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Encyclopedia > Cerebral palsy
Cerebral palsy
Classification & external resources
The motor tract.
ICD-10 G80.
ICD-9 343
OMIM 603513 605388
DiseasesDB 2232
eMedicine neuro/533  pmr/24
MeSH D002547

Cerebral palsy (CP) is an umbrella term encompassing a group of non-progressive,[1] non-contagious conditions that cause physical disability in human development. Image File history File links Question_book-3. ... Image File history File links No higher resolution available. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // G00-G99 - Diseases of the nervous system (G00-G09) Inflammatory diseases of the central nervous system (G00) Bacterial meningitis, not elsewhere classified (G01) Meningitis in bacterial diseases classified elsewhere (G02) Meningitis in other infectious and parasitic diseases classified elsewhere (G03) Meningitis due to other and unspecified causes (G04) Encephalitis, myelitis... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... An umbrella term is a word that provides a superset or grouping of related concepts, also called a hypernym. ... In medicine, infectious disease or communicable disease is disease caused by a biological agent (e. ... The term disability, as it is applied to humans, refers to any condition that impedes the completion of daily tasks using traditional methods. ... Human development may refer to: Human development (biology) Human development (psychology) see Developmental psychology Occasionally, it may refer to both, but because each of these is already an immense area, few if any contemporary academic discussions attempt to tackle both with any completeness. ...


Cerebral refers to the affected area of the brain; the cerebrum (however the centers have not been perfectly localized and the disease most likely involves connections between the cortex and other parts of the brain such as the cerebellum) and palsy refers to disorder of movement. CP is caused by damage to the motor control centers of the young developing brain and can occur during pregnancy (about 75 percent), during childbirth (about 5 percent) or after birth (about 15 percent) up to about age three.[2][3] The telencephalon (IPA: ) is the name for the forebrain, a large region within the brain to which many functions are attributed. ... The cerebellum (Latin: little brain) is a region of the brain that plays an important role in the integration of sensory perception and motor control. ... Palsy is a medical term derived from the word paralysis that is defined as paralysis of a body part often accompanied by loss of feeling and uncontrolled body movements such as shaking. ... This article is about human pregnancy in biological females. ... Parturition redirects here. ...



It is a non-progressive disorder, meaning the brain damage does not worsen, but secondary orthopedic difficulties are common. There is no known cure for CP. Medical intervention is limited to the treatment and prevention of complications possible from CP's consequences.


Onset of arthritis and osteoporosis can occur much sooner in adults with CP. Further research is needed on adults with CP, as the current literature body is highly focused on the pediatric patient. CP's resultant motor disorder(s) are sometimes, though not always, accompanied by "disturbances of sensation, cognition, communication, perception, and/or behavior, and/or by a seizure disorder".[4][5] This article is about epileptic seizures. ...


CP is the second-most expensive developmental disability to manage over the course of a person's lifetime (second to mental disabilities), with an average lifetime cost per person of USD$921,000 (in 2003 dollars).[6] The incidence in the six countries surveyed is approximately an average of 2.12–2.45 per 1000 live births;[7] there has been a slight increase in recent years. Although improvements in neonatal nursing help reduce the number of babies who develop cerebral palsy, they also mean that babies with very low birth weights survive, and these babies are more likely to have cerebral palsy.[8][9] Developmental disability is a term used to describe life-long disabilities attributable to mental and/or physical or combination of mental and physical impairments, manifested prior to age twenty-two. ...

Contents

Classification

CP is divided into four major classifications to describe the different movement impairments. These classifications reflect the area of brain damaged. The four major classifications are:

  • Spastic
  • Athetoid/Dyskinetic
  • Ataxic
  • Mixed

In 30 percent of all cases of CP, the spastic form is found along with one of the other types. There are a number of other, less prevalent types of CP, but these are the most common.


A general classification is as follows:


Spastic

Spastic (ICD-10 G80.0-G80.1) cerebral palsy is by far the most common type, occurring in 70% to 80% of all cases. People with this type are hypertonic and have a neuromuscular condition stemming from damage to the corticospinal tract, motor cortex, or pyramidal tract that affects the nervous system's ability to receive gamma amino butyric acid in the area(s) affected by the spasticity. Spastic CP is further classified by topography dependent on the region of the body affected; these include: The word spastic is used differently depending on location, which has led to some controversy and misunderstanding. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... An increase in stiffness, tension, and spasticity of a muscle. ... Main Entry: neu·ro·mus·cu·lar Pronunciation: nur-O-m&s-ky&-l&r, nyur- of or relating to nerves and muscles; especially : jointly involving nervous and muscular elements <a neuromuscular junction> ... The corticospinal or pyramidal tract is a massive collection of axons that travel between the cerebral cortex of the brain and the spinal cord. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... The corticospinal or pyramidal tract is a massive collection of axons that travel between the cerebral cortex of the brain, and the spinal cord. ... Gamma-aminobutyric acid (usually abbreviated to GABA) is an inhibitory neurotransmitter found in the nervous systems of widely divergent species. ... For discussion of land surfaces themselves, see Terrain. ...

