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Frequently Asked Questions About Cerebral Palsy

 

Cerebral means brain, and Palsy is defined as a loss of control or weakness in movement. Putting the two words together makes Cerebral Palsy (CP) a loose term given to a number of central nervous system (CNS) motor disorders which are characterized by impairment of voluntary muscle movement. In individuals who have Cerebral Palsy, the parts of the body that provide for movement, such as the muscles, nerves, and the spinal cord are normal.

However, the brain, which is the command centre for sending signals to those parts of the body that coordinate movement, is unable to do so in the usual manner. As a result the following conditions, in varying combinations, are usually associated with Cerebral Palsy; Mental retardation in some form, ranging from 25 to 75 percent, seizure disorders, difficulty in swallowing (dysphasia), hearing or speech defects, learning disabilities as well as problems with vision, such as Strabismus, bowel and bladder control, and gross or fine motor control.

Cerebral Palsy is not a disease, it is an injury caused by a permanent brain injury or lesion, which may occur before, during, or after birth. CP is not progressive, it does not get worse as time passes. CP can be the result of the mother having certain viral illnesses during pregnancy, Rh incompatibility (a blood conflict between mother and child), premature birth, any complication during pregnancy which causes hypoxia (lack of oxygen to the brain), genetic defects, head injuries, lead poisoning, and a host of other causes. In many cases, the cause is unknown. There is no 'cure' for CP, but various types of therapies can be used to maximize the child’s potential.

  1. Poor head control after 3 months of age
  2. Increased muscle tone (muscle stiffness)
  3. Decreased muscle tone (floppy or limp muscles)
  4. Arching of the back
  5. Inability to sit up by 8 months
  6. Tending to favour one side of the body
  7. Increased irritability
  8. Feeding problems
  9. Continuous fisting of the hands
  10. Scissoring of the legs
  11. Pointing toes
  12. Tremors or seizures
  13. Exaggerated startle reflex
  14. Strabismus (crossed eyes)

Not all kids with brain damage are diagnosed with CP. It depends on the extent and location of the damage. If the damage does not affect motor control then the child will not be diagnosed with CP. They may have other issues such as mental retardation, behaviour problems, learning problems, vision problems, etc, depending on where the damage is located. Also, many children who are diagnosed with CP have "normal" brain scans. This does not mean that there is not damage, just that it is not visible on the scan.

CP can be classified according to the type of movement the child makes or to the part of the body that is most involved, or both. By type of movement:

  • Spastic = rigid
  • Athetoid = no muscle control
  • Hypotonic = floppy
  • Ataxic = balance and coordination problems
  • Mixed

By involved body parts:

  • Hemiplegia = one arm and one leg on the same side of the body
  • Diplegia = predominantly both legs (arms also involved)
  • Quadriplegia = all four extremities

Cerebral Palsy is caused by an injury to the brain during pregnancy, around the time of birth, or shortly after birth. Occasionally genetic abnormalities cause the brain to develop abnormally, but most cases of brain malformation are due to other factors.

Exposure to toxins can interfere with the proper development of the unborn baby’s brain. Damage to the white matter of the brain is particularly likely to lead to CP. Between 26 and 34 weeks gestation, the unborn baby’s brain is especially vulnerable to injury to the white matter, but damage can occur at any point in the pregnancy.

Infections in the mother or in the unborn baby can lead to brain damage. The inflammation produced as a normal part of the infection fighting process can cause damage to the baby’s developing brain cells. Infections can also trigger strokes in the foetus, leading to oxygen deprivation; prolonged oxygen deprivation can cause brain damage which leads to CP.

Uncontrolled high blood pressure in the mother during pregnancy puts the foetus at higher risk for a stroke. Extremely low maternal blood pressure can also put the unborn baby at risk for a stroke. Monitoring and controlling the blood pressure is a vital part of good prenatal care.

Rh incompatibility, a condition in which the foetus’ Rh blood type conflicts with the mother’s Rh blood type, can also cause Cerebral Palsy. Rh incompatibility leads to severe jaundice - a build-up of bilirubin in the blood which can cause deafness and CP. a Fortunately, Rh incompatibility can be treated if caught in time. In the United States, testing for Rh incompatibility is regular part of prenatal care, but this is not the situation in many other countries. If you are pregnant, make sure your doctor checks for Rh incompatibility as early as possible in the pregnancy.

