Congenital Hemiplegic Cerebral Palsy Health Essay

55 patients, 32 male and 23 female with their age runing from ( 6-8 ) old ages with a mean ( 7 ± 1.2 ) were indiscriminately selected and participated in this survey. Patients were referred Physical Therapy and Rehabilitation section of El-Noor Hospital, Makkah, Saudi Arabia and selected harmonizing to the inclusion and exclusion standards.
The inclusion standards were as follow: The participated kids had a confirmed diagnosing of inborn hemiplegic intellectual paralysis in the prenatal, perinatal, or postpartum period confirmed by magnetic resonance images ( MRIs ) obtained from medical records or personal doctors.Congenital Hemiplegic Cerebral Palsy Health Essay. The grade of spasticity in involved lower appendage harmonizing to Modified Ashworth Scale ranged between classs 1, 1+ and 2 [ 31 ] as shown in the patient flow chart in figure 1.
The degrees of gross motor map were between degrees I through III harmonizing to Gross Motor Function Classii¬?cation System ( GMFCS ) , [ 32 ] degrees I through III ( table 1 ) . Persons with GMFCS degree I ambulate independently without restrictions, but may hold restrictions in more advanced gross motor accomplishments ; individuals with degree II ambulate independently but have restrictions walking out-of-doorss and in the community ; and individuals with degree III ambulate with an assistive device. Children were cognitively competent and able to understand and follow instructions. There were no serious or repeating medical complications harmonizing to the medical study signed by their doctor. During the survey, kids were non having other intercessions to better involved lower appendage map.
The exclusion standards
The exclusion standards included Children who had ocular job that would forestall them from executing the intercession, , uncontrolled ictuss, had no recent history of spasticity-altering specially for tendoachilis and calf musculuss in the affected limb.They were at least one twelvemonth station orthopedic or neurological surgery, 6 months post botulinus toxin type A ( Botox ) injections, and had no history spasticity medicine within 3 months prior to proving. Children were besides excluded if there were fixed contractures or stiffness in the affected lower appendage that would restrict activity battle.
Sample size
In order to cipher a sample size, a preliminary power analysis was applied with power = 0.80, ? = 0.05, utilizing Wilcoxon sing ranking trial, expected consequence size = 0.80 with a consequence of sample size of entire 54 patients at least.

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Treatment groups
The participated kids divided into two groups. The first group ( 35 participants ) received traditional neurodevelopmental physical therapy rehabilitation plan in add-on to floor moving ridge therapy. The other control group ( 20 participants ) received the same plan but with placebo daze wave therapy. The traditional plan consists of beef uping exercisings, stretching exercisings, postural reactions facilitation exercisings, automatic inhibiting forms except for TA of affected limb, pace preparation. This plan strength for one hr, three times / hebdomad for 6 hebdomads.
A individual blinded randomised clinical test was used as the patients did non cognize in which group was assigned and which intervention would be taken. Randomization was performed merely by inquiring the one of the parents to take a piece of paper in which A, B missive was written. ( A ) considered as a Shock moving ridge group, while ( B ) considered as traditional exercisings group. All parents were given a full account of the intervention protocol and a written informed consent signifier to subscribe their understanding for engagement in the survey and publication of the consequences.Congenital Hemiplegic Cerebral Palsy Health Essay. Study was approved by the Ethics Review Committee from the module of applied medical scientific discipline, Um Al Qura University and parents signed a consent signifier authorising the kid ‘s engagement.
Shock wave instrumentality and intervention
A RSWT device ( shock maestro 500 ) consisting of a control unit, a 15 millimeter handpiece and a medical air compressor ( 40 dubnium, 8 saloon, 50l/min ) was used. The compressor generates a pneumatic energy ( Positive end product force per unit area: 18.5 Mpa, Frequency scope: 1 to 21 Hz, Max. energy denseness: 0.38 mJ/mm? ) that is used to speed up a missile inside the handpiece. When the missile strikes the applier, a daze moving ridge is generated and radially spreads from the tip of the applier to the mark zone.
The RSWT was administered utilizing a V-ACTOR manus piece ( applicator 15 millimeter ) . Each patient in the intervention session received 1,500 urges per session ( 500 urges with a force per unit area of 0.5 saloon and a frequence of 15 Hz and 1,000 urges with a force per unit area of 1.0 saloon and a frequence of 20 Hz ) , an EFD of 0.10 mJ/mm2, and a fixed impulse clip of 2 msecs. The intervention country was prepared with a matching gel ( ultrasound gel ) to minimise the loss of shock-wave energy at the interface between applier tip and tegument.
The force per unit area pulsations were focused in the hypertonic musculuss of the lower limb: 1500 shootings were used to handle each gastrocnemius musculuss and soleus musculuss chiefly in the center of the belly. Different points of application were used to handle several countries of the hypertonic musculuss. Because low energy is used, the therapy is painless and does non necessitate the usage of anaesthesia, analgetic drugs or utilizing an ultrasound arrow usher during application
A placebo intervention without daze wave energy was applied with the indistinguishable instrumentality, with the arrow over the musculus. The same high-intensity sound was utilized in all patients.
Appraisal of GMFM
The judges ( physical healers ) who performed all the appraisals throughout the survey did non take portion in the intercession plan. They besides had non been informed about which group ; each evaluated kid was belonged ( blind assessors ) . The GMFM was used to measure alterations in gross motor accomplishment and mobility. [ 33 ] The GMFM is a standard mention tool designed to mensurate alteration in gross motor map over clip in kids with motor damage, and has been validated for sensitiveness to alter in kids with CP. Merely the points from the walk/run/jump dimension were administered. Both the GMFM-88 and GMFM-66 tonss were used to take advantage of the improved grading with the GMFM-66. [ 34 ]
Outcome step
Evaluation for alterations in gross motor accomplishment and the spasticity alterations were the mensurating result. Evaluation for alterations in gross motor accomplishment is performed by utilizing the gross motor map step ( GMFM ) and the spasticity alterations determined by measuring H/M ratio and entering the sum of take downing in this per centum between pre and station intervention scenes.
Statistical analysis
A descriptive statistical survey of the quantitative parametric quantities of mean and SD was performed. Clinical and electrophysiological and instrumental values for each patient were analyzed by Wilcoxon signed-rank trial. The alpha degree chosen for all analyses was 0.05.Congenital Hemiplegic Cerebral Palsy Health Essay.