  • spastic hemiplegia (one side being affected). Generally, injury to the left side of the brain will cause a right sided deficit, and vice versa.
  • spastic diplegia ( the lower extremities are affected more than the upper extremities). Most people with spastic diplegia do eventually walk. The gait of a person with spastic diplegia is typically characterised by a crouched gait. Toe walking and flexed knees are common. Hip problems, dislocations, and side effects like strabismus (crossed eyes) are common. Strabismus affects three quarters of people with spastic diplegia. This is due to weakness of the muscles that control eye movement. In addition, these individuals are often nearsighted. In many cases the IQ of a person with spastic diplegia is unaffected by the condition.
  • spastic quadriplegia (Whole body affected; all four limbs affected equally). Some children with quadriplegia also have hemiparetic tremors; an uncontrollable shaking that affects the limbs on one side of the body and impairs normal movement. A common problem for children with quadriplegia is fluid buildup. Diuretics and steroids are medications administered to decrease any buildup of fluid in the spine that is caused by leakage from dead cells. Hardened feces in a quadriplegia patient are important to monitor because it can cause high blood pressure. Autonomic dysreflexia can be caused by hardened feces, urinary infections, and other problems, resulting in the overreaction of the nervous system and can result in high blood pressure, heart attacks, and strokes. Blockage of tubes inserted into the body to drain or enter fluids also needs to be monitored to prevent autonomic dysreflexia in quadriplegia. The proper functioning of the digestive system needs to be monitored as well.

Occasionally, terms such as monoplegia, paraplegia, triplegia, and pentaplegia may also be used to refer to specific manifestations of the spasticity. Hemiplegia is a condition where there is paralysis in one vertical half of a patients body. ... Spastic diplegia is a neuromuscular type of cerebral palsy involving hypertonia and spasticity in the muscles of the lower extremities, usually those of the legs, hips and pelvis. ... Strabismus (from Greek: στραβισμός strabismos, from στραβίζειν strabizein to squint, from στραβός strabos squinting, squint-eyed[1]) is a condition in which the eyes are not properly aligned with each other. ... Quadriplegia, also known as tetraplegia, is a symptom in which a human experiences paralysis affecting all four limbs, although not necessarily total paralysis or loss of function. ... In medicine, a Monoplegia is a paralysis of a single limb. ... Paraplegia is an impairment in motor and/or sensory function of the lower extremities. ... Triplegia is a medical condition is which the patient has paralysis of three limbs. ...


Ataxic

Ataxia (ICD-10 G80.4) type symptoms can be caused by damage to the cerebellum. Forms of ataxia are less common types of Cerebral Palsy, occurring in at most 10% of all cases. Some of these individuals have hypotonia and tremors. Motor skills like writing, typing, or using scissors might be difficult, as well as problems with balance, especially while walking. It is common for individuals to have difficulty with visual and/or auditory processing of objects. For other uses, see Ataxia (disambiguation). ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The cerebellum (Latin: little brain) is a region of the brain that plays an important role in the integration of sensory perception and motor control. ... Hypotonia is a condition of abnormally low muscle tone (the amount of tension or resistance to movement in a muscle), often involving reduced muscle strength. ... For the film see Tremors (film). ...


Athetoid/dyskinetic

Athetoid or dyskinetic (ICD-10 G80.3) is mixed muscle tone - sometimes hypertonia and sometimes hypotonia (Hypotonia will usually occur before 1 year old; the muscle tone will be increased with age and progress to Hypertonia) . People with athetoid CP have trouble holding themselves in an upright, steady position for sitting or walking, and often show involuntary motions. For some people with athetoid CP, it takes a lot of work and concentration to get their hand to a certain spot (like scratching their nose or reaching for a cup). Because of their mixed tone and trouble keeping a position, they may not be able to hold onto objects (such as a toothbrush or pencil). About one-fourth of all people with CP have athetoid CP. The damage occurs to the extrapyramidal motor system and/or pyramidal tract and to the basal ganglia. It occurs in 40% of all cases. Athetosis is a continuous stream of slow, sinuous, writhing movements, typically of the hands and feet. ... Dyskinesia is a medical condition meaning the person afflicted makes bad or abnormal movements. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... Bodybuilder showing highly developed muscle tone. ... An increase in stiffness, tension, and spasticity of a muscle. ... Hypotonia is a condition of abnormally low muscle tone (the amount of tension or resistance to movement in a muscle), often involving reduced muscle strength. ... In human anatomy, the extrapyramidal system is a neural network located in the brain that is part of the motor system involved in the coordination of movement. ... The corticospinal or pyramidal tract is a massive collection of axons that travel between the cerebral cortex of the brain, and the spinal cord. ... The basal ganglia (or basal nuclei) are a group of nuclei in the brain interconnected with the cerebral cortex, thalamus and brainstem. ...


Incidence and prevalence

In the industrialised world, the incidence of cerebral palsy is about 2 per 1000 live births.[10] The incidence is higher in males than in females; the Surveillance of Cerebral Palsy in Europe (SCPE) reports a M:F ratio of 1.33:1.[11] Variances in reported rates of incidence across different geographical areas in industrialised countries are thought to be caused primarily by discrepancies in the criteria used for inclusion and exclusion. When such discrepancies are taken into account in comparing two or more registers of patients with cerebral palsy (for example, the extent to which children with mild cerebral palsy are included), the incidence rates converge toward the average rate of 2:1000. Incidence is a measure of the risk of developing some new condition within a specified period of time. ...


