating highly targeted exercises to change individual muscles in a person’s body.
For example, one exercise may strengthen a muscle, while another may lengthen a muscle to provide batter symmetry and balance. These exercises, unlike normal gym workouts, are highly customised to each person, and are backed by Evidence-based studies.
Special Equipment is used, with a variety of tensions, angles, and customizations to suit each body. The other major benefit of Clinical Pilates is that it’s extremely low-impact. This makes it safe for damaged joints and unnatural muscles that could be hurt doing other exercises.
Often combined with Traditional Physiotherapy, Clinical Pilates has recently shown major benefits in helping a new population – children with neuromuscular disorders like Cerebral Palsy.
Being a low impact exercise that focuses on strengthening the body and core for better trunk stability, it’s well suited for people with physical limitations as the exercises can be tailored to target each child’s issues and needs.
Children with Cerebral Palsy have difficulty balancing during specific muscle movements. For example: bending and straightening the knee. Oftentimes, they are unable to hold their bodies against gravity, as they lack the alignment and muscle strength to stay upright. This can make other exercises very difficult.
Working on a piece of equipment called the ‘Clinical Pilates Reformer’ allows children to perform the exercises while lying on their back. This is often a more comfortable position that allows these children to move with greater ease and control, and contributes to a positive movement experience, which is a good one to begin with. It also removes the difficulties of dealing with gravity, making for a more successful rehab session.
Reformer work is also an effective way to teach these children how to control their own movements: They receive resistance from the equipment and feel the contact with the foot bar or jump board, which provides a better sense of where their body is in space as they move through a variety of positions.
Besides that, Clinical Pilates can be a brilliant form of neuromuscular relearning programme that teaches a series of function-based controlled movement exercises. These can be very helpful in learning new movement patterns that make performing daily activities easier and more successful. For example: learning to lift your leg properly to climb the stairs or get off of a toilet seat.
Clinical Pilates can help to improve a CP child’s range of motion, flexibility, strength, balance, and posture. But that’s not all. There are also emotional and mental benefits.
For a child who struggles with pain and movement, the improvements that come with exercises can be empowering. It gives them a greater sense of control and achievement.
As a paediatric physiotherapist and Clinical Pilates instructor, there’s nothing more satisfying than seeing a child happy and being able to accomplish achievements be it big or small throughout their therapy session.
The likely outcome for Cerebral Palsy depends on individual factors, but except in the most severe of cases, it’s possible for children to grow up to live a normal life.
They are able to go to school with their peers with and without the help of special education and assistance with communication, hearing or vision aids, and speech and language therapy. Most children with CP grow up to function as independent adults. Those with more severe disabilities may need lifelong care and supervision.
Most children with CP live well into adulthood. Unfortunately there’s also bad news: due to the stress and strain on a person’s body as it functions with impairment from day-to-day life, CP can lead to premature aging, painful and degenerative arthritis as well as fatigue.
Adults with CP may also have limited strength and restricted patterns of movement, which puts them at risk for overuse syndromes and nerve entrapments. Some may develop scoliosis after puberty or experience musculoskeletal pain that can be acute or chronic on their lower back and both lower limbs.
The reality is that dealing with the condition can be a life-long endeavor, and we’re here to help make that the best outcome possible.
The first step is to see your doctor. Get the right diagnosis, and understand exactly what type of Cerebral Palsy they have. After that, it’s time to get in touch with a Physiotherapist:
This combination of experience will lead to the best outcomes for your child, and will help get your and your child’s life on a good track.