Pediatric Cerebral Palsy Myths

Cerebral palsy is an abnormality of brain function caused by brain damage that occurs before and after birth when the brain is not yet mature. Although all functions of the brain can be involved, damage to the motor cortex is the most common, so the main manifestations are central movement disorders and postural abnormalities. The causes of cerebral palsy are complex, but they are mostly related to prematurity, obstructed labor, asphyxia and kernicterus. In addition, cerebral palsy can be caused by maternal drug abuse, alcoholism, metabolic disorders (diabetes mellitus, hyperthyroidism), maternal pneumonia, or cardiopulmonary psychiatric disorders. In recent years, due to the increase in infant survival rate, the number of such patients has also increased, resulting in one of the most common and distressing conditions for children and their parents with pediatric disabilities. Parents’ understanding of cerebral palsy is extremely different, and there are many misconceptions, which seriously affect the reasonable treatment and rehabilitation of cerebral palsy. Worry about early diagnosis: If the child is born prematurely or without oxygen, the pediatrician will remind the parents that the child may develop cerebral palsy in the future, and most of the parents will feel more worried. Most parents are concerned and take their children to the doctor for fear of late diagnosis and delayed treatment. During the newborn period, there are unexplained crying, weak sucking, difficulty in swallowing, and easy to startle. In infancy, the symptoms become more obvious and the child fails to develop motor functions and intellectual ability according to normal developmental procedures. Some children with cerebral palsy often have symptoms of mental retardation, drooling, stupidity, speech and visual impairment. In fact, the diagnosis can be made by observing the above symptoms and visiting the doctor regularly. In addition, early diagnosis can be assisted by ultrasonography and MRI. Failure of early treatment: For many parents of patients in remote areas, due to factors such as awareness and economic aspects, the time for early treatment is missed. Early infants’ brain tissue is in the most vigorous period of growth and development, the brain is highly moldable and has a strong compensatory ability, so if appropriate stimulation is given at an early stage, it will be of great help to the development of the brain. Therefore, if you can seize the child before the age of 2-3 years, which is the period when the child’s brain develops the fastest and has the strongest compensatory ability, and give reasonable rehabilitation, medication, hyperbaric oxygen and other treatments. It can maximize the potential of the brain and promote compensatory recovery, and children with mild cerebral palsy can even recover to the condition of normal children. Third, medication: we see that some parents urge patients to take medication for a long time, and children are not very cooperative. In fact, medication for cerebral palsy is of little value in promoting brain development after the age of 3. In addition, most of the medications that promote nerve growth and brain repair are not very effective, but these medications are generally more expensive, so many parents feel that it is very hard on their finances, and they want the medication to have a miraculous effect. Some parents also go around seeking medical treatment, spending high prices to buy homemade pills from the so-called old Chinese medicine practitioners, which are even more worthless. Fourth, the superstitious belief in a complete cure: Parents often hope that the doctor will be able to cure their children, like other normal children. If the doctor explains that unlikely, and therefore seek medical treatment, hoping that through the “injection, medicine” or ancestral secret recipe to fully reach the purpose of the cure. Nowadays, there are many advertisements that claim to be a cure for cerebral palsy, and many parents are deceived. If the above efforts fail, parents will put their hope for a “cure” on surgical treatment. Fifth, not insisting on rehabilitation Because brain tissue is damaged and its brain function is irreversible during development, rehabilitation for children with cerebral palsy is a lifelong process. No matter which means of treatment is adopted, it is a side of comprehensive rehabilitation. Therefore, parents should have the concept of long-term rehabilitation. Some parents are willing to spend 1-2 months with their children to come to the hospital for rehabilitation treatment, but when they return home, they no longer supervise or guide their children’s rehabilitation exercises. Some parents may give up the rehabilitation program because they do not see the short-term effect of the program. At present, regular hospitals are able to provide comprehensive rehabilitation treatment for children with cerebral palsy, including measures such as exercise therapy (PT), occupational therapy (OT), speech therapy (ST), hydrotherapy, orthopedic production, Chinese medicine and rehabilitation education. Because every patient with cerebral palsy cannot be rehabilitated in the hospital forever, and the active participation of parents is also an important part of the rehabilitation process. Different families from different regions should develop long-term rehabilitation programs according to their own situation. Excessive belief in surgery: Surgical treatment aims to improve certain functions of the patient on the basis of rehabilitation. Surgery is not a cure-all, it is only one method of cerebral palsy treatment, and it is not possible to achieve a complete solution to all the problems of cerebral palsy. Many parents tell our surgeons that they want us to treat their child to the best of our ability. In fact, cerebral palsy surgery mainly includes spasticity relief surgery (SPR, etc.) and orthopedic surgery. There are different indications for different surgical modalities, and the necessary surgical treatment is performed only when the improvement of rehabilitative function is constrained by contractural deformity or excessive spasticity of muscles, tendons and joints, which only creates favorable conditions for further motor function training. In addition, surgery does not improve the patient’s intellectual and speech abilities. There are also many misconceptions about cerebral palsy among medical professionals. In China, cerebral palsy has been emphasized in the last 20 years, and many doctors who were educated in the early days still have the concept of treating cerebral palsy in the treatment of pediatric anesthesia, although some of the surgical methods for cerebral palsy are similar to those for pediatric anesthesia, there are big differences. In addition, cerebral palsy has various clinical subtypes and different surgical programs, and new surgical methods such as SPR have been blindly carried out. There is still a lack of specialized doctors in cerebral palsy surgery in China. In fact, the choice of surgical modality is based on the age of the child, the type of cerebral palsy, the degree of dysfunction and other factors, and an individualized plan must be formulated, and the specific surgical plan needs to be formulated by specialists who have a deeper research in this field. Since hospitals currently have multidisciplinary medical staff such as microsurgery, orthopedics, pediatric surgery, rehabilitation, traditional Chinese medicine, acupuncture, neurology, and pediatrics involved in the diagnosis and treatment of cerebral palsy, some doctors emphasize that exercise training can be a substitute for cerebral palsy. Some doctors emphasize that motor training can replace everything, ignoring the need for surgery, while others over-exaggerate the “effectiveness” of surgery, ignoring the corresponding rehabilitation training. Of course, there are also doctors who, regardless of the cause, only allow children with cerebral palsy to receive single treatment such as medication and hyperbaric oxygen therapy. Doctors from different departments do not share the same viewpoints, which leads to a more chaotic treatment of cerebral palsy. In short, when the child’s family members or doctors go into the misunderstanding of cerebral palsy diagnosis and treatment, they are unable to make a comprehensive rehabilitation plan and miss the opportunity to further improve the function. We believe that rehabilitation is fundamental to cerebral palsy and that surgery, medication and other modalities are useful complements to the treatment of cerebral palsy. The use of individualized surgery can be effective in improving function. Although cerebral palsy cannot be cured at present, it is possible to definitively improve function and quality of life, and allow people with cerebral palsy to better integrate into society.