Any parent, wants their child to be healthy and happy. However, there are always some things that are unpredictable, and there are always children who are born with one or another abnormality, so what is cerebral palsy, how to prevent it, and how exactly to treat it? These questions often bother these parents.
According to medical statistics, the incidence of cerebral palsy is about 4 per 1,000. However, clinicians believe that this is a reduced number – because it only refers to those children with severe cerebral palsy who have severe symptoms and cannot take care of themselves, while those children with milder symptoms and whose behavior and intelligence deviate less from the norm are ignored. These children with cerebral palsy, mild or severe, not only face huge setbacks in their own lives, but their families also bear huge economic and mental burdens. Wei Lin, Department of Neurosurgery, Shandong Qianfo Mountain Hospital
1. What is cerebral palsy?
In layman’s terms, cerebral palsy is a brain injury caused by various factors before and after birth. Usually, this injury will cause limb abnormalities and various functional disorders. Some children may also have co-morbid symptoms such as drooling and epilepsy, and may not be able to take care of themselves.
2. How can parents recognize cerebral palsy?
In medical terms, cerebral palsy is a syndrome of non-progressive brain damage from various causes from before birth to one month after birth, mainly manifested by motor dysfunction and postural abnormalities. Parents can roughly determine this after the baby is born by such methods: when picking up the baby, the baby’s head is tilted back; the baby cannot lift his head at 3 months, and cannot grasp objects with his hands at 4-5 months; the baby is drowsy, has difficulty feeding, is unresponsive or cries abnormally, cannot kick and stir at about 6 months, has both toes facing inward, and cannot take steps when walking with legs crossed when supported;. When some of the above symptoms appear, parents should take the child to a professional and standardized hospital for examination.
3. What causes cerebral palsy?
The causes of cerebral palsy are very complex, and the causes are summarized in the following aspects.
1) Prenatal factors: such as congenital malformation, genetic defects, in utero infection, pre-eclampsia, maternal exposure to toxic substances, radiation damage, gestational hypertension, etc.
(1) prenatal factors: such as congenital malformations, genetic defects, intrauterine infections, preterm abortion, maternal exposure to toxic substances, radiation damage, hypertension in pregnancy, etc.
(2) Intrapartum factors: such as obstructed labor, interruption of umbilical cord blood supply due to sagging and wrapping around the neck during delivery, neonatal asphyxia, huge babies and low birth weight.
Asphyxia, huge babies and low weight babies, premature and immature babies, birth injuries, etc.
(3) Postnatal factors: such as neonatal jaundice, neonatal intracranial hematoma, sepsis leading to shock, aspiration pneumonia, pulmonary atelectasis leading to cerebral hypoxia, etc.
(3) Postnatal factors: such as neonatal jaundice, neonatal intracranial hematoma, sepsis leading to shock, aspiration pneumonia, pulmonary atelectasis leading to cerebral hypoxia.
The causes of cerebral palsy are: prematurity, obstructed labor, asphyxia, and jaundice.
How to prevent cerebral palsy?
The key to prevention of cerebral palsy is to address the above-mentioned factors that cause cerebral palsy before and after childbirth.
Strengthen prenatal and postnatal checkups for high-risk pregnant women, and establish follow-up files after the birth of babies to detect symptoms and provide early treatment.
Monitor newborns with high-risk factors and observe them dynamically for early diagnosis and timely intervention. The reason is that appropriate benign stimulation at an early stage can revive the “dormant” brain cells, thus improving the degree of brain damage.
5. What are the manifestations of children with cerebral palsy?
Children with cerebral palsy have a variety of manifestations and can be divided into several types according to their manifestations.
1. Spastic type (Spatic).
This type is the most common among cerebral palsy patients, accounting for about 65%. The main manifestation is delayed motor development, which is significantly behind that of children of the same age. The muscles of the extremities are obviously stiff, i.e., the muscle tone is increased. The lower limbs may be crossed and become scissor-like gait when walking. The feet droop significantly, as if they were the pointed feet of a ballerina. These phenomena can disappear during sleep. The normal phenomenon is that when we move, there will be two groups of muscles in mutual antagonism, a group of muscles contraction, the other group of muscles is relaxed, so as to produce the perfect action, if the two groups of mutually antagonistic muscle groups, contraction at the same time, the muscle will become director tension, resulting in difficult action, stiffness.
