Cerebral palsy: Mass awareness is urgent need of hour

Dr Bishnu Ram Baishya

(Senior Dermatologist)

The rise in cases of cerebral palsy patients is a major concern for the government as well as the public. This has occurred in newborn cases as per data available. The survey conducted by the government in health camps reveals that out of 30,000 babies, 6,000 are affected by cerebral palsy in Assam. This needs mass awareness among all medical officers and the general public.

The loss of voluntary movement together with spasm of the affected muscles

A muscle is activated by nerve cells in the spinal cord which communicate directly with the muscle by their nerve fibres. If these fibres are cut (e.g., by a penetrating wound of a limb), or if the nerve cells themselves are damaged (e.g., by poliomyelitis), the muscle ceases to act at all; it is limp, and the paralysis is said to be flaccid.

These nerve cells are themselves activated by various other cells in the brain and spinal cord, some concerned with voluntary movement and others with reflex action, some with stimulating and some with suppressing muscular activity. If parts of the brain concerned with movement are damaged, reflex pathways in the spinal cord are left intact with nothing to oppose them or co-ordinate their effects; the muscle is kept permanently taut, and the paralysis is said to be spastic.

Congenital spastic paralysis (cerebral palsy; Little’s disease) in its various forms is among the commoner physical handicaps of childhood. It has come into prominence in recent years not because it is on the increase – if anything, it is becoming rarer – but because many other kinds of physical handicap that used to be common are no longer so (e.g., those resulting from poliomyelitis, tuberculosis of bone, rheumatic fever, and rickets), and because the needs of spastic children are better understood.

The paralysis is due to failure of groups of nerve cells in the brain. There are three main types. Spasm predominates if the affected cells are in the cerebral cortex, lack of co-ordination if they are in the cerebellum, and uncontrolled purposeless movements (athetosis) if they are in the basal ganglia, the grey matter in the centre of the brain. Common to all types is weakness of groups of muscles with persistent spasm that interferes with useful movement. The trouble is often confined to the legs, but in the worst cases it may be very much more widespread, even involving the muscles of speech.

Paralysis in this condition is relative. It does not mean that an affected limb cannot be deliberately moved at all, but that voluntary movement is impaired. A totally paralysed baby would be stillborn or die soon after birth. The disability varies between trivial defects that do not affect the patient’s life in the mildest cases and lifelong dependence on other people’s help in the severest cases.

Mental development is often, but by no means always, retarded. It is difficult to assess because the physical handicap can make an intelligent child seem backward.

The cause cannot always be found, but very often it can be traced to a particular type of injury to brain cells. These include severe jaundice (t> rhesus factor), physical injury during birth (less common than one would expect), temporary shortage of oxygen to the brain during the transition between the baby’s getting oxygen from the mother’s blood and breathing for himself, and lack of glucose as a result of immaturity at birth. In theory these are all largely preventable conditions.

A spastic baby cannot always be recognised at birth. All newborn babies work by reflex action, and the damage may not show itself until purposive movements should begin. This creates a false impression that the disorder is progressive, but in fact all the damage is done at or shortly after birth. From then on there is no further loss of brain cells, and the condition can only remain stationary or improve. Unlike other tissues, nerve cells cannot regenerate, but much can be done to make the most of all the unaffected areas of the brain. Healthy muscles can be taught to take on at least some of the work of paralysed muscles, occasionally with the help of surgery. Severely affected children may need special education for a time at least, and some need speech training before they can communicate and make the most of their intelligence. All this kind of work is still at an early stage, but it has been advancing rapidly in recent years.