Reflections from the pediatric clinic: Cerebral Palsy in children(Beckung & Hagberg, 2002)
- 12 yr old boy, suffered from a stroke as a young child, was left with a unique gait
- Came into the clinic to have a casted device fitted onto his new pair of trainers
- Right leg only
Cerebral palsy is a group of conditions used to describe motor impairment, either partial or total in children who summer from the condition. Impairments such as abnormal muscle tightness, the simultaneous firing of agonist and antagonist muscles, muscle weakness, and limited range of motion affect total or partial motor function. Additionally, impairments such as learning disability, epilepsy, visual impairment, and hydrocephalus are frequently clinically seen and will affect activities and participation in society, naturally. Deficits in speech, language, perception, and behaviour are also common traits that clinicians have commented on as well (Beckung & Hagberg, 2002).
Research done in 2002 by Beckung et al, was a study of 176 children with cerebral palsy, aged between 5-8 years of age, observed additional neuroimpairments, activity limitations, and participation restrictions in terms of social, educational and mobility in terms of classifications set by the international classification of functioning disability and health (ICFDH). Other classification systems used were the Gross Motor Function Classification System (GMFCS) for the activity limitations and a system used for grading results was the Bimanual Fine Motor Function (BFMF) (Beckung & Hagberg, 2002).
Results showed that learning disability occurred in 40% of the participants, epilepsy in 35%, visual impairments in 20%, and infantile hydrocephalus in 9%. The authors state that there was a strong and clinically significant correlation between learning disability, activity limitations and participation restrictions and thereby speculate that learning disability and activity limitations were strong predictors of participation restrictions in children with cerebral palsy.
Additional neurological impairments were seen in children with tetraplegia and dystonic CP and in children suffering an injury immediately or soon after birth (Beckung & Hagberg, 2002). Tetraplegia is the inability to move the upper and lower parts of your body voluntarily (Friden & Gohritz, 2015). Dystonic CP is a form of dyskinetic cerebral palsy causing involuntary muscle movement, fasciculations or contractions either partial or involving the entire body and is seen to develop after injury or damage to the basal ganglia (Lin-Pierre, et al., 2014).
Gait in children with Cerebral Palsy:
Dobson et al do a systemic review in 2007 of the variations in gait in children with cerebral palsy. The system review starts off by addressing the deviations in gait as seen by clinicians and therefore a classification system was developed in attempts to help clinicians with their clinical decision-making such as diagnosis and subsequent management (Dobson, et al., 2007).
Commonly issues in gait are noticed with ground clearance, a weakness in the tibialis anterior causes the foot to drop, displaying a ‘drag’ during gait. This can be quite awkward for children and really hinder social participation (Beckung & Hagberg, 2002).
References
Beckung, E. & Hagberg, G., 2002. Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Developmental Medicine & child neurology, 44(5), pp. 309-316.
Daminano, D. L. & Abel, M. F., 1996. Relation of gait analysis to gross motor function in cerebral palsy. Developmental Medicin & Child Neurology, 38(5), pp. 389-396.
Dobson, F., Morris, M. E., Baker, R. & Graham, K. H., 2007. Gait Classification in Children with Cerebral Palsy: A Systemic Review. Gait and Posture, 25(1), pp. 140-152.
Friden, J. & Gohritz, A., 2015. Tetraplegia management update. The Journal of Hand Surgery, 40(12), pp. 2489-2500.
Lin-Pierre, J., Lumsden, D. E., Gimeno, H. & Kaminska, M., 2014. The impact and prognosis for dystonia in childhood including dystonic cerebral palsy: a clinical and demographic tertiary cohort study. Neurology, Neurosurgery and Psychiatry, 85(11), pp. 1239-1244.
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