Cerebral palsy
In short
What is cerebral palsy?
This disability is the result of irreversible lesions on the brain of the fetus or infant, due to the destruction of certain developing brain cells, that we do not know how to repair.
These lesions cause a set of posture or movement disorders and are often accompanied by cognitive or sensory difficulties that last throughout the course of life.
Causes are mainly infections or diseases during pregnancy, important prematurity of difficult childbirth or diseases during the infant’s first months of life.
The type and importance of disorders depend on which parts of the brain are affected, on the extent of lesions and on the time when these lesions occurred.
A bit of history…
"Cerebral palsy" is the term used internationally to designate this group of disorders. It encompasses cerebral palsy, a term still widely used in France, and polyhandicap:
- Cerebral palsy disorder was described in the 1960s by Professor Guy Tardieu. It refers to predominant motor disorders, sometimes accompanied by sensory disorders, but without intellectual deficiency;
- Polyhandicap designates the most severe forms of motor and sensory disabilities, generally associated with intellectual disabilities.
What causes cerebral palsy?
Causes are multiple, and unexplained in 40% of cases.
Cerebral palsy is the result of a combination of events occurring either before, during or after birth that can lead to an injury in a baby’s developing brain .
These events include complications of a difficult delivery, neonatal stroke, but also an infection or illness during pregnancy (such as rubella, toxoplasmosis or side effects of certain medication) or during the first month of the child (meningitis for example, but also the consequences of trauma due to abuse).
These events will cause a decrease or even a stop of the supply of blood or oxygen to certain parts of the brain (it is referred to as anoxia-ischemia), or a cerebral haemorrhage, causing brain lesions.
These lesions are irreversible, and will cause the various motor, sensory or cognitive disorders experienced by individuals throughout their life.
Please note
Prematurity or low weight at birth are major causes. Premature birth (between 6 and 8 months) exposes the child to a risk of cerebral hemorrhage. The risk is even higher if the weight is low (less than 1500g) and the birth is premature (less than 31 weeks).
Variable consequences of cerebral palsy
Each person affected, depending on the localisation, the extent and the severity of their cerebral lesions, will present particular symptoms of motor disability as well and associated handicaps. It is this heterogeneity of disorders that makes cerebral palsy difficult to define and study.
Some children will only present an isolated motor disability, without any cognitive disability. Other will associate one or several cognitive disabilities with their handicap. Some will walk, “merely” limping, whereas others, quadriplegic, will be totally dependent for all daily actions. Between those two extremes, all intermediary conditions are possible.
What type of treatments for children affected by cerebral palsy?
Cerebral plasticity being more important in the first years of life, it is essential to diagnose cerebral lesions early in order to start care as soon as possible. Implemented elements must be tailored to the wide diversity of affections and needs of each person affected, baring in mind that the combination of disorders is a complexity specific to cerebral palsy.
Care for a child affected by cerebral palsy is therefore in most cases multidisciplinary. Although there is no curative treatment for cerebral palsy, some cares will be able to help the children and allow them to execute some movements with no exterior help, to maintain a posture or to support their body.
In case of contractures, it may be necessary to use the following:
- Injections of botulinic toxin which helps muscles relax;
- Surgery to limit secondary deformations due to contractures in a certain number of cases;
- edication favouring muscular relaxation (for example baclofen)
- Technical assistance such as electric wheelchairs which improve autonomy of affected people who cannot walk by themselves.
Intensive and playful re-education HABIT-ILE
HABIT-ILE (Hand and Arm Bimanual Intensive Therapy Including Lower Extremity) is a new type of intensive rehabilitation involving constant stimulation of the upper and lower limbs.
It is part of new rehabilitation methods which can be offered to children from an early age. Nevertheless, its access is still difficult as training professionals outside research centres has just started. For the time being there is no long-term financing by the National Health.
Physiotherapy
From early childhood and throughout adult life, functional rehabilitation enables the person affected by cerebral palsy to progress by helping them to most effectively use their intact neurological structures. It allows to prevent joint stiffness and deformation. It is also essential for cardio-respiratory effort training and learning to walk for children & adults.
Physical activity and adapted sports
They are essential for children and adults, although always insufficiently accessible.
In its recommendation concerning rehabilitation of the musculoskeletal motor function for people diagnosed with cerebral palsy, the Haute Autorité de Santé (Health Authority) reminds that physical activity and sports are two key priorities relative to re-education and rehabilitation (October 2021).
Occupational therapy
It enables to work on fine motor skills but also to best adapt the person’s environment.
The aim is to maintain and develop the child’s autonomy using playful and home-made training on daily situations (dressing, personal care, feeding, communicating...)
Speech therapy
Allows to work on elocution and language.
Psychomotricity
It allows to work around body awareness, body schema, proprioception, body image, space and time. It offers stimulations adapted to patients in order to use their capacities and possible evolution.
