Spastic - Children

Spastic children are universally identified as children with Cerebral palsy.

Cerebral Palsy and Spasticity:
Cerebral Palsy (CP) is a condition that affects muscle movement. It is usually caused by damage to one or more areas of the brain. This damage can happen to the developing baby while the mother is pregnant, or during birth. In a small number of children, it can develop after birth. CP affects muscle movement and may be associated with difficulties in learning, hearing, seeing and thinking.

The muscles of some children with CP are constantly stiff and rigid. Children with CP may also have reflexes they cannot control. This is called spasticity. Movement is very difficult and often awkward for these children.

Spasticity leads to muscles and joints that are tight all of the time (contractures). Children with spasticity may also have:
  • Dystonia, a movement disorder that causes uncontrollable tightening of the muscles. The child may jerk or twist at random times.
  • Athetosis, a movement disorder that involves continuous twisting and rolling movements of the fingers, hands and toes

Cerebral Palsy (CP) is a general term used to describe a group of disorders that impair muscle control due to damage to the developing brain.
Cerebral Palsy affects movement and posture and is caused by brain damage before, during, or after birth. The brain damage underlying CP cannot be reversed and produces life-long disabilities. Despite remarkable medical advances, the incidence of cerebral Palsy has not decreased, with one out of 500 children being afflicted with the disorder.

Symptoms:
CP may present from extreme clumsiness to extensive spasticity. Parents may first notice that their child is not developing motor milestones normally i.e. the baby may have delayed rolling over or the baby may be late to sit, crawl or walk. The child may also show an unusual posture though spastic children are universally identified as children with CP, there are actually 4 types of CP

  1. Spastic CP - It is the most common type in which the muscles are stiff & weak (due to uncontrolled contraction of the muscles). The stiffness may occur in both legs (diplegia), in the leg & arm on the same side (hemiplegia), or in all four limbs (quadriplegia). These children usually show toe walking & typical crossed (scissoring) gait.
  2. Dyskinetic CP (Athetotic CP) - Patients with this type of CP have bizarre twisting motions or unusual posturing.
  3. Mixed CP - It is a combination of the above two types.
  4. Hypotonic CP - These children usually present with low muscle tone & increased floppiness. These children eventually develop spasticity or athetosis.

Causes
CP is caused by damage to the developing brain. It usually develops by 2-3 years of age. Though most of the causes remain unknown; infections during pregnancy in the mother, severe jaundice in the infant, birth injuries & stress to the fetus in the womb are some of the known factors. Babies born prematurely are at a particular risk. Any severe illness damaging the brain in 1st year of life can result in CP.

The cause of spastic diplegia is periventricular leucomalacia, more commonly known as neonatal asphyxia, a sudden shortage of oxygen delivered through the umbilical cord, combined with premature birth. The presence of certain maternal infections during pregnancy can also lead to spastic diplegia, since such infections can have similar effects to infant hypoxia. This lack of oxygen damages areas of the brain associated with movement.

The risk factors for having a CP child are : -
  • Breech deliveries (babies delivered with feet coming out first).
  • Birth defects such as spinal bone defects or abnormally small jaw bone
  • Low birth weight and premature babies
  • Twin deliveries
  • Abnormally small head (microcephaly)
  • Convulsions shortly after birth

Effects of Spasticity
Spasticity adversely affects muscles and joints of the extremities, causing abnormal movements, and is especially harmful in growing children.

The known adverse effects of spasticity include:
  • Inhibition of movement
  • Inhibition of longitudinal muscle growth
  • Inhibition of protein synthesis in muscle cells
  • Limited stretching of muscles in daily activities
  • Development of muscle and joint deformities

Patients with cerebral Palsy do not have deformities of the extremities at birth but develop them over time. Spasticity of muscles, along with the limitations on stretching and use of muscles in daily activities, is a major cause of deformities.

Diagnosis:
There is no definite test to detect CP. The diagnosis is made by reviewing the child's history and on examination. It may be difficult to diagnose due to changing symptoms over a period of time. In fact, some children with mild CP may be diagnosed at 3 to 4 years of the age. Certain blood tests and brain scans may be done to exclude other conditions.

How can CP be prevented?
  • The pregnant mother should get regular antenatal care.
  • Blood tests of mothers should be checked to detect Rh factor.
  • Parents should seek treatment for a baby who is jaundiced at birth or has prolonged jaundice within a few days after birth.