Cerebral palsy

Watch video only
It's pretty well established that your brain is really important. It's like if your body was a computer, your brain's the mainframe, it controls everything, whether you're aware of it or not.
Cerebral palsy means brain condition causing paralysis. So essentially cerebral palsy refers to damage to the brain that causes loss of muscle control.
Like for example, if the cerebellum was damaged, patients might have issues with fine motor skills like writing or typing.
That being said, though cerebral palsy is a broad umbrella term to basically cover a wide variety of issues. Since ultimately, the muscles affected and severity depends on which part of the mainframe has been affected.
Right? Cerebral palsy is considered a neurodevelopmental condition, meaning that something happens to an area of the brain during its initial development, which is an extremely sensitive period.
If that area doesn't develop, right, then it can't carry out whatever function it's supposed to control. But what's this vague something that can happen though?
Well, it's something because there's a wide variety of causes. The majority of cerebral palsy cases are thought to happen before birth or prenatally, which typically means the underlying cause is really hard to pin down exposure to radiation or infection during fetal development can cause cerebral palsy hypoxia to the developing fetus has been linked as well.
In this case, the developing brain doesn't get enough oxygen potentially from problems like the placenta, not being able to supply oxygen and nutrients.
Cerebral palsy doesn't have to happen prenatally though. And some postnatal causes are things like head trauma or again an infection or a period of oxygen deprivation.
Although most cases are likely due to some trauma or injury, a very small proportion of cases are due to a genetic mutation, even though the brain damage or injury or abnormality is permanent.
One super important point to remember about cerebral palsy is that it doesn't get worse over time. And for that reason, it's considered a nonprogressive condition.
Cerebral palsy is classified by the type of muscle movements that result from the brain injury and how that affects what activities the patient can perform.
The first type is called spastic cerebral palsy, which accounts for about 70% of cases. And this is characterized by having really tight or stiff muscles which can make patients movements seem jerky.
This tightness results from a lesion in an upper motor neuron. So with a lesion, which just means some kind of abnormality, the ability of some of these neurons to receive.
Gabaa might be impaired. And Gabaa is the main inhibitory neurotransmitter.
So if nerve impulses can't be inhibited, which is a double negative, then those nerves are basically overexcited leading to hypertonia, which is an abnormal increase in the muscle activity.
Basically, like if the muscles were constantly contracting, this is why some people with spastic cerebral palsy have a scissor gait.
Think about how hard it'd be to walk when your abductor muscles were always partly contracted, which causes your knees and thighs to constantly touch.
Similarly, sometimes patients have a toe walk because their calf muscles are always contracted which pulls the achilles tendon up and causes someone to go up on their toes.
A second type of cerebral palsy is athetoid or dyskinetic cerebral palsy. And this one involves damage or injury to the basal ganglia.
The basal ganglia is this structure here which essentially helps us to initiate and prevent certain movements. If the basal ganglia becomes damaged, patients can lose the ability to prevent movements and therefore, they can have involuntary movements meaning out of their control.
So, dyskinetic cerebral palsy is characterized by dystonia and or chorea. Dystonia is random, slow and uncontrolled movements in the limbs and trunk.
Chorea is random dance like movements. Since the small uncontrolled movements seem to move from muscle to muscle.
Finally, there's ataxic, cerebral palsy taxus refers to an order or arrangement. So, Ataxic essentially means without order, which is in reference to patients with this type being shaky or uncoordinated and this is caused by damage to the cerebellum which helps with coordination and fine or precise muscle movements.
These patients often have clumsy or unstable movements and poor balance when doing things like walking or picking something up.
Although different from patient to patient, many patients with muscle control issues have other symptoms as well. Patients often experience pain from tightened muscles or abnormal posture and stiff joints.
Also abnormal movements might make it difficult to sleep at night. And patients can develop sleep disorders.
Eating can become difficult as well, which can range from the preparation of food to the action of chewing and swallowing food.
Other brain related issues are also associated like difficulties with speaking and communication, vision problems and learning disabilities.
Diagnosis of cerebral palsy is typically done clinically. However, in some cases, additional lab work can be done to rule out other conditions that present similarly such as thyroid disorders or inherited metabolic conditions.
Imaging tests like a brain or spine MRI or a CT scan can also support the diagnosis of cerebral palsy or rule out other central nervous system lesions.
Since cerebral palsy involves a permanent abnormality to the brain structure, it's not curable, but that doesn't mean it's not treatable.
Treatment for cerebral palsy usually involves a multidisciplinary approach. Pulling from a number of clinical specialties like neurologists, rehabilitation specialists, occupational therapists, speech therapists and others.
Hopefully to find a unique approach for each patient. Ultimately improving their quality of life.
Physical therapy can be used to build strength and improve walking ability along with stretching to reduce contracture, which is a permanent shortening of muscle tissue from being hypertonic or contracted for so long.
Sometimes muscle relaxants are given or botulinum toxin is injected into certain muscles to relax them, which can both help reduce pain associated with hypertonus and also help fit patients with specific orthotic braces.
Sometimes surgery might also be performed to help with a variety of issues like loosening tight muscles, straightening out bones that have been subject to abnormal muscle forces over time and cutting certain nerves to reduce their associated movements or spasms.
All right, it's a quick recap. Cerebral palsy is when central nervous system structures like the brain or cerebellum are damaged and this affects motor function causing palsy even though the damage is permanent.
The condition doesn't get worse over time. So it's considered a nonprogressive disorder.
There are three types of cerebral palsy, spastic, cerebral palsy, which is the most common athetoid or dyskinetic, cerebral palsy and ataxic, cerebral palsy.
All of which are typically diagnosed based on the clinical picture. Treatment for cerebral palsy usually involves a multidisciplinary approach.
And the team can comprise of neurologists, rehabilitation specialists, occupational therapists, speech therapists and others who work together to ultimately improve the quality of life.