Objective classification of gait patterns in children with cerebral palsy

Abstract

“Cerebral” is defined as pertaining to the brain, cerebrum or intellect, and “Palsy” refers to paralysis of muscle or group of muscles. Jointly, Cerebral Palsy (CP) is the term used to describe a group of conditions with motor impairments resulting from brain damage during the early stages of development. Cerebral palsy is non progressive and is usually not diagnosed until a child is about 2 to 3 years of age. About 2 to 3 children in 1,000 over the age of three have cerebral palsy. This is because of the plasticity of a child's central nervous system, or its ability to recover completely or partially after an injury occurs. If a brain injury occurs early, the undamaged areas of a child's brain can sometimes take over some of the functions of the damaged areas. There are four categories of CP based on the different movement impairments: Spastic, Athetoid, Ataxic and Mixed Forms. Spastic cerebral palsy is characterized by muscles that are stiff and permanently contracted, making awkward movements to varying degrees of severity and in turn limits the patients’ range of motion and causing jerky, unpredictable movements. This approximately affects about 70 to 80 percent of CP patients. Often, CP patients have a hard time moving from one position to another and may also have a hard time holding and letting go of objects. Athetoid cerebral palsy is characterized by uncontrolled movements of the hands, feet, arms, or legs and, in some cases, the muscles of the face and tongue. These uncontrolled movements often interfere with speaking, feeding, reaching, grasping, and other skills requiring coordinated movements. About 10 to 20 percent of CP patients have the Athetoid case. Ataxic CP is a rare form of cerebral palsy which affects an estimated 5 to 10 percent of CP patients. Ataxic cerebral palsy affects sense of balance and depth perception. Typically, persons affected by ataxic cerebral palsy have poor coordination, walk unsteadily and exhibit difficulty when attempting quick or precise movements. Lastly, the Mixed form of CP have symptoms of more than one of the categories mentioned. The most common mixed form includes spasticity and athetoid movements. CP is also classified according to the affected region of the body: (1)Diplegia, affects either both arms or both legs of the patients; (2) Hemiplegia, affects the limbs on only one side of the body; (3) Quadriplegia, affects all the limbs; (4) Monoplegia, affects only one limb; and (5) Triplegia, affects three limbs. The cause of CP is still unknown but there are factors identified that can possibly increase the risk. The following are some of the factors that might cause CP: complicated labor and delivery of infants (inborn brain damage, breech presentation, etc.), unhealthy condition of infant (low birth weight, prematurity, Apgar score, nervous system malformation and others), and seizures in the newborn. Due to this prevention like regular prenatal care and proper child care should be noted. The life expectancy of CP patients depends on the severity of their condition. Research has shown that if a child has severe cerebral palsy, other complications may occur to shorten the patients’ life. Otherwise, if the CP patients’ medical condition is considered to be typical, the child is likely to have normal life expectancy. Treatments for CP patients come in various forms. Physical therapy usually begins shortly after the diagnosis is made. Specific exercises are used in physical therapy to prevent the weakening or deterioration of muscles from disuse (disuse atrophy) and to avoid muscle contracture (muscles fixed in a rigid, abnormal position). Drug Therapy is necessary for those who have seizures associated with cerebral palsy, and may be effective in preventing seizures in many patients. Surgery may not be necessary, but it is sometimes recommended to improve muscle development, correct contractures, and reduce spasticity in the legs which in turn can help the patient child achieve his or her optimal level of functioning.