Report on Pathophysiology, Public Health, Assessment And Treatment

Report on Pathophysiology, Public Health, Assessment And Treatment

An evaluation of Cerebral palsy as a medical condition

A Cerebral Palsy is a group of neurological disorders caused by damage in the brain that harms the movement of the muscles and is considered as the most common movement-related disability. According to the CDC, it affects 2 to 5 out of every 1,000 children all over the world. The potential problems that children with cerebral palsy may have to include motor disabilities, problems in establishing communication, difficulties in Learning, partial loss of hearing, epilepsy and spinal problems (Peterson et al., 2015). It affects over 400,500 people in the United States and is known to be the most common motor deformity in children with over 78% of children having spastic cerebral palsy. There is no definite cure for the deformity. However with treatments and proper therapies a big difference can be made. A severely damaged brain is the primary cause of cerebral palsy but there exist many other factors too that may trigger the damage. These include:

  • Inadequate development of the brain in the womb
  • Maternal infections
  • Irregularities in the blood flow to the brain
  • Genetics related conditions
  • Premature delivery
  • Damage to the head at the time of birth

It is probable that small medical mistakes can cause brain damage during the birth of the child and might lead to cerebral palsy. These few mistakes can be any kind of malpractice that might have lead to depriving the baby of oxygen during childbirth or excessive use of vacuum, failure in performing a cesarean section, failure to secure proper treatment during pregnancy, etc.

The symptoms may vary from individual to individual and the symptoms might show more or less severity over time. Common symptoms include:

  • Difficulty in acquiring basic motor skills like sitting and crawling
  • Irregularities in muscle movement, being too stiff or too loose
  • Slow communication development
  • Making excessive use of a particular side of the body
  • Problems in the nervous system
  • Types of cerebral palsy
  • Spastic Cerebral Palsy

This accounts for more than 70% of all the cases of Cerebral Palsy. It leads to excessive muscle tone and causes:

  • Delayed motor movements
  • Abnormal growth
  • Stiff muscles
  • Difficulty in controlling movement

Spastic quadriplegia has an impact on the upper body and lower limbs to f a child and causes adverse effects on mobility
Spastic diplegia has an impact on only the lower half of the child's body. Usually, many children can still manage to walk but due to impairments, they might need helpers or walkers.
Spastic hemiplegia has an impact on only one side of the child's body, usually the arms. Almost all children with hemiplegia can manage to walk.
Dyskinetic Cerebral Palsy comes second in the most common cerebral palsy list. Its symptoms include:

  • Repetitive movements of the body
  • Athetosis
  • Unpredictable hand and limb movements
  • Bad body posture
  • Experiencing pain while making movements
  • Difficulty while talking or swallowing food

Ataxic Cerebral Palsy is termed as the most uncommon cerebral palsy of all. It causes poor movement coordination, difficulty in balancing, Shaking of the body, etc.
Mixed Cerebral Palsy has symptoms of a mixture of two-three different types. Spastic dyskinetic cerebral palsy is considered to be the most common type of Cerebral Palsy.
One can find out that his/her child has Cerebral Palsy if there exists a delay in movements and poor motor skills like holding objects, sitting, and even walking (Novak et al., 2017). The appearance of the body parts as too stiff or too loose and inability in standing even with external support are also some symptoms. If we think of its diagnosis, there is no particular test for it. It makes use of multiple tests and days of observation to get the most appropriate diagnosis. The pediatrician either makes a diagnosis or recommends a specialist if a person is of the view that his/her child has problems in motor development and muscle coordination.

Can Cerebral Palsy be prevented?

There is no definite method to prevent Cerebral Palsy but there exist a few steps that help in lowering the risk. These include:

  • Taking care of the mother's health during pregnancy and managing all pre-existing medical issues properly
  • Maintaining healthy habits during pregnancy
  • Visiting obstetrician and maintain regular checkups and appointments
  • Getting tested for possible complications

There doesn't exists a definite cure for Cerebral Palsy but it also doesn't get worse with time as it is not progressive. However, early diagnosis and therapies can reduce the effect and also improve mobility.

