Module 1: Introduction

Page Objectives 

When you have finished this workshop, you should have a clearer understanding about cerebral palsy, and be able to explain to someone else:

• What cerebral palsy is.
• The causes of cerebral palsy.
• What cerebral palsy looks like.
• How the brain influences movement and posture.
• Other problems often found with cerebral palsy

What is Cerebral Palsy

Has anyone ever told you why your child is not developing as expected, or why your child is disabled?

• What has the doctor or nurse told you?
• What do your family or neighbours say about your child?
• Have you ever heard the words Cerebral Palsy

Cerebral palsy is damage to part of the brain causing problems with movement and/or posture.

Medical Definition

Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviours, by epilepsy, and by secondary musculoskeletal problems. (Rosenbaum et al., 2007)

Questions Parents may ask

• Can other children catch cerebral palsy? Is it contagious?

NO. It cannot be passed from one child to another.

• Are all children with cerebral palsy the same?

NO. Cerebral palsy affects each child differently. Each child is unique, just as you are different from your neighbour, and your sister, mother, uncle, twin…

• Will my child die from cerebral palsy?

Cerebral palsy normally does not affect life-expectancy. Your child with cerebral palsy will grow up to be an adult with cerebral palsy. However, some of the complications of cerebral palsy (for example, severe postural problems leading to decreased lung capacity) can be life threatening.

• Can children with cerebral palsy go to school?

All children have the right to education. Generally speaking, in South Africa parents and teachers have low expectations of children with cerebral palsy.

• What do you expect of your child?

Remember, all children have the right to education, and that includes children with cerebral palsy.

• From what backgrounds do children with cerebral palsy come / Do they live in cities, or on farms? Are they rich or poor?

From all backgrounds. There are children (and adults) with cerebral palsy in every country of the world. And from every city, or town, or rural area. There are poor communities with children with cerebral palsy, and rich communities with children with cerebral palsy. It is commonly accepted that about one in every 400 children all over the world has cerebral palsy. There are no known published statistics about the incidence of cerebral palsy in South Africa.

• Do children with cerebral palsy always have below average intelligence?

Many children with cerebral palsy have average or above average intelligence. Some children with cerebral palsy have below average intelligence, and some may be profoundly intellectually disabled. But many children with cerebral palsy are labeled with an intellectual disability too early, especially when they have difficulty communicating, and are then not helped or trained to their
fullest potential.

• Can cerebral palsy be cured?

Cerebral palsy cannot be cured. Early help and training can help children‟s development. Remember your child with cerebral palsy will develop into an adult with cerebral palsy. Searching for a cure will only bring disappointment. Rather help your child to become an adult who can live with her disability and be as independent as possible. Sometimes, when a child is older and her muscles have become very stiff over a long time, operations can be done, or very strong medication can be used, which can help the child to sit or lie more comfortably.

• Does cerebral palsy get worse?

No. The damaged parts of the brain do not get better, but neither do they get worse. The child‟s movements, body positions and the other problems we spoke about can become more obvious as the child gets older, and seem worse, but they can also be improved. It depends on the amount of damage, and on how we handle and position the baby/child. The earlier you start to help your child to learn, the more she can develop. Sometimes, illnesses that affect the brain, like meningitis, or very severe prolonged bouts of epilepsy, can cause further damage to the child‟s brain. Such a child‟s disability will probably then become worse.

What Causes Cerebral Palsy

Now that we have discussed what cerebral palsy is, let‟s look at what the causes of cerebral palsy are.

The following table show all the risk factors that are associated with cerebral palsy – either before, during or after birth.

Risk Factors before Birth	Risk Factors around time of Birth	Risk Factors after Birth
Unknown Cause	Unknown cause	Very high fever
Alcohol / other drugs	Jaundice	Brain infections
Infections and illnesses of mother during pregnancy	Lack of oxygen	Head injuries
Rhesus incompatibility	Birth injuries	Lack of oxygen
Sexually transmitted diseases	Premature babies	Poisoning
Attempted abortion		Near drowning
Teenage Pregnancy
Pregnancy at an advanced age

Risk Factors before birth 

'Unknown cause'
No cause can be found in about 30% of children.
Alcohol and other Drugs
Drugs are not good, as they disturb the brain. Drugs are substances such as alcohol, tobacco, cocaine, glue, and non-prescription medication. If a pregnant mother uses drugs, they move through the blood to the umbilical cord and, from there, to the child which may cause damage to the child's brain that is still developing, e.g. a drunken person doesn't walk properly and his mind does not function well. In the same way, any drugs the mother takes will affect the child.