Severe jaundice caused by problems other than Rh incompatibility can also lead to CP. Jaundice is common in new-borns, but it can be treated.

The following injuries may also be contributing factors to developing Cerebral Palsy: infection during pregnancy: bleeding, kidney infections, and urinary tract infections. Some of these factors can be avoided by receiving proper prenatal, labour/delivery and post-natal medical care.

Cerebral Palsy cannot be cured. The brain damage or brain abnormalities from which it stems are irreversible, but treatments are available to alleviate the symptoms associated with the disorder. The treatments combine both drug therapy and counselling in order to ease the symptoms associated with this disorder.

The main goal of professionals who work with individuals affected by Cerebral Palsy is to foster as much independence for the individual as his or her impairment will allow. Individuals with seizure disorders may be effectively controlled with anticonvulsive medications. Physical therapy, speech therapy, and occupational therapy are frequently utilized to maximize participation and independence. For individuals who do not have intellectual involvement, accommodations can be made to living spaces, places of employment, and schools so that they may be included in the everyday world of business, education, and recreation. For many individuals with Cerebral Palsy, inclusion is more a matter or management of their disorder, rather than treatment or a cure.

Good prenatal care can help lower the risk of fetal strokes from maternal high blood pressure and infections. Appropriate prenatal care can also prevent complications from Rh incompatibility.

Preventative measures before pregnancy can also reduce the risk of birth defects; women with inflammatory pelvic disease should have the condition treated before becoming pregnant. Women planning on becoming pregnant should vaccinated against Rubella (German measles), which can cause birth defects and should consult their doctor on other measures they can take to assure a trouble-free pregnancy and a healthy baby.

However, some factors which can cause Cerebral Palsy and other birth defects cannot be prevented. There is no guarantee that the mother or the baby will not develop an infection; infections in the unborn baby are difficult to treat.

There are several different types of Cerebral Palsy: spastic diplegia, spastic hemiplegia, spastic quadriplegia, athetoid dyskinetic Cerebral Palsy, choreo-athetoid dyskinetic Cerebral Palsy, dystonic dyskinetic Cerebral Palsy, ataxic Cerebral Palsy, hypotonic Cerebral Palsy, and mixed Cerebral Palsy.

he spastic forms of CP are characterized by stiff muscles and muscle spasms. The dyskinetic forms of CP are characterized by involuntary, writhing movements. Ataxic CP, the least disabling of all the forms, is characterized by balance and depth perception problems which make walking difficult. Hypotonic CP is characterized by overly relaxed, “floppy” muscles. As the name implies, mixed CP is characterized by symptoms of two or more forms of the disorder.

There are four different types of Cerebral Palsy. Spastic Cerebral Palsy is the most common form, affecting approximately 70 percent of all individuals with Cerebral Palsy. Spasticity can be either a mild or severe impairment of motor functions. The affected limbs are usually underdeveloped, and there is a tendency for the individual to have a "scissor gait" or to toe walk. It is also common for the affected individual to have hyper tonicity, an excessive tension of muscles.

There are four sub-groups of spasticity:

  1. Hemiplegia- involvement of both limbs on one side; the arm usually more affected.
  2. Paraplegia- involvement of both legs; arms minimally involved, or not at all.
  3. Quadriplegia or Tetraplegia- involvement of all limbs, usually to the same degree.
  4. Diplegia- intermediate form between paraplegia and quadriplegia; both legs involved.

Athetoid or Dyskinetic Cerebral Palsy occurs approximately 20 percent of the time. It is characterized by low muscle tone, slow, writhing movement patterns and involuntary jerking of the head or of the arms and legs. The movements generally increase with emotional tension and decrease while the individual is asleep.

Ataxic Cerebral Palsy is rare, occurring in only about 10 percent of all individuals affected. It is characterized by weakness, uncoordinated movements, and unsteadiness. A wide gait and difficulty with fine motor skills is also common.

Mixed forms or Cerebral Palsy are common, and is exactly what the name implies. There can be a combination of any of the Cerebral Palsy forms, however, spasticity and athetosis are the most common combination.

If you notice your child developing any of the more obvious symptoms of Cerebral Palsy you should contact your doctor and arrange to see him or her as soon as possible. Your doctor will be able to run the necessary tests to determine whether or not your child has Cerebral Palsy. He or she can also offer advice on the different treatments and therapies available, and suggest which combination will best suit the child.