Clinical presentation of the condition

The 2003 American academy of neurology (AAN) suggests testing for the below mentioned potential cerebral palsy associated deficits:
•    Mental instability
•    Hearing impairments
•    Speech disorders
•    Motor dysfunction
Cerebral palsy manifests as early hypotonia during the first 6 months to 12 months of life after which comes spasticity. A visible hand preference before 12 months is a 'red flag' and suggests possible hemiplegia.
Prenatal history must include basic and important information related to the mother's pregnancy such as exposure to drugs, toxins, radiation, depression or diseases before pregnancy (Gulati and Sondhi, 2018). A piece of detailed information related to the history of abortions and family history is also vital. The perinatal history must have information regarding the child's gestation age during birth, the kind of delivery that was performed, the weight of the child during birth and complications during the surgery (if any).

Developmental history

This should include all the essential information regarding the child's motor growth, language adaptation, and completion of milestones from birth till the time of evaluation. The age usually by which motor milestones are achieved include control over the head at the age of 2-3 months, rolling of the body at the age of 4-5 months, sitting at the age of 6 or 7 months and walking by the time the child is of 1 year (Maenneret al., 2016.). Infants with CP may suggest poor growth of motor skills and early hand preference by the age of 18 months suggesting the underdevelopment of the other side. The social skills of these children along with their performance at schools and academics should be reviewed. Cognitive and educational testing can be put into use to determine if speech therapy or physical therapy is required. An assessment of patient's dependence on equipment and communication devices should be reviewed such as computerized speech programs, walkers, wheelchairs, etc. 

Physical examination

Physical indicators of CP may include difficulty and pain in joint movements, spastic muscles, delay in the growth of cognitive and motor skills and repetitive reflexes.
Before the examination, observation may suggest abnormalities in neck tone, stiff posture, low strength, and difficulty in coordination of hand and limb movements.The overall pattern should be reviewed and each joint both in the upper and lower body must be assessed like the hip, knee, and foot.
Children suffering from cerebral palsy are required to have a proper life care plan consisting big diagnosis, a group of specialists, thorough research, observation and evaluation and laying down of a set of goals (Benevides et al., 2017). Everything mentioned above will eventually lead up to those goals

The purpose of care plan goals

The first and most important reason to maintain a care plan is to have something which will act like a map leading to a child's healthy life. It will consist of everything that is needed to provide him/her with a good life, from diagnosis to evaluation to an assessment of his strengths and weaknesses. Goals may be short term and related to the health and well being of the child. They might also be long term like securing a job.

Categories of goals

Since the condition of children with cerebral palsy is a complex one, simply organizing goals is crucial to make it a little easier to understand and comprehend.

Managing of the initial disability

CP is complex but the initial goal should be to manage the primary condition of the child. To achieve this objective the taking the assistance of a neurologist or paediatrician is very important.

Managing complications

CP has several co-existing conditions like movement and coordination disorders, seizures, underdevelopment of cognitive skills. Laying down of goals to improve in these is the next crucial step.

Improving mobility

Problems in mobility are the most common issue that children with cerebral palsy face and most of them are unable to walk. Goals addressing improving mobility are important to make the child feel comfortable and confident.

Managing pain

Pain is the component that comes hand in hand with Cerebral Palsy. Stiff muscles, spastic movement and inability to move causes pain to the child and setting goals to manage pain is extremely important to help him become more comfortable thereby helping in achieving other simultaneous goals.

Working on communication

A child diagnosed with cerebral Palsy not only has underdeveloped cognitive skills but also has tremendous difficulty in communicating as their vocal cords have been affected adversely due to their medical condition. If a child is struggling with speech and language, including this goal is important to achieve a greater ability to communicate through speech or other ways.

Encouraging socialization

A child suffering from cerebral palsy may have difficulties in making social interactions with people. He may have trouble in making conversation with his peers. But because this is an important aspect of life, it is important for the child to connect with others and for that reason the setting of this goal is important. 
Other goals that are also important are goals related to education, self-care, maximizing the good qualities of life and independence. The setting of goals is an important aspect of life for everybody but a child born with a disability, it is more important. To give a child a better chance at living a good life, taking off these goals seriously is very important.

