CP

What is CP?

Cerebral palsy, or CP for short, is a non-progressive permanent movement and posture disorder due to damage to the developing brain.  The frequency of CP is 2-3 per 1000 live births.

What are the causes of CP?

CP can occur due to prenatal (small or advanced maternal age, multiple pregnancies, genetic diseases, traumas, diseases of the mother), birth order (premature birth, low birth weight, prolonged birth, abnormal arrival and infections) and postpartum (jaundice, infections, trauma, intracranial hemorrhages).

What are the types of CP?

According to the location and severity of the damage, CP tables of various degrees and appearance are formed.

• Spastic type: Spastic type is the most common type of cerebral palsy. Spasticity, in the most general sense, can be defined as muscle stiffness or resistance to passive movement. The change in the normal structure of the muscles and the stiffness cause the movements to be affected and difficult to do. Over time, excessive spasticity leads to deterioration of skeletal structure and posture. In addition, it adversely affects functional activities such as sitting, using hands, walking.

Spastic child is defined according to the body part affected under the diagnosis of cerebral palsy:

• Hemiplegia: In this type, the arm, trunk and leg on one side of the body are affected. In hemiparesic children, crawling is asymmetrical or there is no crawling at all. With rehabilitation, most patients become independent in activities of daily living and become ambulators.
• Diplegia: In this type, spasticity of both legs is greater than that of the arms.  Diplegic patients become spastic after a loose period. Standing and walking are delayed. Children who gain sitting balance by the age of two may become able to walk. The legs are cramped together. Stepping on the fingertip is frequent.
• Tetraplegia: In this type, the whole body is affected. Insufficiency of head control, a fist-shaped posture of the hands and cross-legged posture is a common sight. In 1/4 of children with tetraplegic CP, the disease is mild and these patients can become ambulatory and perform activities of daily living with slight restrictions. In half of them, the disease is moderate, and these children cannot be fully independent but can reach sufficient functional capacity. In the remaining 1/4, the disease is severe and these children are in need of lifelong care.
• Atetoid Type: It can be defined as uncontrolled movement. Involuntary movements occur in the child's legs, arms, hands or face. With this type, sudden changes occur in the muscles. Muscles can go from a very loose state to a very hard state. This prevents the movements from being coordinated.
• Ataxic Type: There is a disorder in maintaining balance. Development is slow due to poor head control, inability to achieve body balance, and walking is achieved too late.
• Mixed Type: When muscle tone is extremely low in some muscles and extremely high in others, the type of cerebral palsy is called karma.

What are the signs and symptoms of CP?

• Problems with movement on one side of the body
• Stiff muscles
• Excessive or loose reflexes
• Involuntary movements or tremors
• Lack of coordination and balance
• Saliva
• Swallowing or sucking problems
• Difficulty with speech (dysarthria)
• Seizures
• Delayed motor skills
• Incontinence
• Gastrointestinal problems

Damage to a developing brain can cause problems other than movement problems associated with cerebral palsy. Other conditions that may be present alongside cerebral palsy include:

• Blind or hearing impairment
• Learning disorders
• Attention deficit hyperactivity disorder (ADHD)
• Inability to communicate through speech

How is CP treated?

There is no complete cure for CP. But treatment usually improves the child's abilities.

It is very important to start an early diagnosis and early rehabilitation program in CP. It is not the definitive and only solution in the treatment and it is a long-term process. In this process, the teamwork of the Physical Therapy Physician, physiotherapist, occupational therapist, child development specialist, speech therapist and family is an indisputable issue. All these approaches should be applied together to an individual with CP. Among the physiotherapy applications, which are the most important pillars of rehabilitation, exercise, robotic treatments, hydrotherapy and occupational therapy are the main building blocks. Exercise applications are applied specifically to the child by physiotherapists by using various techniques to support the child's functional status to support head-holding, sitting, standing and walking. This long and patient treatment process has been more easily accepted by both children and families with the development of robotic treatments. Thanks to arm and walking robots, very repetitive and accurate walking patterns are created and these signals are transmitted to the brain. In addition, applications enriched with a number of games ensure that the treatment is continued with interest by children. Hydrotherapy also increases the child's compliance with the treatment and facilitates exercise and increases active participation by using the buoyancy of water. Occupational therapy, which is one of the main branches that support rehabilitation, includes studies to increase the child's participation in daily living activities. In addition, sensory-integration therapy, which enables the child to receive sensory information from his body and environment, to organize this information and use it in daily living activities, is among the new applications.

All these applications are included in the rehabilitation process by adjusting the doses according to the type and severity of CP. In addition, this process can be supported by various muscle relaxant applications (such as botilinum toxin applications) and surgical treatments.

What is really important is that the individual with CP takes his place in the society and is included in life. For this reason, all these practices should be within a plan and together with continuous rehabilitation support without disrupting the child's education process.