2. Sluggish type.
This type accounts for about 15-20% of cerebral palsy patients. It is mainly characterized by the appearance of involuntary movements of the limbs and trunk. In other words, there is a strange facial movement and uncontrollable twisting of the neck. The more the patient tries to actively control these movements, the more the above phenomena worsen. As a result of these phenomena, the patient is unable to sit, stand or walk stably. The most characteristic feature of this type is poor motor control and exaggerated movements. In the early stages of tardive dyskinesia, muscle tone is weak or hypotonic, but as the patient grows older, without proper rehabilitation, it often turns into a mixed type, such as hypertonic tardive dyskinesia.
3. Ataxia.
The main manifestation is balance dysfunction, that is, the patient cannot maintain a fixed posture. When standing, the body must be constantly adjusted to maintain the standing posture. When walking, the legs are separated, the distance between the left and right feet is wide, the gait is staggering, and the directionality is poor. It is characterized by weakness of limb muscles, inability to maintain body balance, unsteady gait, and inability to complete fine movements such as pointing the nose with fingers. Simple ataxia is less common. Ataxia may be associated with tardive dyskinesia.
The following symptoms may help in the early diagnosis of cerebral palsy.
(1) The child often cries little, moves little, cries weakly, and is excessively quiet shortly after birth. Or they cry a lot, are easily agitated, startle easily or have recurrent flesh jumping.
(2) Difficulty in feeding after birth, such as weak sucking, difficulty in swallowing, and poor oral closure.
(3) Uncoordinated, asymmetrical movements and little casual movement.
(4) Frequent abnormal muscle tone, abnormal posture and movement patterns.
(5) Motor development is delayed. For example, at 3 to 4 months of age, the child cannot hold his head upright in the prone position; at 4 months of age, he still cannot support weight with his forearms; his hands are often clenched in fists and he cannot put his hands in his mouth to suck; at 6 to 7 months of age, he still cannot roll over and sit alone for a moment; he cannot bear weight with his toes on the ground or with his legs flexed when he is supported to stand, or his two lower limbs are too straight or crossed, etc.
In clinical work, it is found that very few children with cerebral palsy have a family history, which cannot indicate the heredity of cerebral palsy. It is recommended to go to the hospital for a detailed differential diagnosis to find out the pathogenic factors.
6. Does a child with cerebral palsy necessarily have a problem with intelligence?
Low intelligence is one of the main accompanying symptoms of children with cerebral palsy. However, it does not mean that a child with cerebral palsy has poor intelligence. Some children with cerebral palsy have completely normal intelligence, and some are even very smart. Therefore, children with cerebral palsy do not necessarily have low intelligence, especially children with spastic cerebral palsy, who only have high muscle tone problems such as tiptoe, scissor step, and inflexible hands and feet.
7. What kind of treatment options are available for cerebral palsy?
With the rapid advancement of science and technology, the treatment of cerebral palsy is also progressing. The main treatments nowadays are
1) Medication: Medication for cerebral palsy is not the primary treatment, but often used as an adjunctive symptomatic application. For example, effective control of cerebral palsy combined with symptomatic epilepsy and other diseases.
2) Rehabilitation training: Rehabilitation training is the most important treatment for cerebral palsy patients and is especially important in early treatment. Through rehabilitation
rehabilitation training can make the brain tissue in the process of continuous maturation and differentiation, so that the function of the damaged part can be compensated, and thus the motor function of the affected child can be improved.
(3) Traditional Chinese medicine treatment: Traditional Chinese medicine treatment methods are mainly acupuncture and massage.
(4) Surgery: Surgery plays an important role in the clinical treatment of children with cerebral palsy. Especially when various non-surgical treatments are ineffective, surgery becomes the most important treatment.
surgery becomes an important tool when various non-surgical treatments are ineffective. Surgery is divided into two categories: neurosurgery and orthopedic surgery.
(1) Functional selective posterior spinal nerve rhizotomy (FSPR): the most advanced treatment for cerebral palsy limb spasticity today.
(2) Orthopedic surgery: Generally speaking, orthopedic surgery is mainly used as a post-FSPR treatment for the fixed deformity that has developed in the limb, and is not the only way to treat cerebral palsy.