Cerebral palsy refers to a group of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination Cerebral palsy (CP) is caused by damage to or abnormalities inside the developing brain that disrupt the brain’s ability to control movement and maintain posture and balance. The term cerebralrefers to the brain; palsy refers to the loss or impairment of motor function.

Cerebral palsy affects the motor area of the brain’s outer layer (called the cerebral cortex), the part of the brain that directs muscle movement.

In some cases, the cerebral motor cortex hasn’t developed normally during fetal growth. In others, the damage is a result of injury to the brain either before, during, or after birth. In either case, the damage is not repairable and the disabilities that result are permanent.

Children with CP exhibit a wide variety of symptoms, including:

• lack of muscle coordination when performing voluntary movements (ataxia);
• stiff or tight muscles and exaggerated reflexes (spasticity);
• weakness in one or more arm or leg;
• walking on the toes, a crouched gait, or a “scissored” gait;
• variations in muscle tone, either too stiff or too floppy;
• excessive drooling or difficulties swallowing or speaking;
• shaking (tremor) or random involuntary movements;
• delays in reaching motor skill milestones; and
• difficulty with precise movements such as writing or buttoning a shirt.

The symptoms of CP differ in type and severity from one person to the next, and may even change in an individual over time. Symptoms may vary greatly among individuals, depending on which parts of the brain have been injured. All people with cerebral palsy have problems with movement and posture, and some also have some level of intellectual disability, seizures, and abnormal physical sensations or perceptions, as well as other medical disorders. People with CP also may have impaired vision or hearing, and language, and speech problems.

CP is the leading cause of childhood disabilities, but it doesn’t always cause profound disabilities.  While one child with severe CP might be unable to walk and need extensive, lifelong care, another child with mild CP might be only slightly awkward and require no special assistance. The disorder isn’t progressive, meaning it doesn’t get worse over time. However, as the child gets older, certain symptoms may become more or less evident.

A study by the Centers for Disease Control and Prevention shows the average prevalence of cerebral palsy is 3.3 children per 1,000 live births.

There is no cure for cerebral palsy, but supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.

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What are the early signs?

The signs of cerebral palsy usually appear in the early months of life, although specific diagnosis may be delayed until age two years or later. Infants with CP frequently have developmental delay, in which they are slow to reach developmental milestones such as learning to roll over, sit, crawl, or walk. Some infants with CP have abnormal muscle tone. Decreased muscle tone (hypotonia) can make them appear relaxed, even floppy. Increased muscle tone (hypertonia) can make them seem stiff or rigid. In some cases, an early period of hypotonia will progress to hypertonia after the first 2 to 3 months of life. Children with CP may also have unusual posture or favor one side of the body when they reach, crawl, or move. It is important to note that some children without CP also might have some of these signs.