In the United States, approximately 10,000 infants and babies are diagnosed with CP each year, and 1200-1500 are diagnosed at preschool age.[12]


Overall, advances in care of pregnant mothers and their babies has not resulted in a noticeable decrease in CP. This is generally attributed to medical advances in areas related to the care of premature babies (which results in a greater survival rate). Only the introduction of quality medical care to locations with less-than-adequate medical care has shown any decreases. The incidence of CP increases with premature or very low-weight babies regardless of the quality of care.[citation needed]


Prevalence of cerebral palsy is best calculated around the school entry age of about six years, the prevalence in the U.S. is estimated to be 2.3 out of 1000 children[13] In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ...


The SCPE reported the following incidence of comorbidities in children with CP (the data are from 1980-1990 and included over 4,500 children over age 4 whose CP was acquired during the prenatal or neonatal period):

  • Mental retardation (IQ < 50): 31%
  • Active seizures: 21%
  • Mental retardation (IQ < 50) and not walking: 20%
  • Blindness: 11%[14]

The SCPE noted that the incidence of comorbidities is difficult to measure accurately, particularly across centers. For example, the actual rate of mental retardation may be difficult to determine, as the physical and communicational limitations of people with CP would likely lower their scores on an IQ test if they were not given a correctly modified version.


Apgar scores have sometimes been used as one factor to predict whether or not an individual will develop CP.[15] The Apgar score was devised in 1952 by Virginia Apgar as a simple and repeatable method to quickly and summarily assess the health of newborn children immediately after childbirth. ...


Signs and symptoms

All types of CP are characterised by abnormal muscle tone, posture (i.e. slouching over while sitting), reflexes, or motor development and coordination. There can be joint and bone deformities and contractures (permanently fixed, tight muscles and joints). The classical symptoms are spasticity, spasms, other involuntary movements (e.g. facial gestures), unsteady gait, problems with balance, and/or soft tissue findings consisting largely of decreased muscle mass. Scissor walking (where the knees come in and cross) and toe walking are common among people with CP who are able to walk, but taken on the whole, CP symptomatology is very diverse. The effects of cerebral palsy fall on a continuum of motor dysfunction which may range from virtually unnoticeable to"clumsy" and awkward movements on one end of the spectrum to such severe impairments that coordinated movements are almost impossible on the other end of the spectrum.


Babies born with severe CP often have an irregular posture; their bodies may be either very floppy or very stiff. Birth defects, such as spinal curvature, a small jawbone, or a small head sometimes occur along with CP. Symptoms may appear, change, or become more severe as a child gets older. Some babies born with CP do not show obvious signs right away.


Secondary conditions can include seizures, epilepsy, speech or communication disorders, eating problems, sensory impairments, mental retardation, learning disabilities, and/or behavioral disorders. This article is about the medical condition. ... Mental retardation is a term for a pattern of persistently slow learning of basic motor and language skills (milestones) during childhood, and a significantly below-normal global intellectual capacity as an adult. ... In broad terms, the phrase learning disability covers any of a range of conditions that affect a persons ability to learn new information. ...


History

CP, then known as "Cerebral Paralysis", was first identified by English surgeon William Little in 1860. Little raised the possibility of asphyxia during birth as a chief cause of the disorder. It was not until 1897 that Sigmund Freud, then a neurologist, suggested that a difficult birth was not the cause but rather only a symptom of other effects on fetal development.[16] Research conducted during the 1980s by the National Institute of Neurological Disorders and Stroke (NINDS) suggested that only a small number of cases of CP are caused by lack of oxygen during birth.[17] For other uses, see England (disambiguation). ... William Little was an English surgeon who, in the 1860s, identified cerebral palsy in children. ... 1860 is the leap year starting on Sunday. ... Suffocation redirects here, for the band, see Suffocation (band). ... 1897 (MDCCCXCVII) was a common year starting on Friday (see link for calendar). ... Sigmund Freud (IPA: ), born Sigismund Schlomo Freud (May 6, 1856 – September 23, 1939), was an Austrian neurologist and psychiatrist who founded the psychoanalytic school of psychology. ...


Causes

Despite years of debate, the exact cause of CP remains unclear.


Some contributing causes of CP are asphyxia, hypoxia of the brain, birth trauma, premature birth, and certain infections in the mother during and before birth such as strep infections, central nervous system infections, trauma, consecutive hematomas, placenta abruptio and multiple birth. Suffocation redirects here, for the band, see Suffocation (band). ... Hypoxia is a pathological condition in which the body as a whole (generalised hypoxia) or region of the body (tissue hypoxia) is deprived of adequate oxygen supply. ... In most systems of human pregnancy, the condition, premature birth (also known as a preterm birth), occurs when the baby is born within sooner than 36 weeks of completed gestation. ... An infection is the detrimental colonization of a host organism by a foreign species. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... Hematoma on thigh, 6 days after a fall down stairs, 150ml of blood drained a few days later A hematoma, or haematoma, is a collection of blood, generally the result of hemorrhage, or, more specifically, internal bleeding. ... Placental abruption (Also known as abruptio placentae) in biology, is the separation of the placental lining from the uterus of a female. ... Identical triplet brothers at graduation. ...


