Cerebral Palsy - Case study - preventive care and cure

 Bob is now 25 years old. From birth, CP affected the muscles of the right side of his body. At several months of age, he was evaluated at a children's hospital and seemed to be developing normally except for his right-sided weakness. He learned slowly, however, and his parents were guided by physicians, physical therapists, and other specialists on what to expect, how to help him develop, and how to prevent muscle deformities through daily exercises. He went to a school for the handicapped and received intensive help in speech and in feeding and clothing him.

He was found, in evaluations by a psychologist and vocational counselor, to have some aptitude for mathematics and was enrolled in an accounting course. It took him longer than average to complete his training, but he did become an accountant, now holds a job, and goes to school at night with the hope of becoming a certified public accountant. 

Families of children with Cerebral Palsy are under great strain. Parents unconsciously may feel guilty about the birth of a child with CP. This can be a tremendous emotional burden, and help from a doctor, social worker, psychologist, or psychiatrist can do much to alleviate it. Cerebral palsy never resulted from bad thoughts, quarrels, lack of willingness to have a child, or even attempted abortion.

A family may hinder, rather than help, development of a child with CP through overprotection. Like other children, the CP child must learn through experience. Encouraging a Cerebral Palsy child to do things, rather than doing everything for him, will get him over many hurdles and help him to achieve a certain degree of self-confidence. For example, climbing stairs may seem well-nigh impossible at first to some CP children and their families. 

Yet if the child is not allowed to try and try again until he learns to manage stair climbing, he will be at a disadvantage. Setting realistic goals for a youngster with CP is important for his mental development and eventual ability to care for him.

A realistic but optimistic view about what can be done is most helpful. It is best when goals are set collaboratively by professionals, family, and the child him- self. An optimistic view is justified. The outlook for the person with CP is much brighter than it has ever been, and further gains seem most likely.

Cerebral Palsy-prenatal and obstetrical care - premature birth-bstetrical and anesthetic care

Good prenatal and obstetrical care can greatly decrease the risk of prematurity. No one has yet clearly defined exactly how much of an effect good nutrition may have in preventing birth defects. There is little doubt that extreme malnutrition in the mother can have serious consequences for her child. There are more subtle forms of malnutrition-involving deficiency of a vitamin or a mineral-which may predispose to the birth of a handicapped child. Most obstetricians today stress the importance of good diet for the mother and instruct their patients in sound eating habits.

Diseases present in a pregnant woman can significantly influence the health of her child. They can, and should, be detected and treated even before a woman becomes pregnant. Failing that, their early detection and treatment during pregnancy can be helpful in avoiding handicaps for the child. By getting a chance to know a patient long before delivery, throughout her pregnancy, an obstetrician can anticipate and be prepared for any problems that may arise at the time of birth. 

Good obstetrical and anesthetic care during labor and delivery are important in preventing brain damage. Improper use of forceps and techniques to hasten labor and delivery can cause brain damage in the infant. General anesthesia, narcotics, sedatives, and obstetrical complications have some potential for depressing the breathing center of the newborn, with the risk that insufficient oxygen may reach the brain, resulting in damage there. 

Many obstetricians prefer to have an anesthesiologist present at delivery to administer the anesthetic for the mother and to evaluate and treat any respiratory difficulties that may arise in the infant. Similarly, pediatric care during the first months of life helps in primary prevention, particularly in the area of prompt detection and treatment of an infection such as meningitis, which is a common cause of brain damage in the early period after birth.

Unfortunately, in about 40 percent of cases it is not possible to detect or prevent causes of brain damage. For example, some errors of metabolism- either hereditary or arising spontaneously-are difficult to detect immediately at birth and treat adequately. Radiation is probably a somewhat exaggerated hazard. 

Nevertheless, every physician will attempt to keep radiation exposure to a minimum during pregnancy, because of harmful effects demonstrated in animal studies and because the effects in humans of x-rays, except in very large doses, are still not clearly established. 

Occasionally,x-ray study may be required to detect disease; at such times, there should be no hesitancy about its use. Secondary preventive measures are most effective when applied early. 

Early detection and proper evaluation of CP may require study by a neurologist and other specialists who are most often readily available at a children's hospital.

The aim of secondary prevention is to keep emotional difficulties from arising as a result of handicap and to train the CP patient and his or her family to utilize to the fullest their abilities to overcome physical and personality problems. A child with CP needs individual evaluation and a program of therapy most appropriate for him.