8. Can cerebral palsy be cured?
Cerebral palsy is a lesion of the brain, and all current treatments cannot yet be directed at the brain lesion. Strictly speaking, cerebral palsy cannot be cured in the strictest sense at this time. All current treatment modalities and methods are aimed at achieving functional improvement, rather than treating the brain lesion. It is hoped that the children with cerebral palsy who have passed the treatment all have different degrees of functional improvement, especially the patients with tiptoe, scissor step and twisting spasticity, the effect is obvious, the patients and parents are satisfied, and some of them are no different from normal people and have embarked on a normal life track.
9. What is the treatment for cerebral palsy?
From the medical point of view, any kind of treatment has its indications, that is, the range of suitable applications. Currently, all kinds of treatments are mainly for spastic or spastic-based types of cerebral palsy. In terms of treatment mechanism, it should include three steps: release of spasticity, correction of deformity, and rehabilitation training. Therefore, FSPR surgery becomes the primary choice for the treatment of patients with this type of spastic cerebral palsy. There is no other treatment that can effectively relieve spasticity.
Indications for FSPR surgery.
(1) Spastic cerebral palsy or mixed type of cerebral palsy with predominantly spasticity.
(2) Normal or near normal intelligence.
(3) Age above 3 years old, with normal development.
(4) The limbs have some motor ability.
One point must be highlighted that surgery only provides the basis for rehabilitation training. To achieve functional improvement, timely, effective and standardized rehabilitation training is necessary.
10. How to determine early that an infant will have cerebral palsy?
The diagnosis of a child with cerebral palsy focuses on early diagnosis so that early treatment can be given, which plays a decisive role in the child’s motor development and treatment outcome. The following phenomena should be noted during infancy.
1) Abnormalities during the mother’s pregnancy; any history of prematurity, obstructed labor, or asphyxia before or after birth
2) Little or abnormally increased activity of the infant, but weakness of the limbs. Weakness in breastfeeding, frequent choking, etc.
3） Significant delay in the development of motor function.
4） The limbs are fixed in an abnormal posture for a long time. For example, the legs are crossed and the feet are pointed on the ground.
11. What should I do if I suspect that my child has cerebral palsy?
If you suspect that your child has cerebral palsy, you should go to a regular hospital as soon as possible to facilitate early recovery and future functional improvement of your child.
In terms of the disease, cerebral palsy is a disability disorder, which means that long-term rehabilitation is required after having cerebral palsy. Some experts have pointed out that the rehabilitation of cerebral palsy is lifelong, therefore, the treatment of cerebral palsy should focus on family rehabilitation and social rehabilitation. It should be supplemented with surgical intervention when necessary, especially for children with spastic cerebral palsy. Early treatment for such children with cerebral palsy can generally be carried out with rehabilitation to prevent skeletal and spinal deformities, but once the typical symptoms of high muscle tone – tiptoe, scissor step, inability to land on the heels, etc. – appear, at the age of 2.5 years, they can be treated with FSPR to release the spasticity and resolve the hypertonia. After the surgery, the patient can be rehabilitated and grow up to work, study and live like a normal person.
12. Are there any risks associated with the surgery?
Generally speaking, any surgery of any size has certain risks. The key is how we should look at the surgery and how we should perform it. Through FSPR surgery, many children with cerebral palsy have been able to go back to society and gain basic living skills. After surgery, compared to before surgery, all functions are greatly improved, and some children are even indistinguishable from normal people: tiptoe walking is solved, speaking ability is greatly improved, self-care ability is improved, and so on. Having FSPR surgery becomes the primary choice for those who desire to live freely, wish to relieve the parents’ burden, and gain the ability to take care of themselves in life with cerebral palsy. Moreover, there are strict indications for cerebral palsy surgery, and systematic, standardized and professional rehabilitation training must be carried out after the surgery to achieve good results. Since the introduction of this advanced technology for the treatment of cerebral palsy from abroad, we have accumulated rich clinical experience and have an experienced and professional cerebral palsy treatment team. For any patient before surgery, we will organize experts to make a clear diagnosis first to see if it is suitable for surgical treatment and make a specific treatment plan according to the patient’s specific situation.