After years of epidemiological study at Liverpool University, there is increasing support for the hypothesis that many cases of cerebral palsy, and other defects, are caused by the death, in very early pregnancy, of an identical twin in cases where they share the same chorion [18]. Not all identical twins share the same blood supply, but if they do, and one dies, the suggestion is that this damages the development of the surviving embryo. It is common knowledge amongst midwifery that a tiny dead foetus (fetus papyraceus) can sometimes be found attached to a placenta following birth. In the past, this has not been considered important and knowledge of the so called ‘vanishing twin’ has been kept quiet so as to avoid triggering feelings of loss, grief or guilt in mothers. The University of Liverpool is a university in the city of Liverpool in the United Kingdom. ...


Between 40% and 50% of all children who develop cerebral palsy were born prematurely. Premature infants are at higher risk in part because their organs are not yet fully developed, increasing the risk of asphyxia and other injury to the brain, which in turn increases the incidence of CP. Periventricular leukomalacia is an important cause of CP. About 10% of cases with CP are caused by malformation of the CNS. Periventricular leukomalacia (PVL) is characterized by the death of the white matter of the brain due to softening of the brain tissue. ...


Recent research has demonstrated that intrapartum asphyxia is not the most important cause, probably accounting for no more than 10 percent of all cases; rather, infections in the mother, even infections that are not easily detected, may triple the risk of the child developing the disorder, mainly as the result of the toxicity to the fetal brain of cytokines that are produced as part of the inflammatory response.[19] Low birthweight is a risk factor for CP--and premature infants usually have low birth weights, less than 2.0 kg, but full-term infants can also have low birth weights. Multiple-birth infants are also more likely than single-birth infants to be born early or with a low birth weight. Cytokines are a category of less-widely-known signalling proteins and glycoproteins that, like hormones and neurotransmitters, are used extensively in cellular communication. ...


After birth, other causes include toxins, severe jaundice, lead poisoning, physical brain injury, shaken baby syndrome, incidents involving hypoxia to the brain (such as near drowning), and encephalitis or meningitis. The three most common causes of asphyxia in the young child are: choking on foreign objects such as toys and pieces of food; poisoning; and near drowning. Look up jaundice in Wiktionary, the free dictionary. ... Lead poisoning is a medical condition, also known as saturnism, plumbism or painters colic, caused by increased blood lead levels. ... Shaken baby syndrome (SBS) is a form of child abuse affecting between 1,200 and 1,600 children every year in the USA.[1] SBS encompasses a variety of outcomes that are attributed to shaking an infant or small child. ... Drowning is death due to asphyxia caused by immersion in fluid, usually water. ... Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ...


Some structural brain anomalies such as lissencephaly cause symptoms of CP, although whether that could be considered CP is a matter of opinion (some people say CP must be due to brain damage, whereas these people never had a normal brain). Often this goes along with rare chromosome disorders and CP is not genetic or hereditary. Cephalic disorders are congenital conditions that stem from damage to, or abnormal development of, the budding nervous system. ... A chromosome abnormality reflects an abnormality of chromosome number or structure. ...


Presentation: bones

In order for bones to attain their normal shape and size, they require the stresses from normal musculature. Osseous findings will therefore mirror the specific muscular deficits in a given person with CP. The shafts of the bones are often thin (gracile). When compared to these thin shafts (diaphyses) the metaphyses often appear quite enlarged (ballooning). With lack of use, articular cartilage may atrophy, leading to narrowed joint spaces. Depending on the degree of spasticity, a person with CP may exhibit a variety of angular joint deformities. Because vertebral bodies need vertical gravitational loading forces to develop properly, spasticity and an abnormal gait can hinder proper and/or full bone and skeletal development. People with CP tend to be shorter in height than the average person because their bones are not allowed to grow to their full potential. Sometimes bones grow at different lengths, so the person may have one leg longer than the other


Prognosis

CP is not a progressive disorder (meaning the actual brain damage does not worsen), but the symptoms can become worse over time due to 'wear and tear.' A person with the disorder may improve somewhat during childhood if he or she receives extensive care from specialists, but once bones and musculature become more established, orthopedic surgery may be required for fundamental improvement. People who have CP tend to develop arthritis at a younger age than normal because of the pressure placed on joints by excessively toned and stiff muscles.


The full intellectual potential of a child born with CP will often not be known until the child starts school. People with CP are more likely to have some type of learning disability, but this is unrelated to a person's intellect or IQ level. Intellectual level among people with CP varies from genius to mentally retarded, as it does in the general population, and experts have stated that it is important to not underestimate CP sufferer's capabilities and to give them every opportunity to learn.[citation needed] This article is about the use of the term in the United States and Canada. ...


The ability to live independently with CP also varies widely depending on the severity of the disability. Some individuals with CP will require personal assistant services for all activities of daily living. Others can live semi-independently, needing support only for certain activities. Still others can live in complete independence. The need for personal assistance often changes with increasing age and the associated functional decline. However, in most cases persons with CP can expect to have a normal life expectancy; survival has been shown to be associated with the ability to ambulate, roll and self-feed.[citation needed] As the condition does not directly affect reproductive function, some persons with CP have children and parent successfully.