The answer depends on the type of CP and the extent of the brain damage or brain malformation which caused it. Impairment from CP ranges from mild to severe. Many people with Cerebral Palsy lead nearly normal lives, while some CP patients require constant care from others throughout their lives.

Side effects of Cerebral Palsy include seizures, spasms, visual problems, hearing problems, hyperactivity disorder, speech problems, and learning problems. Approximately half of all people with Cerebral Palsy suffer from seizures. Seizures occur when there is abnormal brain activity (the brain attempts to send abnormal messages very close together). Seizures affect people in different ways - some people may stop moving and stare, others may fall down. Some can cause a person to fall and shake violently. They are generally not dangerous and will only last a few minutes.

Cerebral Palsy is an abnormality in the brain that effects the muscular and nervous systems. There is no cure for Cerebral Palsy. However, it is not dangerous like cancer, heart attacks, or other serious diseases and it is not a life-threatening situation. Although there is no cure, therapy such as physical, speech, and/or occupational may be very helpful for your health.

The answer is No. Cerebral Palsy is not a disease, but a condition that is not contagious in any form. A parent who has Cerebral Palsy cannot pass it to their children. In addition, having Cerebral Palsy will not affect a woman's chances of becoming pregnant, maintaining a normal pregnancy, or increase any chances of complications during labour and delivery.

Some cases of brain malformation are due to gene abnormalities which prevent the brain from developing normally, but this is rare. Most cases of CP are not in any way hereditary, but are due to factors which occurred during the course of the pregnancy.

Alcohol consumption during pregnancy raises the risk of complications which can cause Cerebral Palsy, and many other birth defects. There is no established safe-level of alcohol consumption during pregnancy, so pregnant women should avoid alcohol entirely.

Babies born prematurely are at a higher risk for Cerebral Palsy. Modern medical techniques save a higher percentage of premature babies, but these babies are more prone to developing disabilities than full term babies are.

Babies with a low birthweight are also more at risk for Cerebral Palsy, even if they are full-term.

Women with mental retardation, a seizure disorder, or a thyroid disorder are slightly more likely to have a baby with CP, than women who do not have these conditions.

The term congenital means present at birth. Between 90 to 95 percent of CP cases are congenital. Congenital CP includes those cases which were caused by oxygen deprivation during birth. Doctors used to believe that most cases of CP were caused by a lack of oxygen during a difficult labor and delivery, but it is now known that fewer than 10 percent of congenital Cerebral Palsy cases stem from asphyxia or other problems during birth. The majority of problems that cause CP occur during development in the womb.

Brain trauma, infections, strokes, and other problems after birth can occasionally cause acquired CP. As the name implies, acquired CP means that the condition was acquired after birth.

According to the National Institute of Neurological Disorders and Stroke, approximately two-thirds of patients with CP have some mental impairment. Mental retardation can range from mild to severe. People with the spastic quadriplegia are more likely to have mental disabilities than those with other forms of CP. CP patients with epilepsy are also more likely to have mental retardation. Because of communication difficulties it is sometimes difficult to accurately assess the IQs of CP patients.

Learning disabilities without mental retardation are also associated with Cerebral Palsy. The speech, hearing, and vision problems which sometimes accompany CP can make learning difficult.

Many CP patients have normal IQs and no learning disabilities. A few CP patients are intellectually gifted.

No. Cerebral Palsy is a non-progressive disorder. This means that whatever damage was done to the brain will not get any worse. The problem that many parents face is that, generally, it is impossible to diagnose Cerebral Palsy with any certainty in infancy. Many cases are not diagnosed until somewhere around age two. It only appears that the disorder is progressive because the symptoms may not appear until the child's lack of motor skills, or other developmental delays begin to emerge. For example, a child at age two may have difficulty walking and at age six difficulty in writing and reading. The difficulty in reading and writing is not a progression of the Cerebral Palsy, but has appeared as a developmental milestone should have been attained. In other words, the difficulty at age six will occur if the brain injury affected that particular developmental milestone, regardless of any interventions on the part of the parents.

Cerebral Palsy is not a terminal condition, but before the advent of newer medical techniques in the mid-twentieth century most children with CP did not live into adulthood; complications from the disorder claimed their lives. Today, between 65 and 90 percent of children with Cerebral Palsy reach adulthood. CP is stressful for the entire body and can cause premature aging, particularly of the heart, blood vessels, muscles, joints, and bones.

