In the present day, cerebral palsy (CP) may be regarded as the most frequently occurring motor disability among children. At the same time, considerable misunderstanding related to this chronic condition still exist, especially within communities all over the world. CP is a permanent, chronic, and incurable disorder, however, it is non-progressive and non-life-threatening. It is not contagious and cannot be spread from person to person through contact. At the same time, CP is manageable, and appropriate therapy, treatment, medications, assistive technologies, and surgery help increase inclusion, reduce barriers, maximize independence, and enhance the general quality of life. The purpose of this paper is to describe CP, its signs and symptoms, risk factors, types, epidemiology, surveillance systems, screening, and interventions to raise awareness related to it.
CP is a group of specific neurological disorders characterized by the impairment or complete loss of motor function that has a negative impact on an individual’s ability to maintain posture or balance and move (“What is cerebral palsy?” 2020). CP is caused by “a non-progressive brain injury or malformation that occurs while the child’s brain is under development” and subsequently affects the child’s ability to control muscle coordination, reflex, and body movement (“Definition of cerebral palsy,” n.d., para. 1). While some people have CP due to the brain injury caused by hypoxia, or a low oxygen level, its reasons remain unknown.
Although disorders traditionally occur during the child’s growth in the womb, they may appear during the first years of life as an immature brain continues developing. Several conditions may lead to CP during early infancy including brain bleeding, meningitis, encephalitis, herpes simplex infections, and other brain infections, mother’s infections transmitted during pregnancy, head injury, brain injuries received during childbirth, and untreated jaundice.
Signs and Symptoms
In general, the signs and symptoms of CP may substantively vary between people. They may be either very severe or very mild and almost invisible, involve both or only one side of the person’s body, and affect arms, legs, or all limbs. An individual with a severe form of CP may be unable to walk and require lifelong health care, or he or she may need special equipment for maintaining balance and walking (“What is cerebral palsy?” 2020). In turn, people with a mild form of CP walk independently, though slightly awkwardly, and do not need any special additional help. Major symptoms of CP include:
- Muscle tightness;
- Abnormal walk that is traditionally characterized by the “scissors” movements of legs, crossed or touching knees, walking on the toes, or the unusual positions of arms (University of Florida Health, 2019);
- Joint contracture;
- Muscle weakness or muscle paralysis.
Despite the fact that symptoms may change during the person’s life even if the general condition remains the same, all individuals with this chronic disorder have problems with posture and movement. Other symptoms of CP that may occur as well are the abnormal movements of arms, hands, legs, and feet, including jerking, writhing, or twisting, that frequently become more severe during stress, unsteady gait, tremors, loss of coordination, and floppy muscles and joints (University of Florida Health, 2019).
In addition, a substantial number of people with CP have additional conditions related to nervous and brain systems, such as learning disabilities in the context of normal intelligence, intellectual disability, problems with hearing, vision, and speech, seizures, scoliosis, and hardly manageable pain. The symptoms of CP connected with eating and digestion are difficulties with chewing and swallowing, constipation, and vomiting (University of Florida Health, 2019). Other possible symptoms include slower growth, increased drooling, urinary incontinence, and irregular breathing.
In general, the first signs of CP may be observed “in the early months of life, although specific diagnosis may be delayed until age two or later” (Cerebral Palsy Foundation, n.d., para. 1). Children with CP younger than six months of age feel floppy and stiff; their head droops and their legs may cross when they are picked up from lying position (Cerebral Palsy Foundation, n.d.). Later, they cannot roll over, have difficulties with bringing their hands together and to their mouth, keep hands fisted, and cannot stand independently without support. Older children frequently walk on their toes, have random involuntary movements or tremor, and demonstrate delays in reaching motor skill milestones or difficulties with precise movements, including buttoning clothes and writing (Cerebral Palsy Foundation, n.d.).
Types of CP
There are four major types of CP – spastic CP, dyskinetic CP, ataxic CP, and mixed CP. Spastic CP is traditionally regarded as the most common type of CP that affects approximately 80% of people with this chronic disorder (“What is cerebral palsy?” 2020). They generally have awkward movements determined by increased muscle tone. Based on affected body parts, spastic CP is divided into spastic diplegia, or diparesis (legs are predominantly affected), spastic hemiplegia, or hemiparesis (only on side of the body is affected), and spastic quadriplegia, or quadriparesis (“What is cerebral palsy?” 2020). Spastic quadriplegia is the most severe form of spastic CP as all limbs, the face, and the trunk are affected, and intellectual disability, problems with speech, hearing, and vision, and seizures may be frequently observed as well.