  • Treatment plan
  • The cerebral palsy treatment makes use of a multidisciplinary team and a comprehensive effective plan. Stated below is a six-step treatment plan which includes:
  • Obtaining a diagnosis of the patient and acquiring his/her medical records
  • Assembling of a care team
  • Assessing abilities 
  • Laying down of goals
  • Creating a proper plan, monitoring and coordinating it
  • Developing and maintaining records
  • Rational intervention

Treatment Plan for the patient

Performing a diagnosis is important to provide the patient with an explanation of the type of brain injury, it's location, possible causes and the extent to which it has spread and a description of other associated conditions (Levitt and Addison , 2018). A medical care plan is essential for addressing all medical conditions and making sure that one treatment does not come in the way of another or prove to be harmful to the child. The listing of goals helps in providing a child with the highest degree of independence and good quality of life in the long run. Researching about the condition will help in optimizing the life expectancy of the child, improves mobility, helps in socializing, developing seizure control and improves cognitive function. All the treatments are required to be well-coordinated so that any procedure does not affect the child in any way or put his/ her/ health in jeopardy. Maintaining Medical records of a patient with cerebral Palsy has several advantages like the evaluation of progress, helpful in updating new goals and plans, reduce duplication costs, obtaining assessment results, etc and these records can be used at any point in the development and treatment of the child.

The approach of Centres for Disease Control and Prevention:

Promoting early identification of Cerebral Palsy

Through the 'Learn the signs. Act early' program, the authorities of CDC are aiming to improve and initiate early identification of children for disabilities by promoting monitoring and screening so that patients are detected early and necessary help and support are provided.
Determining how many people are affected by this medical condition.
If the number of children suffering from cerebral palsy is tracked, it will be easier to find out if their numbers are increasing or falling or staying constant (Spittle et al., 2018). A comparison between patients from different parts of the country can also be made to observe different traits and new features for better understanding.

Understanding risk factors

Research can be initiated for finding out potential risk factors or new ways for the prevention of Cerebral Palsy. Both tracking and researching are required for direct prevention efforts.

Increasing awareness

Spreading awareness and circulating important information regarding cerebral palsy is extremely crucial for the prevention of the condition and ways to improve it.According to some research, for the treatment of children with CP in Korea over the last ten years, the percentage of patients that received outpatient treatment was way more than those who received inpatient treatment. With the help of the 2007 National survey of children's health many types of research have found that about 4% of US children have unmet medical needs, especially the ones having CP. Of 3,552,000 babies born between 2003 and 2011, a total of 13.500 children were treated for CP. Constant attempts are being made to improve these numbers and to help patients with CP and their families as much as possible. CDC held its first Cerebral Palsy awareness day in March 2006. 

References List

Peterson, M.D., Ryan, J.M., Hurvitz, E.A. and Mahmoudi, E., 2015. Chronic conditions in adults with cerebral palsy. Jama, 314(21), pp.2303-2305.
Novak, I., Morgan, C., Adde, L., Blackman, J., Boyd, R.N., Brunstrom-Hernandez, J., Cioni, G., Damiano, D., Darrah, J., Eliasson, A.C. and De Vries, L.S., 2017. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA pediatrics, 171(9), pp.897-907.
Gulati, S. and Sondhi, V., 2018. Cerebral palsy: an overview. The Indian Journal of Pediatrics, 85(11), pp.1006-1016.
Maenner, M.J., Blumberg, S.J., Kogan, M.D., Christensen, D., Yeargin-Allsopp, M. and Schieve, L.A., 2016. Prevalence of cerebral palsy and intellectual disability among children identified in two US National Surveys, 2011–2013. Annals of epidemiology, 26(3), pp.222-226.
Benevides, T.W., Carretta, H.J., Ivey, C.K. and Lane, S.J., 2017. Therapy access among children with autism spectrum disorder, cerebral palsy, and attention?deficit–hyperactivity disorder: a population?based study. Developmental Medicine & Child Neurology, 59(12), pp.1291-1298.
Levitt, S. and Addison, A., 2018. Treatment of cerebral palsy and motor delay. John Wiley & Sons.
Spittle, A.J., Morgan, C., Olsen, J.E., Novak, I. and Cheong, J.L., 2018. Early diagnosis and treatment of cerebral palsy in children with a history of preterm birth. Clinics in perinatology, 45(3), pp.409-420.