According to OMIM, only 2% of cases of CP are inherited (with glutamate decarboxylate-1 as one known enzyme involved.)[20] There is no evidence of an increased chance of a person with CP having a child with CP. The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... Glutamate decarboxylase (GAD) is an enzyme that catalyzes the decarboxylation of glutamate to GABA and CO2. ...


Treatment

There is no cure for CP, but various forms of therapy can help a person with the disorder to function and live more effectively. In general, the earlier treatment begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them. Treatment may include one or more of the following: physical therapy; occupational therapy; speech therapy; drugs to control seizures, alleviate pain, or relax muscle spasms (e.g. benzodiazepienes, baclofen and intrathecal phenol/baclofen); hyperbaric oxygen; the use of Botox to relax contracting muscles; surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; wheelchairs and rolling walkers; and communication aids such as computers with attached voice synthesizers. For instance, the use of a standing frame can help reduce spasticity and improve range of motion for people with CP who use wheelchairs. Nevertheless, there is only some benefit from therapy. Treatment is usually symptomatic and focuses on helping the person to develop as many motor skills as possible or to learn how to compensate for the lack of them. Non-speaking people with CP are often successful availing themselves of augmentative and alternative communication systems such as Blissymbols. Botulin toxin or botox is the toxic compound produced by the bacterium Clostridium botulinum. ... A standing frame (also known as a stand, stander, standing technology, standing aid, standing device, standing box, tilt table) is assistive technology used by a child or adult who uses a wheelchair for mobility. ... Range of motion or (ROM), as used in the medical and weightlifting communities, is the achievable distance between the flexed position and the extended position of a particular joint or muscle group, or more precisely, the measurement of that distance. ... Augmentative and alternative communication (AAC) refers to an area of research, clinical, and educational practice. ... Blissymbolics or Blissymbols were conceived of as an ideographic writing system consisting of several hundred basic symbols, each representing a concept, which can be composed together to generate new symbols that represent new concepts. ...


Physical therapy (PT) programs are designed to encourage the patient to build a strength base for improved gait and volitional movement, together with stretching programs to limit contractures. Many experts believe that life-long physical therapy is crucial to maintain muscle tone, bone structure, and prevent dislocation of the joints. Physical therapy (or physiotherapy[1]) is the provision of services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. ...


Occupational therapy helps adults and children maximise their function, adapt to their limitations and live as independently as possible.[21][22] Occupational therapy refers to the use of meaningful occupation to assist people who have difficulty in achieving healthy and balanced life; and to enable an inclusive society so that all people can participate to their potential in daily occupations of life. ...


Orthotic devices such as ankle-foot orthoses (AFOs) are often prescribed to minimise gait irregularities. AFOs have been found to improve several measures of ambulation, including reducing energy expenditure[23] and increasing speed and stride length.[24] Orthotics is the field concerned with the application and manufacture of orthoses, devices which support or correct human function. ... Ankle-foot orthosis (abbreviated: AFO) is a brace, usually plastic, worn on the lower leg and foot to support the ankle, hold the foot and ankle in the correct position, and correct foot drop. ...


Speech therapy helps control the muscles of the mouth and jaw, and helps improve communication. Just as CP can affect the way a person moves their arms and legs, it can also affect the way they move their mouth, face and head. This can make it hard for the person to breathe; talk clearly; and bite, chew and swallow food. Speech therapy often starts before a child begins school and continues throughout the school years.[25] It has been suggested that Speech-Language Pathology, Speech pathology, Phoniatrics be merged into this article or section. ...


Hyperbaric oxygen therapy Recent studies have demonstrated a dramatic improvement in CP symptomology when hyperbaric oxygen therapy is used as a treatment. Researchers in Brazil found a significant alleviation in symptomology and other characteristics in a study involving 218 cerebral palsy patients. Significant enhancements were documented showing improved vision, hearing and speech as well as a reduction of spasticity by 50%, which occurred in 94% of study patients.[26] This article does not cite any references or sources. ...


Nutritional counseling may help when dietary needs are not met because of problems with eating certain foods.


Both massage therapy[27] and hatha yoga[citation needed] are designed to help relax tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises are sometimes used to try to prevent lung infections. More research is needed to determine the health benefits of these therapies for people with CP. In alternative medicine, body work or massage therapy refers to any treatment which involves some form of touching or physical manipulation. ... Hatha yoga (Sanskrit हठयोग), also known as Hatha Vidya (हठविद्या), is a particular system of Yoga introduced by Yogi Swatmarama, a sage of 15th century India, and compiler of the Hatha Yoga Pradipika. ...


Surgery for people with CP usually involves one or a combination of:

  • Loosening tight muscles and releasing fixed joints, most often performed on the hips, knees, hamstrings, and ankles. In rare cases, this surgery may be used for people with stiffness of their elbows, wrists, hands, and fingers.
  • Straightening abnormal twists of the leg bones, i.e. femur (termed femoral anteversion or antetorsion) and tibia (tibial torsion). This is a secondary complication caused by the spastic muscles generating abnormal forces on the bones, and often results in intoeing (pigeon-toed gait). The surgery is called derotation osteotomy, in which the bone is broken (cut) and then set in the correct alignment.[28]
  • Cutting nerves on the limbs most affected by movements and spasms. This procedure, called a selective dorsal rhizotomy, "rhizo" meaning root and "tomy" meaning "a cutting of" from the Greek suffix 'tomia' reduces spasms and allows more flexibility and control of the affected limbs and joints.[29]
  • Botulinum Toxin A (Botox) injections into muscles that are either spastic or have contractures, the aim being to relieve the disability and pain produced by the inappropriately contracting muscle.[30]

Another way is that a new study has found that cooling the bodies and blood of high-risk full-term babies shortly after birth may significantly reduce disability or death.[31] Botulin toxin or botox is the toxic compound produced by the bacterium Clostridium botulinum. ...


