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Managing children with cerebral palsy

Written by Dr. Rotimi Adesanya - Nigeria. 

Master O.K is an 11 months old infant who was brought to my clinic because the mother noticed the child could not crawl or make attempts to stand.
The infant's history was taken, the examination was done and the infant's condition was said to be fair.

She was asked to bring her husband the following day for full explanation of the child's condition.
The following day, I explained to the parents that the child was likely to have suffered some brain damage during child birth, a condition called Birth Asphyxia.

The Infant now has Cerebral Palsy. This means this child developmental milestones will be delayed, that is, she will not be able to walk, talk, stand and probably hear on time.
Cerebral palsy (CP) is not a disease; it is not hereditary or contagious, it is a disability.
The disorder can be managed with proper therapies and medication, with the use of assistive technology that can maximise independence, reduce barriers and enhance quality life.
Parents of children with this special condition need adequate orientation and education so that they would know the health status of their children.

The first thing a family whose child was diagnosed with CP needs is counselling, information and education. Without this, the family will be left groping in the dark.
Management of CP is not only intensive, it is also expensive. CP is said to be one of the most expensive congenital disorder to manage. It is difficult for a family to keep up.
I have approached Dr. Gbemisola Boyede, a consultant neurodevelopmental paediatrician at the department of Paediatrics, Lagos University Teaching Hospital, to give us a specialist overview to the subject.

Here is Dr Gbemisola's overview: Cerebral palsy often abbreviated as CP is a group of disorders that affect a person's ability to move and maintain balance and posture.
"Cerebral" means having to do with the brain. "Palsy" means weakness or problems with using the muscles.

The problem in CP is actually caused by abnormal brain development or damage to the developing brain (early childhood) that affects a person's ability to control his or her muscles. October 7 is World Cerebral Palsy Day. This is a day set aside to create awareness and support the 17million people worldwide who live with cerebral palsy.
CP is the most common motor disability in childhood. The prevalence of CP is 2-3 per 1000 live births. It is especially much more common (100 per 1000 live births) in children who were born extremely premature.

Although the abnormality in the brain remains unchanged (non-progressive), the clinical picture of CP may change or be modified with age.
All people with CP have problems with movement and posture. However, these are not the only problems with CP.
Many also have other conditions such as intellectual disability; seizures; problems with vision, hearing, or speech; changes in the spine (such as scoliosis); or joint problems (such as contractures).

The associated problems may even be more limiting to lifestyles than the posture or movement problems which primarily defined CP.
The symptoms of CP vary from person to person. A person with severe CP might need to use special equipment to be able to walk, or might not be able to walk at all and might need lifelong care.
A person with mild CP, on the other hand, might walk a little awkwardly, but might not need any special help. CP does not get worse over time, though the exact symptoms can change over a person's lifetime.

Most of the time the cause of a child's CP is not known, because it is difficult to tell exactly when the damage to the brain happened.
However, common causes of CP in our own environment are delayed cry at birth (perinatal asphyxia) due to anything going wrong before and during delivery, prematurity (especially below 32 weeks and weight less than 1.5kg)

Other causes are severe neonatal jaundice (often requiring exchanged blood transfusions), infections in the brain (meningitis), bleeding in the brain, severe convulsions after birth and head injuries in very young children.

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