Dyskinetic CP and its sub-varieties that including dystonic, athetoid, and choreoathetosis CP are characterized by problems related to movement control. People with this type of CP experience differences in controlling their feet, legs, arms, hand, tongue, and face, walking, sitting, swallowing, sucking, and talking. Their uncontrollable movements may be either writhing and slow or extremely rapid and jerky (“What is cerebral palsy?” 2020). In addition, these people’s muscle tone may vary from too loose to too tight during a day. Ataxic CP relates to problems with coordination and balance, and people who have it may be unsteady while walking and have difficulties in reaching objects, controlling their hands, and writing. Finally, as some individuals may present the symptoms of several types of CP, it is possible to conclude that they have mixed CP, the most frequently occurring of which is spastic-dyskinetic CP.
Statistics Related to CP
Since the middle of the 1980s, multiple researchers in cooperation with the Centers of Disease Control and Prevention (CDC) have undertaken efforts to determine statistical data concerning the incidence and prevalence of CP in the United States (“Facts & Statistics,” n.d.). In general, more than 17 million people across the globe have this chronic disorder (“Facts & Statistics,” n.d.). In the United States, around 764,000 adults and children are currently affected by CP, approximately 100,000 children are born with it every year, and 500,000 children under the age of 18 suffer from CP (“Facts & Statistics,” n.d.).
According to the general CP rate, “out of every 1,000 births, about 2.3 to 3.6 are diagnosed with cerebral palsy,” and these measures vary in dependence to the state (“Facts & Statistics,” n.d., para. 6). According to the research conducted in 2010, dedicated to the investigation of CP prevalence among 8-years-old children, and involved various areas, the prevalent rate across the country is 2,9 (“Data and statistics for cerebral palsy,” 2020).
|General, across the country||Georgia||Missouri||Wisconsin||Alabama||Other states (including Florida)|
|CP Rate (per 1000 birth)||2.3-3.6||3.4||2.7||2.5||2.4||2.9|
(“Facts & Statistics,” n.d.)
CP is predominant among boys rather than girls, and almost 50%of all children with CP were born prematurely. As the most common CP type, spastic CP accounts 61-77% of all diagnosed CP cases (“Facts & Statistics,” n.d.). In general, approximately 59% of individuals with CP may walk independently, while 11.3% walk with the help of a particular hand-held mobility device, and the ability to walk is limited or absent for 30.6% of people (“Facts & Statistics,” n.d.). However, the majority of adults and children with CP have normal or even superior intelligence.
Surveillance and Reporting
To describe and monitor the prevalence of CP, population-based surveillance programs as the criterion standard are constantly developing. The earliest systems related to surveillance and registering of CP started to appear since the 1950s, and in the present day, there are almost 40 CP surveillance programs all over the world (Goldsmith et al., 2016). The collaboration between geographically close programs allows to conduct researches and collect and compare data applying subgroup analyses more efficiently. The largest networks of CP surveillance programs in the world are the Surveillance of Cerebral Palsy in Europe (SCPE), the Autism and Developmental Disabilities Monitoring (ADDM) CP Network in the United States, and the Australian Cerebral Palsy Register (ACPR) (Goldsmith et al., 2016).
Since the 1980s, CDC tracks the characteristics and number of children with CP across the states. In fact, due to population-based tracking, it is possible to define whether the number of CP cases increase, decrease, or remain the same and compare rates in different parts of the country to determine risk factor and potential causes of CP, raise awareness of its signs and symptoms, and evaluate prevention efforts’ efficiency (“Tracking and research on cerebral palsy,” 2020). In turn, communities may use information collected by CDC, such as CP subtypes, co-occurring conditions, and walking ability, to plan for appropriate guide policies. Along with tracking, CDC regularly conducts the National Health Interview Survey (NHIS) to collect data on citizens’ health conditions, developmental disabilities, and heal-related special needs and limitations (“Tracking and research on cerebral palsy,” 2020). And CDC organizes numerous researches dedicated to the risk factors of CP for its better understanding and prevention.