Conductive education (CE) was developed in Hungary from 1945 based on the work of András Pető. It is a unified system of rehabilitation for people with neurological disorders including cerebral palsy, Parkinson's disease and multiple sclerosis, amongst other conditions. It is theorised to improve mobility, self-esteem, stamina and independence as well as daily living skills and social skills. The conductor is the professional who delivers CE in partnership with parents and children. Skills learned during CE should be applied to everyday life and can help to develop age-appropriate cognitive, social and emotional skills. It is available at specialised centres. Conductive education [1], or CE, is an educational system that has been specifically developed for children and adults who have motor disorders of neurological origin such as cerebral palsy. ... Professor András PetÅ‘ (born in Hungary in 1893) was a practitioner of physical rehabilitation whose work provided the foundation for conductive education. ...


Biofeedback is an alternative therapy in which people with CP learn how to control their affected muscles. Some people learn ways to reduce muscle tension with this technique. Biofeedback does not help everyone with CP. Biofeedback mechanism. ... Alternative medicine has been described as any of various systems of healing or treating disease (as chiropractic, homeopathy, or faith healing) not included in the traditional medical curricula taught in the United States and Britain.[1] Alternative medicine practices are often based in belief systems not derived from modern science. ...


Cultural aspects

Use of terms when referring to people with CP

Many people would rather be referred to as a person with a disability instead of handicapped. "Cerebral Palsy: A Guide for Care" at the University of Delaware offers the following guidelines:[32] The University of Delaware (UD) is the largest university in the U.S. state of Delaware. ...

Impairment is the correct term to use to define a deviation from normal, such as not being able to make a muscle move or not being able to control an unwanted movement. Disability is the term used to define a restriction in the ability to perform a normal activity of daily living which someone of the same age is able to perform. For example, a three year old child who is not able to walk has a disability because normal three year old can walk independently. Handicap is the term used to describe a child or adult who, because of the disability, is unable to achieve the normal role in society commensurate with his age and socio-cultural milieu. As an example, a sixteen-year- old who is unable to prepare his own meal or care for his own toileting or hygiene needs is handicapped. On the other hand, a sixteen-year- old who can walk only with the assistance of crutches but who attends a regular school and is fully independent in activities of daily living is disabled but not handicapped. All disabled people are impaired, and all handicapped people are disabled, but a person can be impaired and not necessarily be disabled, and a person can be disabled without being handicapped.

The term "spastic" describes the attribute of spasticity in types of spastic CP. In 1952 a UK charity called The Spastics Society was formed.[33] The term "spastics" was used by the charity as a term for people with CP. The word "spaz" has since been used extensively as a general insult to disabled people, which some see as extremely offensive. It is also frequently used to insult able-bodied people when they seem overly anxious or unskilled in sports. The charity changed its name to Scope in 1994.[33] In the United States the word spaz has the same usage as an insult, but is not generally associated with CP.[34] The word spastic is used differently depending on location, which has led to some controversy and misunderstanding. ... SCOPE is a UK based charity for disabled people in England and Wales. ...


Misconceptions

A common misconception about those born with Cerebral Palsy is that they are less intelligent than those born without it. Cerebral Palsy is defined as damage to the part of the brain that controls movement; areas of the brain that define a persons intelligence are not affected by CP.


Spastic Cerebral Palsy, the most common form of CP, causes the muscles to be tense, rigid and movements are slow and difficult. This can be misinterpreted as cognitive delay due to difficulty of communication. Individuals with cerebral palsy can have learning difficulties, but sometimes it is the sheer magnitude of problems caused by the underlying brain injury that prevents the individual from expressing what cognitive abilities they do possess.[35]


Public perception

Those with CP are sometimes stigmatized and shunned. This has lessened since the 1950s thanks to public education and to United Cerebral Palsy in the U.S. and similar organizations in other countries. Prior to that time the great majority were often sent to asylums or confined to attics. They were perceived to be the products of incest and partial smothering.[citation needed] Often parents kept their children away from them in the mistaken belief that the condition was the product of disease or poor sanitary habits.


Thomas Galton believed that there was a correlation between physical disability and aptitude, and this attitude remained prevalent as concerned CP until the 1970s. At this time, CP was an over diagnosed disorder, and a common misunderstanding then and now is that CP causes mental retardation. In fact, only CP individuals with brain damage in the hippocampus or the frontal cerebral cortex develop mental retardation. While learning difficulties and CP may occur, it is common for individuals with CP to lead normal lives.