The complications stemming from CP can be life-threatening. Cerebral Palsy can lead to respiratory and swallowing difficulties. Difficulty swallowing can lead to malnutrition and/or aspiration pneumonia—in which food is inhaled into the lungs causing an infection. Malnutrition causes weakness and muscle deterioration; it weakens the immune system making the patient more vulnerable to infections and less able to fully recover if an infection occurs.

CP patients whose mobility is extremely restricted may have to sit or lay down for extended periods of time, running the risk of pressure sores. Untreated pressure sores can develop life-threatening infections.

The bowel and bladder problems frequently associated with CP can lead to more serious complications when not properly managed.

Extensive research is being done on Cerebral Palsy treatment and prevention. Much of this research is funded by the National Institute of Child Health and Human Development, the National Institute of Neurological Disorders and Stroke, and private organizations such as the United Cerebral Palsy Research and Educational Foundation.

Research is being done on brain development in hopes of learning what can be done to prevent brain abnormalities from developing. Scientists are also studying the role uterine infections play in the development of CP. Other research centres on finding new ways to diagnosis CP earlier, so that treatment can be begun as quickly as possible; early treatment leads to better outcomes for CP patients.

In addition, research is being conducted on the various methods of physical therapy used for CP to determine which methods are most effective and to develop better technology to utilize with these methods. For example, functional electrical stimulation of the muscles can help strengthen spastic muscles, but the technique uses bulky implanted devices; research is being done on using a hypodermic needle to inject small devices at the necessary sites, thus making this therapy more practical and affordable.

Physical therapy, occupational therapy, and speech therapy can help improve the quality of life for CP patients. There are many methods of physical therapy, including conductive education. Conductive education is a complete educational program given in a group setting for five days a week, several hours a day; some experts dispute whether this is any more effective than traditional physical therapy, but many children who enjoy the stimulation of being in a group seem to benefit from conductive therapy.

Medication such as muscle relaxants can benefit patients with spastic Cerebral Palsy. An implantable pump which delivers the muscle relaxant baclofen has helped some patients with chronic stiff muscles or involuntary movements; this therapy is called intrathecal baclofen therapy.

Some CP patients have benefited from BT-A (botullinum toxin) injections. This treatment helps relax spastic muscles for approximately three months and is most beneficial when combined with physical therapy, especially stretching. Parents or caregivers considering BT-A injections should make sure the doctor giving them has experience in using this treatment on children; BT-A injections are approved by the FDA for treatment of other conditions, but they have not yet been formally approved for the treatment of CP.

Surgery to correct or relieve complications from CP such as foot drop, ankle equines, contractures, or spinal deformities is sometimes needed. Other treatments for CP involve treating other conditions sometimes associated with the disorder, such as hearing and vision problems.

Ask about a Cerebral Palsy support group at your paediatrician’s office, your child’s school or local children's hospital. If a support group has not been started, try networking with some of the families at your child’s therapy or other groups to which you have access.

Ask the paediatrician if he or she is willing to consult with experts in CP about comprehensive treatment approaches. Has he or she had any previous patients with Cerebral Palsy and how many?

Find a paediatric physical therapist. The best way to do this is to call your local children’s hospital or paediatrician’s office. It is also good to pursue therapy through your child’s school, especially when relevant to their learning. Find out the therapist’s attitude towards accomplishments, and what kind of innovative ideas he or she has to challenge the child.

Any level of disability should not limit a child’s participation in whatever sport he or she has an interest. Many adaptations can be made to accommodate individual needs. Swimming is a great example of an activity that can be done at all ages and with children of varying ability. The age at which a child can participate depends on the specific sport.

Yes, definitely!! Your child SHOULD NOT decrease his or her amount of traditional therapy when beginning sports-based therapy. Once your child is actively involved in a sports program, he or she may decide to decrease traditional therapies after consulting your physician and therapists.

Children with CP can have foot deformities, some of which can cause pain. If your child has a foot deformity, especially if he or she is in pain, you may want to look into orthotics to prevent and/or alleviate as much pain as possible. You can start by seeing your paediatric physical therapist for evaluation of orthotic needs. If you are not currently seeing a physical therapist, you will need to obtain a prescription from your physician. Orthotics are generally made by a physical therapist or an orthotist. It is extremely important that you see a reputable orthotist or bracing specialist with knowledge of foot biomechanics. Your physical therapist should be able to point you in the right direction.