Epidemiological Analysis of CP
- What? CP is “a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing foetal or infant brain” (Eunson, 2012, p. 361). It is regarded as the most frequently occurring motor disability among children.
- Who? In general, any child may be born with CP, however, there is a number of risk factors that determine its development. These factors that operate independently or in conjunction with each other traditionally include prematurity, perinatal infections, twins or higher multiple births, and low birth weight (Eunson, 2012). In addition, the socio-economic status of a family plays a significant role in the CP frequency, as poverty is closely connected with malnutrition that may cause its permanent disorder. Accidents, abuse, medical malpractice, and negligence contribute to the occurrence of CP as well.
- Where? Children with CP are born across the globe, however, in developing countries with poor economic development, a lack of technologies in the health care service, and limited access to medical services for people a prevalence of CP may be observed.
- When? CP traditionally occurs during the child’s growth in the womb, however, its signs may appear during the first years of life as an immature brain continues developing.
- Why? In general, the majority of CP cases cause by abnormal brain development or a non-progressive brain injury under the child’s development before birth or during labor and delivery (“Definition of cerebral palsy,” n.d). Moreover, CP-related conditions include brain bleeding, meningitis, encephalitis, herpes simplex infections, and other brain infections, mother’s infections transmitted during pregnancy, head injury, brain injuries received during childbirth, and untreated jaundice. According to recent researches, the cost of lifetime care for a person with CP is almost $1,400,000 (“Facts & Statistics,” n.d.).
Screening and Guidelines
Developmental monitoring, developmental screening, and medical evaluations are the fundamental effective, sensitive, and cost-efficient steps of diagnosing CP (“Screening and diagnosis of cerebral palsy,” 2020). The health care provider monitors a child’s development and growth during each visit by updating medical history, asking parents about their concerns related to their child’s development, and examining the child to see his or her movements.
Developmental screening implies short tests in the form of questionnaires or interviews for parents and children provided by specialists to define whether children have movement or motor delays. Screening is organized at child’s 9, 18, 24, and 30 months as not all delays may be observed at the earliest stages of development (“Screening and diagnosis of cerebral palsy,” 2020). According to its results, a doctor may suggest early intervention or early childhood services or developmental and medical evaluations (“Screening and diagnosis of cerebral palsy,” 2020). Evaluations are made by multiple specialists that include developmental and neurodevelopmental pediatricians, pediatric psychiatrists, child neurologists, and pediatric rehabilitation doctors.
Plan: Integrating Evidence
In general, nurse practitioners play a highly significant role in PC management as they not only help to improve patients’ quality of life and achievement of developmental milestones but increase their self-esteem and the awareness of family members. Thus, possible nursing interventions include assistance in multidisciplinary therapeutic procedures designed to establish communication, locomotion, and self-help, the prevention of patients’ injury and deformity, the encouragement of their mobility, and enhancement of self-care. The care plan may be regarded as successful if it is evidenced by the achievement of the patient’s age-appropriate growth, skills, and behaviors, the maintenance of possible optimal functioning, and the parents’ identification of goals that may be defined as realistic according to their child’s abilities.
Cerebral palsy is a group of specific neurological disorders characterized by the impairment or complete loss of motor function. It is a permanent, chronic, and incurable, though non-progressive, non-life-threatening, and manageable condition. In general, the majority of CP cases cause by abnormal brain development or a non-progressive brain injury under the child’s development before birth or during labor and delivery.
All individuals with CP have problems with posture and movement, and major symptoms include muscle tightness, abnormal walk, joint contracture, and muscle weakness or paralysis. In the United States, the prevalent rate of CP across the country is 2,9 out of 1,000 births. The main steps of its diagnosing are developmental monitoring, developmental screening, and medical evaluations. Nurses play a crucial role in this disorder’s management and their interventions include assistance in therapeutic measures, the prevention of deformity and injury, and the encouragement of patients’ mobility and self-confidence.
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Goldsmith, S., McIntyre, S., Smithers-Sheedy, H., Blair, E., Cans, C., Watson, L., Yeargin-Allsopp, M., & Australian Cerebral Palsy Register Group. (2016). An international survey of cerebral palsy registers and surveillance systems. Developmental Medicine & Child Neurology, 58(2), 11-7. Web.
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