Infections of the mother while she is pregnant
These include German measles and shingles (herpes zoster). If a mother has German measles, her child can become disabled even before birth. This is why it is very important to immunise girls

Illnesses of the mother
Diabetes
Toxaemia of pregnancy
High blood pressure
If the mother has high blood pressure, her blood vessels become hardened or narrower. The blood circulation decreases, and the child won't receive enough blood and oxygen.
Rhesus incompatibility
When the blood of the mother and child doesn't go together well, there may be blockage. This may result in the clotting of brain vessels.

Sexually transmitted diseases
HIV / Aids - If a pregnant mother is HIV positive, there is a greater chance of her giving birth to a child with cerebral palsy than when the mother is HIV negative. The risk of cerebral palsy is also higher because the mother may already be immune-compromised or malnourished.
Neurosyphilis - This disease is curable but, if left untreated, it may cause a child to become disabled or blind.

Attempted abortion
If there was an attempted abortion, the child's brain may be affected.

Teenage pregnancy
When a mother is not yet physically ready to have a child, the unborn baby may sustain brain damage through prolonged delivery, due to the pelvis being too narrow. (A father under the age of 20 is a risk factor too, though not due to the size of his pelvis!)

Becoming pregnant at an advanced age
If a mother falls pregnant when she is over 40 years old, especially if it is her first child, her child may have cerebral palsy. When the mother is already older, her pelvic bones are hardened, as they haven't opened before. Delivery can be expected to be more difficult.

Risk factors around the time of birth

Lack of oxygen (air) at birth
The baby does not breathe soon enough and becomes blue and limp. In some areas, mis use of hormones (oxytocics) to speed up birth narrows the blood vessels in the womb so much that the baby does not get enough oxygen. The baby is born blue and limp-with brain damage.

Birth injuries from difficult births
These are mostly large babies of mothers who are small or very young. The baby's head may be pushed out of shape, blood vessels torn, and the brain disturbed.

Baby born too early (pre-maturity)
Babies born before 9 months and who weigh less than 2 kilos (5 pounds) are much more likely to have cerebral palsy. In rich countries, over half the cases of cerebral palsy happen in babies that are born early.

Jaundice (yellow baby)
Developing jaundice, which is a sign of an immature liver, may affect the central nervous system.

Risk factors after birth 

High fever and dehydration
Very high fever due to infection or dehydration (water loss from diarrhoea). It is more common in bottle-fed babies.

Brain infections
From meningitis or encephalitis. There can be many causes, including malaria and tuberculosis.

Head injuries
This can be from accidents, falling, and baby battering.

Lack of oxygen
From near drowning, gas poisoning, severe pneumonia or TB, or other causes.

Poisoning

From lead glazes on pottery, pesticides sprayed on crops, and other poisons.

Bleeding or blood clots in the brain

Often from unknown cause.

Brain tumours
A tumour is tissue in the brain that grows without control, causing pressure and damage to the brain. The signs are similar to cerebral palsy but steadily get worse ie it is progressive

What does Cerebral Palsy Look Like

No two children look exactly the same. It is important to remember that cerebral palsy affects every child differently. However, there are some broad categories which describe the main ways in which a child can be affected.

Let‟s look at these different ways that cerebral palsy can appear. We‟ll start with the child whose muscles are stiff. Medical people will call this "spasticity‟ or "hypertonia‟.

Muscle Stiffness or Hypertonia

The child who has has muscle stiffness, or 'muscle tension'. This causes part of her body to be rigid, or stiff. Movements are slow and awkward. Often the position of the head triggers strange positions of the whole body. The stiffness increases when the child is upset or excited, or when her body is in certain positions. The pattern of stiffness varies greatly from child to child and she has no control over these movements. These are children with stiff muscles. Notice the positions that the stiff parts of the body go into.