Cerebral palsy
In a few words
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 movement or postural disorders, often accompanied by cognitive or sensory difficulties. It is a permanent condition.
The main risk factors are infection or illness during pregnancy, prematurity or a difficult childbirth, or illness during the first months of the child’s life.
For each affected individual, the nature and extent of the disorders depend on the affected areas of the brain, the extent of the lesions, and the timing of the lesions.
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 L’infirmité motrice cérébrale was described in the 1960s by Professor Guy Tardieu. It refers to predominant motor disorders, sometimes accompanied by sensory disorders, but without intellectual impairment;
- Polyhandicap refers to the most severe forms of motor and sensory impairment, generally associated with intellectual deficiencies.
The causes of cerebral palsy
The causes of cerebral palsy are multiplebut the cause is unknown 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 and low birth weight are important causes. Premature birth (between 6 and 8 months of pregnancy) exposes the child to the risk of cerebral hemorrhage. The greater the risk, the smaller the point (less than 1500 g) and the more premature the birth (less than 31 weeks).
Variable Disabilities
Some children will only show an isolated motor deficiency without any cognitive impairment. Others associate one or more cognitive impairments with their motor deficiency. Some will walk, with a slight limp, while others, quadriplegics, will be totally dependent for each everyday activity. Between these two extremes, all intermediate states are possible.
Some children will only show an isolated motor deficiency without any cognitive impairment. Others associate one or more cognitive impairments with their motor deficiency. Some will walk, with a slight limp, while others, quadriplegics, will be totally dependent for each everyday activity. Between these two extremes, all intermediate states are possible. Entre ces deux extrêmes, tous les états intermédiaires sont possibles.
What type of treatment for people wlo live with cerebral palsy?
La plasticité cérébrale étant plus importante dans les premières années de la vie, il est essentiel que le diagnostic de lésions cérébrales soit posé précocement afin de démarrer une prise en charge adaptée dès que possible. Les éléments mis en œuvre doivent être adaptés à la grande diversité des atteintes et des besoins de chaque personne touchée, sachant que la combinaison des troubles est un facteur de complexité spécifique à la paralysie cérébrale.
As cerebral plasticity is greatest in the first years of life, it is essential to diagnose cerebral lesions at an early stage, so that appropriate care can begin as soon as possible. The elements implemented must be adapted to the wide variety of disorders and needs of each person affected, bearing in mind that the combination of disorders is a factor of complexity specific to cerebral palsy. The care of a child with cerebral palsy is therefore usually multidisciplinary. While there is as yet no cure for cerebral palsy, certain treatments can help the child to make movements without outside help, to maintain a position or to support his or her body.
En cas de contractures, il peut être nécessaire d’avoir recours :
- botulinum toxin injections, which allow the muscle to relax;
- surgery to limit the deformities caused by contractures in certain cases;
- surgery to limit the deformities caused by contractures in certain cases;
- technical aids, such as electric wheelchairs, help people who can't walk on their own.
HABIT-ILE intensive and fun rehabilitation
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 one of the new rehabilitation methods that can be offered to children from an early age. Nevertheless, it is still very difficult to access, as training for professionals outside research centers has only just begun, and there is as yet no permanent funding from the French Social Security system.
Physical therapy
Beginning in early childhood and continuing throughout adulthood, functional rehabilitation helps people with cerebral palsy to make the best possible use of their intact neurological structures. In particular, it helps prevent joint stiffness and deformity. It is also essential for cardio-respiratory exercise training and gait training, for both children and adults.
Physical activity and adapted sports
They are essential for both children and adults, but are still not sufficiently accessible.
In its recommendations for the re-education and rehabilitation of motor function in the locomotor system of people diagnosed with cerebral palsy, the French National Authority for Health (HAS) reminds us that physical activity and sports activities are two of the priority areas of intervention in re-education and rehabilitation (October 2021).
Ergotherapy
It allows to work on fine motor skills, but also to optimize the child's environment.
The aim of this type of therapy is to maintain or develop the child's autonomy in daily activities, through play and craft activities and role-playing (dressing, personal care, eating, communication, etc.).
Speech therapy
It allows to work on speech and language.
Psychomotricity
It focuses on body awareness, body schema, proprioception, body image, space and time. It offers stimuli adapted to the patient's needs, to capitalize on his or her abilities and potential for development.