Leg length discrepancies are common and even seemingly small ones can significantly affect a child’s gait. An orthopaedic physician or pedorthotist should be able to provide your child with a lift to help any leg discrepancy. However, it is important that your child be evaluated for hip problems that can cause leg-length discrepancies BEFORE a lift is put on the shoe.

Each child has different needs, so the best device will depend on the specific needs of your child. The best thing to do is to contact a pediatric physical therapist or physician for an equipment assessment.

Your child should be in a school that challenges him/her to their utmost potential cognitively. That may mean he/she is in a regular classroom with an aide, or in a regular classroom most of the day, and pulled out for parts of the day to attend therapy or resource room. Whatever the situation, your child should be provided with the resources needed to participate at a level with his/her peers (i.e, aide, computer, communication device, etc.).

Your child should also receive any necessary therapy services to promote improved performance in the school environment (i.e, PT, OT and Speech). If these services aren’t provided, you may need to advocate for them. Your neurologist, paediatrician, or caseworker can help you with this.

You may ask your current treating therapist(s) to visit the school with you and your child to ensure it is accessible and make any recommendations. These recommendations can even be included in your child’s IEP (individualized education plan).

Ask your paediatrician about an augmentative communication evaluation. This is usually done by an occupational therapist and a speech therapist. They will evaluate your child’s communication abilities and make recommendations for the most appropriate communication method.

Conductive education (CE) is a unique system of teaching and learning for children with motor disorders such as Cerebral Palsy and spina bifida. It is designed to improve motor skills and increase independence of many aspects of common living. It is not a cure, but a method of exercises and education which are broken down into basic functional movements. The exercises are performed intensively (5 hours per day, 5 days per week) in small groups which promotes interactivity and fun.

Conductive Education was developed at the Pet Institute in Hungary over 40 years ago and has now been widely established in England, Belgium, Australia, Israel, Holland, Hong Kong, Japan, Germany and Canada. There are other centres using principles of Conductive Education in Malta and New Zealand as well. It slowly becoming available in the United States.

Dystonia is the term used to describe an illness dominated by involuntary spasms and muscle contractions that induce abnormal movements and postures. Such dystonic spasms may affect one part of the body, such as the eyes, neck or a limb; a larger region, such as the neck and arms; or the whole body.

Botox (Botulin toxin) is a medication which can be injected directly into spastic muscles to reduce high tone in that particular muscle. The dose is varied according to which muscle and how severe the tightness is. Various muscles can be injected at once, although in young children this may require brief anaesthetizing. Most people notice improvement within a few days after the injections, with the results lasting for 2 - 4 months. This is usually a good time for serial casting and range of motion therapy. Over time, the effectiveness of the Botox injections seems to decrease.

Botox is not yet FDA approved specifically for children with CP, but approval has been requested and meanwhile it is being used successfully to treat spasticity. Botox almost never causes any central nervous system side effects and is known for its safety and complete reversibility. The drawback of Botox is that it only affects the muscle(s) into which it is directly injected. Children and adults with severe, overall spasticity will not benefit, as the amount needed would be far more than the maximum limit. In such cases other methods are generally recommended. Careful evaluation is recommended before choosing any method of dealing with high muscle tone.

Baclofen (Lioresal) is very commonly used as an oral medication for the treatment of spasticity. After a dose is administered, the muscles begin to relax within two hours, reaching peak effectiveness about 2 or 3 hours later, and has often lost its effect after about 8 hours. This means that the medication is taken up to four times per day. The Baclofen pump has therefore been developed to administer the medication directly into the spinal fluid, where it has maximum effect. The pump is implanted under the skin of the abdomen and a computer is programmed to release the Baclofen as desired. In most children, spasticity is decreased and they have made improvements in swallowing, speech, and other activities of daily living.

The advantages of the pump are that doses can be monitored very precisely with the computer, and the treatment is fully reversible. The pump does need to be refilled every few months, and replaced every 4 to 5 years. There is a higher risk of infection than with rhizotomies, and there is a potential for overdosing - although this is extremely rare. The pump is generally only used for children over the age of 3, who are big enough for the pump to be inserted. Careful evaluation is recommended before choosing any method of dealing with high muscle tone

SDR (Selective Dorsal Rhizotomy) is a surgical procedure which is not reversible. It involves an operation under general anaesthetic, which aims to distinguish nerve branches giving unusual responses to stimuli. The nerves tested are those leading to and from spastic muscles in the legs. Any branches which reveal abnormal responses are cut by the paediatric neurosurgeon. 'Selective' means that the nerves which are cut have been selected by careful testing. 'Dorsal' refers to the top half of the nerves leading down from the brain, which is where they are cut. A Selective Dorsal Rhizotomy aims to permanently relieve spasticity in the legs, which means that walking may also improve.

