Article On Cerebral Palsy, Mar 07, 2006

Each year, about 10,000 babies born in the U.S. develop cerebral palsy. More than 500,000 Americans have cerebral palsy. A study in California showed that the lifetime costs per new case of cerebral palsy was $503,000 (in 1992 dollars).48 Half of these costs are borne by families, who often find it difficult to obtain all the services they need to help their children.

Cerebral palsy results from injury to the brain. About 20 percent of children who have cerebral palsy acquire the disorder after birth, while 80 percent of cases are congenital. Meningitis, encephalitis, and trauma cause most of the acquired cases. According to the National Institute of Neurological Disorders and Stroke, the mechanism of injury in the majority of cases of congenital cerebral palsy is not known. Until recently, the belief that birth complications cause most cases of cerebral palsy was widespread. Then, in the 1980s, a careful study of 35,000 births showed that fewer than 10 percent of children with cerebral palsy had a history of birth complications such as rubella or other infections during pregnancy, jaundice, Rh incompatibility, asphyxia (oxygen shortage), or head trauma during labor and delivery. Most children with congenital cerebral palsy do not have a history of any of these conditions.

Premature birth and low birthweight predispose to cerebral palsy, but the reason for this association is not clear. Cerebral palsy represents a very broad range of motor disorders, varying in the part of the body they affect (e.g., diplegia, hemiplegia, quadriplegia); the type of motor disorder (spastic, athetoid, or ataxic) and their severity. The most familiar pattern is spastic diplegia, meaning that the patient has stiff, contracted muscles in the legs. By definition, the muscle disorder in cerebral palsy is not progressive.

However, muscle spasticity, even if stable, can cause new problems as a child grows. For example, pain and contractures may increase as the bones of the child’s legs lengthen. Standardized scales, such as gait analysis, and functional scales, such as the Gross Motor Function Measure (GMFM), are used to assess and monitor progress. The GMFM is a validated and reliable scale used for measuring function in patients with cerebral palsy. It consists of five domains with a possible total score of 88. Various prognostic criteria for the patient’s function have been developed over the years. For example, if a patient is not sitting independently when placed by age 2, then one can predict with approximately 95 percent confidence that he/she never will be able to walk. On occasion, such a child will walk, but usually aids are necessary, such as a walker. Most children with cerebral palsy will improve in their function over time,  but many have deficits that continue into adulthood.

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