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.
