Dr. Deepak Sharan

repetitive strain injuries


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Cerebral Palsy

Definition

Cerebral Palsy (CP) is an umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development (i.e., up to 5 years). It includes various kinds of disabilities such as difficulty in coordinated and alternate movements, abnormal movements and postures, and difficulty in keeping the body in antigravity postures.

Types of CP

1. Spastic (70-80% of cases). Further classified by the following descriptions of extremity involvement:

a) Quadriplegia (10-15%): All 4 extremities are affected equally along with the trunk

b) Diplegia (30-40%): Lower extremities are affected to a greater degree than the upper extremities

c) Hemiplegia (20-30%): Involvement is observed on 1 side of the body, including an arm and a leg

d) Monoplegia (rare): Involvement is noted in 1 limb, either an arm or a leg

2. Dyskinetic (10-15% of cases). Characterized by abnormal movements

3. Ataxic (<5% of cases). Characterized by unsteadiness

Magnitude of the problem

The incidence of CP is 2-2.5 cases per 1000 live births
There are an estimated 25 lakh children and people in India with CP, making it the commonest cause of disability
75% out of approximately 1000 cases of locomotor disabilities evaluated for the Govt. of Karnataka by Dr. Deepak Sharan's team from Bangalore Children's Hospital in 2002-3 were found to be due to CP. In just one residential school in Tumkur, nearly 90% of the children were found to be suffering from CP. None of them were ambulant either with or without assistive devices. Tragically, almost all these children had the potential to walk but in spite of promise of government funding the parents refused to accompany the children to Bangalore for surgery.

Current scenario in India

The usual medical advice currently given to parents of children with CP is one of the following:

CP is incurable: so don't waste money on treatment.
Unsubstantiated but well publicised alternative modalities claiming to "cure the brain without side-effects", e.g., homeopathy, herbal or biochemic pills, oil massges or biofeedback
Refer to physiotherapist for further management and physicians take no further active role in treatment

The team of medical professionals who are going to treat a child with CP must have:

Knowledge of normal anatomy and physiology, particularly with respect to ambulation
A good understanding of the functional pathology present in CP
Realistic goals / objectives for treatment that are shared commonly by the patient, family, and others concerned with the child's welfare
Knowledge and ability to carry out any of the treatments that are required
A facility with the resources to carry out the necessary evaluations / treatments

Very few centers exist in India that provide a dedicated, trained and qualified multi disciplinary team comprising of Developmental Paediatrician, Paediatric Orthopaedic Surgeon, Paediatric Neurologist / Neurosurgeon, Physiotherapist, Occupational Therapist and Orthotist. Each of these specialists offers a unique perspective that enhances the development of a comprehensive evaluation and treatment programme for each individual patient. The absence of such a team means that doctors are completely marginalised in the management plan, and the child with CP is completely dependent on N.G.O.'s, CBR workers and Physiotherapists, who are frequently not trained or qualified to take complex medical decisions for them.

For details of our multi-disciplinary rehabilitation team CLICK HERE

Currently the treatment of CP offered in India is largely palliative, e.g., special schools, vocational training (candle making, card making, etc.), even for children with normal intelligence, while accepting whatever locomotor disability there is without attempting to improve the ability to walk or even sit better, other than a few perfunctory stretching exercises. This approach is several decades behind what is available in developed countries. The main reason for this is an acute shortage of medical professionals trained in the recent rehabilitation trends, except in a handful of tertiary level centres.

The natural history of untreated CP is one of progressive deterioration. It has been shown that without intervention, detrimental changes in gait and function will occur over time spans as short as 1.5 years. Unfortunately, there is a misconception that the only treatment available for CP is physiotherapy (or muscle stretching) and if that fails the child is condemned to crawling or being bed-bound for life. The prognosis for a child with CP in India is currently exactly the same as that of a child with muscle dystrophy (which is recognized as progressive and dismal).

Read a detailed article on recent advances in the treatment of cerebral palsy HERE

Forum for Cerebral Palsy Treatment

This discussion list is intended for parents of a child with CP, adults with CP, therapists, medical professionals, and interested persons. The list will primarily discuss newer treatment options for CP available in India.