Some early warning signs:

In a Baby Younger Than 6 Months of Age

• His head lags when you pick him up while he’s lying on his back
• He feels stiff
• He feels floppy
• When you pick him up, his legs get stiff and they cross or scissor

In a Baby Older Than 6 Months of Age

• She doesn’t roll over in either direction
• She cannot bring her hands together
• She has difficulty bringing her hands to her mouth
• She reaches out with only one hand while keeping the other fisted

In a Baby Older Than 10 Months of Age

• He crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg
• He cannot stand holding onto support

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What causes cerebral palsy?

Cerebral palsy is caused by abnormal development of part of the brain or by damage to parts of the brain that control movement. This damage can occur before, during, or shortly after birth. The majority of children have congenital cerebral palsy CP (that is, they were born with it), although it may not be detected until months or years later. A small number of children have acquired cerebral palsy, which means the disorder begins after birth. Some causes of acquired cerebral palsy include brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, problems with blood flow to the brain, or head injury from a motor vehicle accident, a fall, or child abuse.

In many cases, the cause of cerebral palsy is unknown. Possible causes include genetic abnormalities, congenital brain malformations, maternal infections or fevers, or fetal injury, for example. The following types of brain damage may cause its characteristic symptoms:

Damage to the white matter of the brain (periventricular leukomalacia, or PVL). The white matter of the brain is responsible for transmitting signals inside the brain and to the rest of the body.  Damage from PVL looks like tiny holes in the white matter of an infant’s brain. These gaps in brain tissue interfere with the normal transmission of signals. Congenital Hemiplegic Cerebral Palsy Health Essay.Researchers have identified a period of selective vulnerability in the developing fetal brain, a period of time between 26 and 34 weeks of gestation, in which periventricular white matter is particularly sensitive to insults and injury.

Abnormal development of the brain (cerebral dysgenesis).  Any interruption of the normal process of brain growth during fetal development can cause brain malformations that interfere with the transmission of brain signals. Mutations in the genes that control brain development during this early period can keep the brain from developing normally. Infections, fevers, trauma, or other conditions that cause unhealthy conditions in the womb also put an unborn baby’s nervous system at risk.

Bleeding in the brain (intracranial hemorrhage).  Bleeding inside the brain from blocked or broken blood vessels is commonly caused by fetal stroke.   Some babies suffer a stroke while still in the womb because of blood clots in theplacenta that block blood flow in the brain.  Other types of fetal stroke are caused by malformed or weak blood vessels in the brain or by blood-clotting abnormalities.  Maternal high blood pressure (hypertension) is a common medical disorder during pregnancy and is more common in babies with fetal stroke.  Maternal infection, especially pelvic inflammatory disease, has also been shown to increase the risk of fetal stroke.

Severe lack of oxygen in the brain.   Asphyxia, a lack of oxygen in the brain caused by an interruption in breathing or poor oxygen supply, is common for a brief period of time in babies due to the stress of labor and delivery.  If the supply of oxygen is cut off or reduced for lengthy periods, an infant can develop a type of brain damage called hypoxic-ischemic encephalopathy, which destroys tissue in the cerebral motor cortex and other areas of the brain.   This kind of damage can also be caused by severe maternal low blood pressure, rupture of the uterus, detachment of the placenta, or problems involving the umbilical cord, or severe trauma to the head during labor and delivery.

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What are the risk factors?

There are some medical conditions or events that can happen during pregnancy and delivery that may increase a baby’s risk of being born with cerebral palsy. These risks include:

Low birthweight and premature birth. Premature babies (born less than 37 weeks into pregnancy) and babies weighing less than 5 ½ pounds at birth have a much higher risk of developing cerebral palsy than full-term, heavier weight babies.  Tiny babies born at very early gestational ages are especially at risk.

Multiple births.  Twins, triplets, and other multiple births — even those born at term — are linked to an increased risk of cerebral palsy. The death of a baby’s twin or triplet further increases the risk.

Infections during pregnancy.  Infections such as toxoplasmosis, rubella (German measles), cytomegalovirus, and herpes, can infect the womb and placenta. Inflammation triggered by infection may then go on to damage the developing nervous system in an unborn baby. Maternal fever during pregnancy or delivery can also set off this kind of inflammatory response.