The advantages of rhizotomies are that the effects are permanent. Young children have better ability to make the most of the reduction of tone, to increase their strength, and learn new movements to increase function. The disadvantages are that the effects cannot be undone, children must have good leg strength to make the most of the operation, and extensive therapy is needed afterwards. Careful evaluation is recommended before choosing any method of dealing with high muscle tone.

Phenol blocks are similar to Botox injections (see "What is Botox?"). Phenol has been used for the past 20 years, but has certain disadvantages when compared with Botox. The injections are quite painful, and may cause muscle tenderness for several days. There is also a small amount of permanent muscle damage caused by the injections. As a result, Phenol injections are giving way to Botox, which appears to be safer and is certainly less painful.

Note: Phenol blocks last longer and are more precise than Botox and may be the treatment of choice in some cases, especially for large muscle groups.

The Ketogenic Diet is a very precisely prescribed diet that is used to help control seizures in children with intractable epilepsy. The diet is very high in fat and low in sugar and carbohydrates. Calories and fluid are very strictly controlled and all food and fluids have to be precisely weighed and measured in order for the diet to work. The diet can be fairly complicated and will effect a family's daily routine

Cortical Vision Impairment (CVI) or cortical blindness results from injury to the brain's visual centres in the Cerebral cortex. A child with cortical blindness is able to pick up visual information with her eyes, but her brain cannot process and interpret the information correctly. The result is total or partial blindness. About 25 percent of children with hemiplegia have cortical visual impairments to parts of their visual field (hemianopia). They are able to see objects in front of them, but can't see objects to one side. Total cortical blindness is rare and usually occurs when there is extensive brain injury-for example, in children with severe quadriplegia.

Strabismus or "cross-eye" is due to an imbalance of the eye muscles and occurs in half of all children with spastic CP.

The treatment for strabismus is either glasses or patching. If this is unsuccessful, then surgery is needed to ensure that both eyes work together for visual acuity in each eye. The surgery may need to be repeated before proper alignment is obtained (25% of children with strabismus need more than one surgery).

FO stands for Ankle Foot Orthosis or leg braces. There are so many kinds of ankle-foot orthosis (orthosis = brace). Depending on the person’s needs, braces can do various things. A minimum requirement would be to hold at least 90 degrees.

DAFO stands for "Dynamic Ankle Foot Orthotic." DAFOs are specialized AFO's custom made from casts of the child's lower extremity and can be personalized with different colour padding, Velcro straps, and ribbon trim.

Your body jacket is designed to help stabilise your spine, restrict movement and provide support for the trunk. Body jackets of often used for children with CP to help them maintain correct positioning such as sitting up in the wheelchair and/or to prevent or reduce scoliosis (curvature of the spine).

Jackets are custom made for the individual.

The spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. But some people have spines that also curve from side to side. Unlike poor posture, these curves can't be corrected simply by learning to stand up straight. On X-ray, the spine of a person with scoliosis looks more like an "S" or a "C" than a straight line.

People with Cerebral Palsy have a high incidence of scoliosis which often becomes severe. This can lead to sitting balance problems for patients who are wheelchair dependent, and ultimately to respiratory and cardiac problems. Some patients can be treated with bracing, but many will benefit from surgery.

A gentle blend of stretching and massage, myofascial release therapy uses hands-on manipulation of the entire body. MFR consist of soft tissue mobilization and is enormously effective in increasing range and quality of movement. This technique is especially beneficial with patients that have spastic Cerebral Palsy and have limits with flexibility in their muscles and connective soft tissue.

The hip has two major structures: a cup shaped socket called the acetabulum and the ball shaped upper end of the femur (thigh bone). Developmental hip dysplasia implies that the alignment of the head of the femur (ball) to the acetabulum (socket) is not normal. The hip may be dislocated, subluxed or dislocatable. In dislocation, the growing femoral head sits completely out of the socket. In subluxation, the growing head is partially out of the socket and if the head can be displaced by the examiner, it is considered dislocated. Treatment for the unstable hip is aimed at achieving a repositioning of the hip in the socket, maintaining the improved position, and following the child’s hip development. Splints, braces, casts, tendon releases, and bony surgery are possible treatment choices for select hips.