Cultural references

  • (1991) In the book Gridlock (novel) the main character Geoffrey Peason has Spastic Cerebral Palsy.
  • (2000) The film King Gimp is a documentary on the life of Dan Keplinger who has CP.
  • (2002) The South Korean film Oasis follows the unconventional romance between two social outcasts, a marginalized ex-con and a young woman with CP.
  • (2004) The film Inside I'm Dancing focuses on a quadriplegic youth in Dublin who befriends someone with CP and acts as his translator.
  • (2005) In the Ricky Gervais and Stephen Merchant sitcom "Extras", a series one episode featured main protagonist Andy Millman ridiculing a female extra with CP (by mistaking her as a drunk); after the character (played by Francesca Martinez) corrects him, he empathizes with her.
  • (2008) The TV drama Breaking Bad features the son of the main character as having CP. The actor, RJ Mitte actually has a mild case of CP, and Breaking Bad is his breakout role.

William Horwood is an English novelist who has written sequels to The Wind in the Willows by Kenneth Grahame and has also been responsible for the novels Skallagrigg, The Stonor Eagles, and the most famous of his works, the Duncton series of books, allegorical tales about a community of moles. ... Skallagrigg is a 1987 novel written by William Horwood. ... Gridlock is a novel by Ben Elton. ... The Usual Suspects is a 1995 American neo-noir film written by Christopher McQuarrie and directed by Bryan Singer. ... Kevin Spacey (born July 26, 1959) is an Academy Award-winning American actor (film and stage) and director. ... King Gimp is a documentary that took home the 2000 Academy Award for best short subject documentary. ... Storytelling is a 2001 film about dysfunctional adolescents, directed by Todd Solondz. ... Selma Blair (born June 23, 1972) is an American actress. ... Oasis (Hangul: 오아시스) (2002) is South Korean director Lee Chang-dongs third feature film, and the last one he directed before his stint as South Koreas Minister of Culture. ... This page meets Wikipedias criteria for speedy deletion. ... The Used is the self-titled debut album by The Used. ... Inside Im Dancing (also known as Rory OShea Was Here) is a film that was released in 2004. ... Ricky Dene Gervais (IPA: ; born June 25, 1961) is an Emmy-, Golden Globe- and BAFTA award-winning English comic writer and performer from Reading, Berkshire. ... Stephen Merchant (born 24 November 1974 in Bristol) is an English Emmy, Golden Globe, British Comedy Award and BAFTA-award winning writer, director, and comedic actor. ... Not to be confused with Extra (TV series). ... Francesca Martinez is an English stand-up comedian. ...

Notable cases

The cover of the film My Left Foot, which was based on Browns life Christy Brown (June 5, 1932 - September 6, 1981) was an Irish author, painter and poet, born in Crumlin, Dublin. ... My Left Foot is the 1954 autobiography of Christy Brown, born on June 5, 1932, in Dublin, Ireland in poor conditions. ... DVD cover of My Left Foot My Left Foot, by Christy Brown, is a 1989 autobiographical film which tells the story of Christy Brown, an Irishman born with cerebral palsy, who can only move his left foot. ... Daniel Michael Blake Day-Lewis (born April 29, 1957) is a British actor. ... Eric S. Raymond (FISL 6. ... Open source refers to projects that are open to the public and which draw on other projects that are freely available to the general public. ... Steady Eddy is the stage name of a Christopher Widdows, an Australian comedian and actor with Cerebral Palsy. ... Francesca Martinez is an English stand-up comedian. ... For other uses, see England (disambiguation). ... Josh Blue (born November 27, 1978) is an American comedian who was voted the Last Comic Standing on NBCs reality show Last Comic Standing during its fourth season, which aired May–August, 2006. ... Last Comic Standing is an American reality television talent show that premiered in 2003. ... Gianna Jessen Gianna Jessen (born April 6, 1977 in Los Angeles, California) is a Christian recording artist and pro-life activist. ... Stephen Hopkins Stephen Hopkins (March 7, 1707–July 13, 1785) was an American political leader from Rhode Island who signed the Declaration of Independence. ... This article is about the salesman. ... Watkins corporate headquarters and plant in Winona, Minnesota. ... Door to Door was a 2002 TV movie about Bill Porter (played by William H. Macy), a door-to-door salesman afflicted with cerebral palsy. ... Karen Killilea (b. ... AMC is a cable television network that primarily airs movies. ... Gabriela Brimmer, Gaby, (September 12, 1947 - January 2, 2000), a writer and activist for persons with disabilities, was born in Mexico as a daughter of Austrian Jewish immigrants. ... Geri Jewell (born 1956) is an actress and comedian born with cerebral palsy. ... Paul Henshall (born 1977, Staffordshire) is a British actor. ... Ruben David Gonzalez Gallego (born 1968) was born in Moscow, Russia, with severe cerebral palsy. ... Hes a retarded preacher on the Olde Time Gospel Hour. ... For other Romans named Claudius see Claudius (gens). ... Susie Maroney, Australian marathon swimmer. ... Baruch Kimmerling (born 1939) is a Professor of Sociology at the Hebrew University, Jerusalem. ... Greg Walloch (born July 8, 1970 in San Bernardino, California) is an American comedian, actor, author, and monologist. ... Joseph John Joey Deacon (24 May 1920 - 3 December 1981) was a British author and television personality. ... Team Hoyt is a father (Dick Hoyt) and son (Rick Hoyt, b. ... Signing Time! is a childrens television program that teaches American Sign Language. ...

