Cerebral palsy

Cerebral palsy is a condition rather than a disease. The term cerebral palsy is used to denote conditions that stem from brain injury, including a number of types of neuromuscular disabilities characterized by disturbances of voluntary motor function. It is the re­sult of a permanent brain injury and is therefore life­long.

Certain groups of infants including those with pro­longed birth anoxia, very low birth weight, and ab­normal neurological symptoms are possible candi­dates for cerebral palsy. Many cerebral palsy children possess poor postural adjustment. As a re­sult simple gross motor movements (e.g., kicking, throwing, and jumping) are difficult to perform effectively.

Cerebral palsy can include mental retardation, con­vulsive disorders, impulsive disorders such as hyper-kinetic behavior, and learning disabilities such as minimal cerebral dysfunction and visual, auditory, and perceptual problems. Some of the secondary impairments that may accompany motor involvement are mental retardation, hearing and vision loss, emo­tional disturbance, loss of perceptual ability, and in­ability to make psychological adjustments.

Classification. The different clinical types of cerebral dysfunction involve various obvious motor patterns, commonly known as hard signs. There are six clinical classifica­tions – spasticity, athetosis, rigidity, ataxia, tremor, and atonia.

Spasticity. Muscular spasticity is the most preva­lent type of hard sign among persons with cerebral palsy. One characteristic of spasticity is that muscle contractures that restrict muscular movement give the appearance of stiffness to affected limbs. This makes muscle movement jerky and uncertain. Spastic children have exaggerated stretch reflexes that cause them to respond to rapid passive stimulation with vigorous muscle contractions. Tendon reflexes are also hyperactive in the involved part. Consequently, good posture is extremely difficult to maintain. Because of poor balance among reciprocal muscle groups, innervation of muscles for functional motor patterns is often difficult. Mental impairment is associated with spasticity more than with any other clinical type of cerebral palsy, so the incidence of mental retardation among this group is high.

Athetosis. Athetosis is the second most prevalent clinical type of severe cerebral palsy. The distinguish­ing characteristic of the athetoid individual is recog­nizable incoordinate movements of voluntary mus­cles. These movements take the form of wormlike motions that involve the trunk, arms, legs, or tongue or muscle twitches of the face. The unrhythmical, un­controllable, involuntary movements seem to in­crease with voluntary motion and emotional or envi­ronmental stimuli. Because of the athetoid individual's inability to control muscles and the pres­ence of primitive reflexes, posture is unpredictable and poses a problem. Impairment in the muscular control of hands, speech, and swallowing often ac­companies athetosis,

Rigidity. A central feature of the rigid type of ce­rebral palsy is the functional incoordination of recip­rocal muscle groups. There is great resistance to slow motion, and the stretch reflex is impaired. Mental re­tardation often accompanies this clinical type of ce­rebral palsy.

Ataxia. A primary characteristic of the ataxic type of cerebral palsy is a disturbance of equilibrium, which impairs the ability to maintain balance. This impairment in balance becomes evident in the walk­ing gait. The gait of the person with ataxic cerebral palsy is unstable, which causes weaving about during locomotion. Standing is often a problem. Kinesthetic awareness seems to be lacking in the ataxic individ­ual. Also, muscle tone and the ability to locate objects in three-dimensional space are poor in persons with ataxic cerebral palsy.

Tremor. Tremor is evidenced by a rhythmic movement that is usually caused by alternating con­tractions between flexor and extensor muscles Tremors appear as uncontrollable pendular move­ments.

Atonia (flaccidity). Atonia is characterized by lack of muscle tone. The muscles of the atonic per­son are often so weak that the activities of daily living are severely hampered.

Medical Treatment. The four procedures prevalent in medical treatment of orthopedically handicapped persons are bracing, drug therapy, operation, and rehabilitation. Braces are important as an aid in teaching joint function as well as in assisting in the locomotion of patients who are severely handicapped. Another use for bracing is the prevention of deforming contractures. Drug ad­ministration usually serves two functions – aiding in relaxation of muscle groups when neuromuscular ex­ercise therapy is attempted, and controlling epileptic seizures through the use of anticonvulsant drugs.

There are various opinions as to the value of or­thopedic surgery for persons with cerebral palsy. Certain types of operative procedures have met with considerable success, especially with particular types of cerebral palsy. The physical growth of children af­fects the efficiency of muscle and tendon surgery; however, operation, for the most part, is not curative but rather assists the functional activities of daily liv­ing.

Therapeutic Treatment. There is no treatment for the repair of a damaged brain. However, the portion of the nervous system that remains intact can be made functional through a well-managed training program. Intervention by the physical educator and other personnel is needed to build functional developmental motor patterns with the operative pare of the body. Each child should be evaluated closely, and programs that foster those functional abilities should be formulated. Develop­mental programs should be constructed to correct deficiencies that respond to treatment. The specific child should be considered when determining the exercise regimen. Because of their numerous invol­untary muscular activities, athetoid children are much more active than spastic, ataxic, and rigid chil­dren, who are inhibited regarding physical activity.

There is growing evidence that some of the per­ceptual characteristics can be improved through training. Perceptual training techniques are devel­oped primarily through vasomotor and sensorimotor training programs. The aspects of such a program include reducing primitive reflex involvement, devel­oping locomotor patterns, balancing, performing ac­tively to rhythm, developing ocular control, and us­ing devices that detect form perception. All of these perceptual activities are inherent in most physical ed­ucation programs. However, the quality of physical education programs could be improved by imple­mentation of programs of activities that might en­hance these particular perceptual characteristics.

The IEP is designed to meet the unique needs of each child. Therefore, special physical education and related services include many types of physical activ­ity. Some of the therapeutic activities and techniques include the following:

1. Muscle stretching to relieve muscle contractures, prevent deformities, and permit fuller range of purposeful motion

2. Gravity exercises that involve lifting the weight of the body or body part against gravity

3. Muscle awareness exercises to control specific muscles or muscle groups

4. Neuromuscular reeducation exercises that are performed through the muscles' current range to stimulate the proprioceptors and return the muscles to greater functional use

5. Reciprocal exercises to stimulate and strengthen the action of the protagonist

6. Tonic exercises to prevent atrophy or to main­tain organic efficiency

7. Relaxation training to assist in the remediation of muscle contractures, rigidity, and spasms

8. Postural alignments to maintain proper align­ment of musculature

9. Gait training to teach or reteach walking pat­terns

10. Body mechanics and lifting techniques to ob­tain maximum use of the large muscle groups of the body

11. Proprioceptive facilitation exercises to bring about maximal excitation of motor units of a muscle with each voluntary effort to overcome motor functioning paralysis

Дата добавления: 2015-11-16