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Cerebral palsy

Cerebral palsy or CP is a group of permanent disorders associated with developmental brain injuries that occur during fetal development, birth, or shortly after birth. It is characterized by a disruption of motor skills, with symptoms such as spasticity, paralysis, or seizures. Cerebral palsy is a form of static encephalopathy. The incidence is about 1.5 to 4 per 1000 live births. One form of it, spastic diplegia, is sometimes known as Little's disease in the United Kingdom. Properly speaking, the fact that CP does not get better or worse implies that it is a 'condition' (chronic nonprogressive neurological disorder) rather than a 'disease'. more...

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There is no cure, but therapy and Conductive Education has been shown to be helpful. Conversely, gait and posture can get worse over time if left untreated. While severity varies widely, cerebral palsy ranks among the most costly congenital conditions to manage.

Cerebral palsy has been described as something of an "umbrella term" in that it refers to a group of different conditions. It has been suggested that no two people with CP will have an identical case even if they have the same diagnosis.

Cerebral palsy develops while the brain is under development. 80% of all cases occur before the baby reaches 1 month old, however this disorder can occur within about the first 5 years of life. It is a nonprogressive disorder; once damage to the brain occurs, no additional damage occurs as a result of this condition. Cerebral palsy neither improves nor worsens, though symptoms may seem to increase with time, likely due to the aging process.

History

Cerebral palsy, then known as "Cerebral Paralysis", was first identified by a British surgeon named William Little in 1860. Little raised the possibility of asphyxia during birth as a chief cause of the disorder. It was not until 1897 that Sigmund Freud suggested that a difficult birth was not the cause but rather only a symptom of other effects on fetal development. Modern research has shown that asphyxia is not found during birth in at least 75% of cases. Such research also shows that Freud's view was correct, even though during the late 19th century and most of the 20th century Little's view was the traditional explanation. ("Conditions", 9)

Cause

Since cerebral palsy refers to a group of disorders, there is no exact known cause. Some major causes are asphyxia, hypoxia of the brain, birth trauma or premature birth, genetic susceptibility, certain infections in the mother during and before birth, central nervous system infections, trauma, and consecutive hematomas. In most people with CP, the cause is unknown. After birth, the condition may be caused by toxins, physical brain injury, incidents involving hypoxia to the brain (such as drowning), and encephalitis or meningitis. Despite all of these causes, the cause of many individual cases of cerebral palsy is unknown.

Recent research has demonstrated that asphyxia is not the most important cause as it was once considered to be, though it still plays a role, probably accounting for about 10 percent of all cases. The research has shown that infections in the mother, even infections that are not easily detected, may triple the risk of the child developing the disorder.

Premature babies have a higher risk because their organs are not yet fully developed. This increases the risk of asphyxia and other injury to the brain, which in turn increases the incidence of cerebral palsy.

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High frequency chest wall oscillation improves outcomes in children with cerebral palsy
From CHEST, 10/1/05 by Penny M. Overgaard

PURPOSE: Children with cerebral palsy (CP) have an increased risk of recurrent pneumonia from impaired airway clearance. Ineffective cough, poor oral secretion control, reduced mucociliary function from recurrent infections and chest wall abnormalities contribute to poor airway clearance. Improving airway clearance may reduce the number of pneumonias. There is very little information regarding the value of high frequency chest wall oscillation (HFCWO) in this population.

METHODS: We performed a retrospective quality assurance review on 13 children with CP, follow0ed in our pediatric pulmonary clinic, who use HFCWO to enhance airway clearance.

RESULTS: Of the 13 children with CP, 5 are females, 8 males. Three children have tracheostomies, 7 have gastrostomy buttons. Hospital and clinic charts were reviewed to determine the number of emergency room (ER) visits and hospitalizations for respiratory problems including pneumonia and asthma. Calls were made to families to assess HFCWO usage and parental satisfaction. Parent recall and patient records documented 8 hospitalizations and 5 ER visits 1 year before HFCWO. Parents reported frequent illnesses requiring multiple antibiotics, 1 child missed 50 days of school, and another required increased oxygen use. After using HFCWO, 5 hospitalizations and 1 ER visit were documented. Parents reported less respiratory illnesses, less antibiotic use, and 1 child had a 58% reduction in missed school days. Six of the children have used HFCWO for more than 1 year; seven for at least 6 months. The average minutes of HFCWO use per day calculated from the hour meter was 41.3 minutes for 11 patients; information was not available on 2. Parental satisfaction with HFCWO was high with 9 parents expressing improvement in their child's health and quality of life.

CONCLUSION: This retrospective analysis would suggest that there is benefit from HFCWO use in children with CP by declines in respiratory illnesses, antibiotic use, missed school days, hospitalizations and ER visits.

CLINICAL IMPLICATIONS: A controlled, prospectively designed study would be able to provide more scientific support for the use of the vest in this population.

DISCLOSURE: Peggy Radford, None.

Penny M. Overgaard RN Peggy J. Radford MD * Phoenix Children's Hospital, Phoenix, AZ

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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