Before the mid-twentieth century, few children with Cerebral Palsy survived to adulthood. Now, because of improvements in medical care, rehabilitation, and assistive technologies, 65 to 90 percent of children with Cerebral Palsy live into their adult years. This increase in life expectancy is often accompanied by a rise in medical and functional problems - some of them beginning at a relatively early age - including the following:

  • Premature aging. The majority of individuals with Cerebral Palsy will experience some form of premature aging by the time they reach their 40s because of the extra stress and strain the disease puts upon their bodies. The developmental delays that often accompany Cerebral Palsy keep some organ systems from developing to their full capacity and level of performance. As a consequence, organ systems such as the cardiovascular system (the heart, veins, and arteries) and pulmonary system (lungs) have to work harder and they age prematurely.
  • Functional issues at work. The day-to-day challenges of the workplace are likely to increase as an employed individual with Cerebral Palsy reaches middle age. Some individuals will be able to continue working with accommodations such as an adjusted work schedule, assistive equipment, or frequent rest periods. Early retirement may be necessary for others. Depression. Mental health issues can also be of concern as someone with Cerebral Palsy grows older. The rate of depression is three to four times higher in people with disabilities such as Cerebral Palsy. It appears to be related not so much to the severity of their disabilities, but to how well they cope with them. The amount of emotional support someone has, how successful they are at coping with disappointment and stress, and whether or not they have an optimistic outlook about the future all have a significant impact on mental health.
  • Post-impairment syndrome. Most adults with Cerebral Palsy experience what is called post-impairment syndrome, a combination of pain, fatigue, and weakness due to muscle abnormalities, bone deformities, overuse syndromes (sometimes also called repetitive motion injuries), and arthritis. Fatigue is often a challenge, since individuals with Cerebral Palsy use three to five times the amount of energy that able-bodied people use when they walk and move about.
  • Osteoarthritis and degenerative arthritis. Musculoskeletal abnormalities that may not produce discomfort during childhood can cause pain in adulthood. For example, the abnormal relationships between joint surfaces and excessive joint compression can lead to the early development of painful osteoarthritis and degenerative arthritis. Individuals with Cerebral Palsy also have limited strength and restricted patterns of movement, which puts them at risk for overuse syndromes and nerve entrapments.
  • Pain. Issues related to pain often go unrecognized by health care providers since individuals with Cerebral Palsy may not be able to describe the extent or location of their pain. Pain can be acute or chronic, and is experienced most commonly in the hips, knees, ankles, and the upper and lower back. Individuals with spastic Cerebral Palsy have an increased number of painful sites and worse pain than those with other types of Cerebral Palsy. The best treatment for pain due to musculoskeletal abnormalities is preventive - correcting skeletal and muscle abnormalities early in life to avoid the progressive accumulation of stress and strain that causes pain. Dislocated hips, which are particularly likely to cause pain, can be surgically repaired. If it is managed properly, pain does not have to become a chronic condition.
  • Other medical conditions. Adults have higher than normal rates of other medical conditions secondary to their Cerebral Palsy, such as hypertension, incontinence, bladder dysfunction, and swallowing difficulties. Curvature of the spine (scoliosis) is likely to progress after puberty, when bones have matured into their final shape and size. People with Cerebral Palsy also have a higher incidence of bone fractures, occurring most frequently during physical therapy sessions. A combination of mouth breathing, poor hygiene, and abnormalities in tooth enamel increase the risk of cavities and periodontal disease. Twenty-five percent to 39 percent of adults with Cerebral Palsy have vision problems; eight to 18 percent have hearing problems.

It is should also be noted that owing to the unique nature of their medical situation, adults with Cerebral Palsy benefit from regular visits to their doctor and ongoing evaluation of their physical status. It is important to evaluate physical complaints to make sure they are not the result of underlying conditions. For example, adults with Cerebral Palsy are likely to experience fatigue, but fatigue can also be due to undiagnosed medical problems that could be treated and reversed.

In addition, the fact that many individuals with Cerebral Palsy tend to outlive their primary caregiver demands that the issue of long-term care and support be taken into account and planned for.

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