The program-to prevent loss of the child's potential for maturation and independence-may include medicines, various forms of counseling, physical therapy, and special training. There are medicines to help control the seizures which may afflict some of those with CP Other medications help minimize uncontrolled movements; still others aid learning ability and may help bring about a more positive attitude toward life and work.

Antibiotics are available as needed to help combat infections to which defective body systems are prone. Vocational counselors, social workers, and psychologists are just a few of the professional people whose special training enables them to assess the mental and physical assets of a child with CP and advise the best way to maximize these assets. It is often difficult to gain insight into the real capabilities of children with CPbecause of difficulties of communication resulting from speech and hearing impairment, depression, and withdrawal. Help in overcoming such difficulties is increasingly available now at centers dealing with the problems of CPo Physicaltherapists can help to correct deformities and to educate muscles to perform such important functions as walking, eating, and dressing.

Speech therapists, occupational therapists, and sympathetic teachers are other members of the team. In many areas now, special schools and special classes are available to train children with CPo Employment is an important part of every adult's life. Training for jobs- if necessary, for jobs under special, favorable conditions such as those to be found in sheltered workshops-is helping many with CP. Today, it is being recognized increasingly that the handicapped are often punctual, dependable, even outstanding workers.

 Employment often gives new meaning to the life of a CP victim because it establishes goals and makes the patient feel more independent and self- sufficient, important factors in the maturation of anyone's personality. Those CP victims who are mentally retarded often function well in employment where there are simple repetitive tasks to perform. They may derive tremendous satisfaction from jobs that nobody else is willing to per- form. It is surprising what the handicapped can achieve with training and encouragement. Ambition to achieve is an important attitude to be inculcated in a child withCP.

CEREBRAL PALSY - symptoms-treatment-medicines- signs, preventive care and cure

CEREBRAL PALSY

Cerebral palsy (CP) ranks as the most common cause of crippling of children in the United States. Almost one quarter of a million persons are afflicted. Too often people associate the abnormalities of movement and muscular control, which are the outstanding features of CP, with mental retardation and lifelong dependency on others. But the majority of CP victims is not mentally retarded and is capable, with special training, of becoming self-sufficient. Cerebral palsy is not an inherited disorder, or a contagious one, or a progressive one.

 Cerebral refers to the brain, and palsy to muscularweakness. So the name implies that it is a condition of muscular weakness or disability resulting from brain dam- age. The brain damage may occur before, during, or shortly after birth for many different reasons. (Brain damage in adulthood leading to disability is not considered CP.)

The nature and extent of disability will, of course, depend on the amount of brain damage. There are three ways in which the muscles may be affected: in the spastic variety of CP, muscles are stiff and tight, and weakness is profound; in the athetoid form, muscles contract without apparent reason, leading to uncontrolled grimaces and limb movements; in the ataxic form, talking and other movements are poorly coordinated. 

Along with these difficulties there may be hearing and sight impairment, speech disturbance, poor ability to learn, convulsions, emotional problems, and sometimes, unfortunately, mental retardation. Despite these handicaps, however, modern training methods offer more hope than ever before for even the most severe form of CPO Primary prevention of CP begins with good antenatal (prenatal) care.

German measles and other infections early in pregnancy may damage the brain of the developing child. Vaccination against German measles- before a girl reaches childbearing age or, in the case of an adult woman, when there is little likelihood of immediate pregnancy-is an important preventive measure. Other infections during pregnancy are often hard to detect, and the physician cannot al- ways predict whether or not they will harm the baby. 

The preventive approach is limited to recommending adequate protection against diseases for which vaccines are available and avoiding unnecessary exposure to others. Another known, and now preventable, cause of potential brain damage to children is Rh incompatibility.

Detecting this blood problem is now part of routine antenatalcare. The use of special techniques-such as intra- uterine blood transfusion for the fetus and delivery by cesarean section if necessary before severe damage occurs can prevent brain and other organ harm. A recent development promises to eliminate the hazard of Rh incompatibility. 

It is well known that the first child does not suffer harmful effects from Rh incompatibility; the succeeding children are at risk. This is because it takes time for the mother to become sensitized to the Rh factor.

A new medication, called Rhogram, when given to the mother within 48 hours after birth of the first child, prevents development of sensitization to the Rh factor and eliminates risk for succeeding children. To prevent sensitization from ever developing, the medication must be given after each subsequent pregnancy. 

Premature infants are more likely than others to be afflicted with CPo Among factors in the mother which predispose toward premature birth are cigarette smoking, infection of the kidney and bladder, and a history of having borne previous premature infants.