Hesperian Health Guides
Questions About Cerebral Palsy
1. What causes it?
In each child with cerebral palsy, the parts of the brain that are damaged are different. The causes are often difficult to find.
Causes before birth:
- Infections of the mother while she is pregnant. These include German measles (rubella), chicken pox, cytomegalovirus (CMV), and some bacterial infections.
- Differences between the blood of mother and child (Rh incompatibility).
- Problems of the mother, such as gestational diabetes or toxemia of pregnancy.
- Inherited. This is rare, but there is a ‘familial spastic paraplegia’.
- No cause can be found in about 30% of the children.
Causes around the time of birth:
- Prematurity. Babies born before 32 to 37 weeks and who weigh under 2.5 kilos (5.5 pounds) are more likely to have cerebral palsy. In rich countries, over half the cases of cerebral palsy happen in babies that are born early.
- 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 damaged.
- Lack of oxygen (air) at birth, although this does not often cause CP. The baby does not breathe soon enough and becomes blue and limp. In some areas, misuse of hormones (oxytocics) to speed up birth narrows the blood vessels in the womb so much that the baby does not get enough oxygen. In other cases, the baby may have the cord wrapped around her neck. The baby is born blue and limp—with brain damage.
Causes after birth:
- Very high fever due to infection or dehydration (water loss from diarrhea). It is more common in bottle-fed babies.
- Brain infections (meningitis, encephalitis). There are many causes, including cerebral malaria and tuberculosis.
- Head injuries.
- Lack of oxygen from drowning, gas poisoning, 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 tumors. These cause progressive brain damage in which the signs are similar to cerebral palsy but steadily get worse.
The damaged parts of the brain cannot be repaired, but often the child can learn to use the undamaged parts to do what she wants to do. It is important for parents to know more or less what to expect:
Families can do a lot lo help these children learn to function better. Generally, the child who is more intelligent will learn to adapt successfully to her condition. However, intelligence is not always necessary. In fact, some intelligent children become more easily frustrated and discouraged, so they stop trying. Extra effort is needed to find new and interesting ways to keep them progressing. Even children with severe mental slowness can often learn important basic skills.' Only when mental damage is so great that the child does not respond at all to people and things is there little hope for much progress. However, before judging the child who does not respond, be sure to check for deafness or loss of eyesight.
Family members can learn to play and do daily activities with the child in ways that help her both to function better and to prevent secondary problems such as contractures.
Most important is that the parents (and grandparents!) learn not to do everything for the child. Help her just enough that she can learn to do more for herself.
For example, if your child is beginning to hold up her head, and to take things to her mouth,
|instead of always feeding her yourself||look for ways to help her begin to feed herself.|
6. Will my child ever be able to walk?
- Having confidence in yourself and liking yourself
- Communication and relationship with others
- Self-care activities such as eating, dressing, toileting
- Getting from place to place
- (And if possible) walking
We all need to realize that walking is not the most important skill a child needs— and it is certainly not the first. Before a child can walk he needs reasonable head control, needs to be able to sit without help, and to be able to keep his balance while standing.
Most children with cerebral palsy do learn to walk, although often much later than normal. In general, the less severely affected the child is and the earlier she is able to sit without help, the more likely she is to walk. If she can sit without assistance by age 2, her chances for walking may be good—although many other factors are involved. Some children begin to walk at age 7, 10, or even older.
Hemiplegic and diplegic children usually do learn to walk, although some may need crutches, braces, or other aids.
Many severely affected children may never walk. We need to accept this, and aim for other important goals. Whether or not the child may someday walk, he needs some way to get from place to place. Here is a true situation that helped us to realize that other things are more important than walking.
In a Mexican village, we know 2 brothers, both with cerebral palsy.
|Petronio walks but with great difficulty. Walking tires him and makes him feel so awkward that he stays at home and does not play or work. He is unhappy.|
|His brother, Luis, cannot walk. But since he was small, he has loved to ride a donkey. He uses a wall to get off and on by himself. He goes long distances and earns money carrying water. He is happy.||(Not only does the donkey take Luis where he wants to go, but by keeping his legs apart, it helps prevent knock-knee contractures. This way ‘therapy’ is built into daily activity.)|
There are many different ways to help children who cannot walk, or who walk with difficulty, get where they want to go. These include wheelboards, wagons, wheelchairs, special walkers, and hand-pedal tricycles. Many of these are described in Chapter 66 of this book.