Typical of infantile cerebral palsy is abnormal muscle tension, which manifests itself in increased, decreased or strongly fluctuating muscle tone. The majority of children develop spasticity.
The English orthopaedist and pediatrician William John Little first described ICP in the 19th century. Doctors therefore also call it "Little Disease". ICP describes impaired motor function that affects the transmission of signals from the brain to the musculoskeletal system and back again. The disorder is caused by brain damage.
In addition to the movement disorder, there are other possible symptoms:
- Epileptic seizures
- Reduced intelligence
- Sensory and perceptual disorders
- Partial performance deficits
- Hearing, vision or speech problems
Internationally, 1.5 to 2.5 children are born with infantile cerebral palsy for every 1,000 children born alive. Premature babies are particularly affected , as the risk increases with decreasing birth weight.
Infantile cerebral palsy usually leads to problems with motor skills and increased muscle tone (spasticity) @ Maria Sbytova /AdobeStock
ICP can develop before birth (prenatal), during birth (perinatal) or after birth (postnatal).
There are different causes:
- Oxygen deficiency during pregnancy
- Thrombosis or embolism (intrauterine or in infancy)
- premature detachment of the placenta
- Infectious diseases of the mother during pregnancy
- birth trauma
- Intoxication in the womb due to alcohol, drugs, medication or carbon monoxide
- Undersupply due to placental insufficiency
- genetic disorder
- blood group incompatibility
- Infectious diseases in infancy
- Craniocerebral trauma
However, experts can only identify a clear cause of brain damage in around half of all cases. It is often a lack of oxygen during the birth process.
If the newborn reaches four or fewer points on the Apgarscore, there is an increased risk of infantile cerebral palsy. The Apgarscore is a scoring system that assesses the condition of the newborn.
The symptoms vary depending on which region of the brain is affected.
Movement disorders are the most common. Affected children cannot control their muscles sufficiently. Infants usually do not notice the movement disorders at first.
A slight stiffness of the body when lifting may be the first indication. Doctors usually only recognize the condition when babies have difficulty turning, crawling or walking.
Doctors summarize the symptoms. They can affect the whole body (tetraparesis), one half of the body (hemiparesis) or one part of the body (diparesis):
- Spastic syndromes (severe cramps, involuntary movements, signs of paralysis and even inability to move due to increased muscle tension)
- Dyskinetic syndromes (involuntary and uncontrolled movements due to alternating tensing and relaxing of the muscles)
- Congenital ataxia syndromes (lack of gross motor skills, no targeted movements possible)
- Hypotonia syndromes (reduced muscle tension, which can lead to epileptic seizures, shortening of tendons and muscles and deformation of bones and joints)
Children with infantile cerebral palsy often suffer from a shortened Achilles tendon, which results in the so-called pointed foot position.
Typical of the disease are inwardly rotated and bent hips and arms as well as a curvature of the spine. Affected children can also exhibit behavioral problems and reduced intelligence. 30 to 50 percent of children develop symptomatic epilepsy.
By MC2 Jilleanne Buda - https://www.dvidshub.net/image/126489, Public Domain, Link
If ICP is suspected, the treating physician first rules out other diseases. He takes a detailed medical history of the pregnancy, the birth and the child's development to date.
This is followed by a physical examination and close observation of the child. The doctor pays particular attention to the child's posture and movement patterns. Further examinations such as a skull sonography or magnetic resonance imaging (MRI) can confirm the suspicion.
There is no cure for ICP. However, targeted therapies can reduce the symptoms.
Treatment takes place on a multidisciplinary level and involves the following specialists in addition to the patient and relatives:
The following therapies are generally used:
- Physiotherapy according to Vojta or Bobath to loosen the muscles and improve muscle movement
- occupational therapy
- Speech therapy if required
- Possibly medication to reduce muscle tone
- Orthopaedic walking aids
- Psychological counseling if necessary
For some years now, children who have suffered from a lack of oxygen during the birth process have been immediately placed in a cold bed. Reducing the body temperature to around 32 degrees is intended to prevent further brain cells from dying (therapeutic hypothermia). Cold therapy has shown considerable success.
Patients with infantile cerebral palsy should undergo lifelong physiotherapy @ Ivan /AdobeStock
If conservative treatment methods do not produce satisfactory results or if regression becomes apparent, surgical interventions are necessary.
For example, doctors lengthen shortened tendons. This reduces muscle tension and makes the joints more mobile.
It is also possible to implant a drug pump near the spinal cord (baclofen pump). This allows the medication to act directly in the central nervous system and reduce spasticity more effectively.
For patients who are able to walk, an operation on the back, the selective dorsal rhizotomy, is also an option. In this procedure, doctors selectively cut the nerve fibers that cause the spastic muscle cramps in the legs.
If the child's cognitive abilities are not impaired, there is nothing to stop them attending a regular school. Nevertheless, it is usually a lengthy process for parents.
This is because many teachers are not trained to deal with children with physical disabilities. An integration assistant can support the child in everyday school life.
If attending a mainstream school is not an option, the child's motor and cognitive development is of particular importance. Starting therapy as early as possible (as early as infancy) will always have a positive impact on the child's development.