See also

Boccia is a competitive sport, similar to bowls (but closer to bocce as the balls are not biased), but designed to be played by people with disabilities _ specifically, cerebral palsy and other locomotor disabilities (those which affect motor skills). ... Chorioamnionitis is a inflammatory condition of pregnancy affecting the uterus. ... This article or section does not cite its references or sources. ...

External links

The Open Directory Project (ODP), also known as dmoz (from , its original domain name), is a multilingual open content directory of World Wide Web links owned by Netscape that is constructed and maintained by a community of volunteer editors. ...

References

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  3. ^ "". WebMD Medical Reference from Healthwise.
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  20. ^ OMIM - CEREBRAL PALSY, SPASTIC, SYMMETRIC, AUTOSOMAL RECESSIVE. Retrieved on 2007-07-29.
  21. ^ Hansen, Ruth A.; Atchison, Ben (2000). Conditions in occupational therapy: effect on occupational performance. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-683-30417-8. 
  22. ^ Crepeau, Elizabeth Blesedell; Willard, Helen S.; Spackman, Clare S.; Neistadt, Maureen E. (1998). Willard and Spackman's occupational therapy. Philadelphia: Lippincott-Raven Publishers. ISBN 0-397-55192-4. 
  23. ^ Balaban B, Yasar E, Dal U, Yazicioglu K, Mohur H, Kalyon TA (2007). "The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy". Disability and rehabilitation 29 (2): 139-44. PMID 17373095. Retrieved on 2007-08-12.
  24. ^ White H, Jenkins J, Neace WP, Tylkowski C, Walker J (2002). "Clinically prescribed orthoses demonstrate an increase in velocity of gait in children with cerebral palsy: a retrospective study". Developmental medicine and child neurology 44 (4): 227-32. PMID 11995890. Retrieved on 2007-08-12.
  25. ^ Pennington L, Goldbart J, Marshall J (2004). "Speech and language therapy to improve the communication skills of children with cerebral palsy". Cochrane database of systematic reviews (Online) (2): CD003466. doi:10.1002/14651858.CD003466.pub2. PMID 15106204.
  26. ^ HBO Treatment.com. Retrieved on 2007-09-03.
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  33. ^ a b A very telling tale. Retrieved on 2007-07-29.
  34. ^ Language Log: A brief history of "spaz". Retrieved on 2007-07-29.
  35. ^ snowdrop.cc
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  37. ^ About Marie Killilea. Retrieved on 2007-07-29.
  38. ^ Pearce JM (2000). "The emperor with the shaking head". Journal of the Royal Society of Medicine 93 (6): 335-6. PMID 10911840.
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A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 187th day of the year (188th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 187th day of the year (188th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 186th day of the year (187th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 210th day of the year (211th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 224th day of the year (225th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 224th day of the year (225th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 246th day of the year (247th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 210th day of the year (211th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 210th day of the year (211th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 210th day of the year (211th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 210th day of the year (211th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 210th day of the year (211th in leap years) in the Gregorian calendar. ... Paresis is a condition typified by partial loss of movement, or impaired movement. ... Paralysed redirects here. ... Quadriplegia, also known as tetraplegia, is a symptom in which a human experiences paralysis of all four limbs, although not necessarily total paralysis. ... Triplegia is a medical condition is which the patient has paralysis of three limbs. ... Hemiparesis is the partial paralysis of one side of the body. ... Paraplegia is an impairment in motor and/or sensory function of the lower extremities. ... Diplegia is a form of paralysis affecting one part of the body and the corresponding part on the other side of the body (i. ... In medicine, a Monoplegia is a paralysis of a single limb. ... Flaccid is a term used in medicine to refer to an object that is soft, or not tense. ... The word spastic is used differently depending on location, which has led to some controversy and misunderstanding. ... Flaccid paralysis, is a clinical manifestation characterized by weakness or paralysis and reduced muscle tone without other obvious cause (e. ... Spastic diplegia is a neuromuscular type of cerebral palsy involving hypertonia and spasticity in the muscles of the lower extremities, usually those of the legs, hips and pelvis. ... Spastic paraplegia is a form of paraplegia defined by spasticity of the affected muscles, rather than paralysis. ... Cauda equina syndrome is a serious neurologic condition in which there is compression of the vertebral column (spine) affecting the S1-S4 nerve roots. ... Locked-In syndrome is a condition in which a patient is aware and awake, but cannot move or communicate due to complete paralysis of nearly all voluntary muscles in the body. ...

  Results from FactBites:
 
Cerebral Palsy (1028 words)
For kids with cerebral palsy, called CP for short, taking a first step or saying a first word is not as easy.
Cerebral palsy (say: seh-ree-brel pawl-zee) is a condition that affects thousands of babies and children each year.
The word palsy means a weakness or problem in the way a person moves or positions his or her body.
Cerebral Palsy Source - Cerebral Palsy Quick Facts (419 words)
Cerebral palsy is a broad term used to describe conditions whereby brain trauma adversely affects a child's motor abilities.
Spastic cerebral palsy affects 70 to 80 percent of patients and is characterized by stiff or permanently contracted muscles.
Athetoid cerebral palsy affects 10 to 20 percent of patients and is characterized by uncontrolled, slow, writhing movements.
  More results at FactBites »

 
 

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