Blood type incompatibility between mother and child.   Rh incompatibility is a condition that develops when a mother’s Rh blood type (either positive or negative) is different from the blood type of her baby. Congenital Hemiplegic Cerebral Palsy Health Essay.The mother’s system doesn’t tolerate the baby’s different blood type and her body will begin to make antibodies that will attack and kill her baby’s blood cells, which can cause brain damage.

Exposure to toxic substances.  Mothers who have been exposed to toxic substances during pregnancy, such as methyl mercury, are at a heightened risk of having a baby with cerebral palsy.

Mothers with thyroid abnormalities, intellectual disability, excess protein in the urine, or seizures.  Mothers with any of these conditions are slightly more likely to have a child with CP.

There are also medical conditions during labor and delivery, and immediately after delivery that act as warning signs for an increased risk of CP. However, most of these children will not develop CP. Warning signs include:

Breech presentation.  Babies with cerebral palsy are more likely to be in a breech position (feet first) instead of head first at the beginning of labor. Babies who are unusually floppy as fetuses are more likely to be born in the breech position.

Complicated labor and delivery.  A baby who has vascular or respiratory problems during labor and delivery may already have suffered brain damage or abnormalities.

Small for gestational age.  Babies born smaller than normal for their gestational age are at risk for cerebral palsy because of factors that kept them from growing naturally in the womb.

Low Apgar score.   The Apgar score is a numbered rating that reflects a newborn’s physical health. Doctors periodically score a baby’s heart rate, breathing, muscle tone, reflexes, and skin color during the first minutes after birth. A low score at 10-20 minutes after delivery is often considered an important sign of potential problems such as CP.

Jaundice. More than 50 percent of newborns develop jaundice (a yellowing of the skin or whites of the eyes) after birth when bilirubin, a substance normally found in bile, builds up faster than their livers can break it down and pass it from the body. Severe, untreated jaundice can kill brain cells and can cause deafness and CP.

Seizures.  An infant who has seizures faces a higher risk of being diagnosed later in childhood with CP.

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Can cerebral palsy be prevented?

Cerebral palsy related to genetic abnormalities cannot be prevented, but a few of the risk factors for congenital cerebral palsy can be managed or avoided. For example, rubella, or German measles, is preventable if women are vaccinated against the disease before becoming pregnant. Rh incompatibilities can also be managed early in pregnancy.Congenital Hemiplegic Cerebral Palsy Health Essay. Acquired cerebral palsy, often due to head injury, is often preventable using common safety tactics, such as using car seats for infants and toddlers.

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What are the different forms?

The specific forms of cerebral palsy are determined by the extent, type, and location of a child’s abnormalities. Doctors classify CP according to the type of movement disorder involved — spastic (stiff muscles), athetoid (writhing movements), or ataxic (poor balance and coordination) — plus any additional symptoms, such weakness (paresis) or paralysis (plegia). For example, hemiparesis (hemi = half) indicates that only one side of the body is weakened.Quadriplegia (quad = four) means all four limbs are afffected.

Spastic cerebral palsy is the most common type of the disorder. People have stiff muscles and awkward movements. Forms of spastic cerebral palsy include:

• Spastic hemiplegia/hemiparesis typically affects the arm and hand on one side of the body, but it can also include the leg. Children with spastic hemiplegia generally walk later and on tip-toe because of tight heel tendons. The arm and leg of the affected side are frequently shorter and thinner. Some children will develop an abnormal curvature of the spine (scoliosis). A child with spastic hemiplegia may also have seizures. Speech will be delayed and, at best, may be competent, but intelligence is usually normal.
• Spastic diplegia/diparesis involves muscle stiffness that is predominantly in the legs and less severely affects the arms and face, although the hands may be clumsy. Tendon reflexes in the legs are hyperactive. Toes point up when the bottom of the foot is stimulated. Tightness in certain leg muscles makes the legs move like the arms of a scissor. Congenital Hemiplegic Cerebral Palsy Health Essay.Children may require a walker or leg braces. Intelligence and language skills are usually normal.
• Spastic quadriplegia/quadriparesis is the most severe form of cerebral palsy and is often associated with moderate-to-severe intellectual disability. It is caused by widespread damage to the brain or significant brain malformations. Children will often have severe stiffness in their limbs but a floppy neck. They are rarely able to walk. Speaking and being understood are difficult. Seizures can be frequent and hard to control.