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World Cerebral Palsy Day – 6th October 2023
Cerebral palsy (CP), the most common disability in childhood, occurs as a result of non-progressive insult to a developing fetal or infant brain that leads to the disturbances in the development of movement and posture causing limitations in the physical activity. It is often accompanied by disturbances in cognition, sensory processing, communication, behavior and seizures. The prevalence rate in India is 3 to 4 per 1000 live births. CP is caused most commonly by antenatal factors followed by birth injuries and post-natal causes such as brain infections, trauma or epilepsy. The timing of the injury determines its type and associated co-morbidities. It is increasingly being recognized that genetic and epigenetic factors may contribute to the development of CP. The burden is severe such that, 1 in 2 had intellectual disability, 3 in 4 were in pain, 1 in 4 could not talk and had epilepsy, 1 in 3 could not walk and 1 in 10 were blind.
CP is not a disease, it is a disorder and the effects of CP change from child to child. The World CP day is being celebrated since 2012, in order to educate the world about CP and to promote more inclusive societies for children with CP. This day also provides an opportunity to share ideas about newer technologies and products that people with CP can use to make their lives easier and better.
CP is often diagnosed between 1 to 2 years of age, however, earlier diagnosis helps to improve the natural history of this condition by initiation of early interventions. Owing to the remarkable brain plasticity and aptitude for learning during infancy and childhood, early intervention must be done in order to maximize functional outcomes and minimize complications. Children with involvement of four limbs experience higher co-morbidities and worse outcomes when compared to children with involvement of fewer limbs. CP-specific and age-specific interventions must be started in all children with CP or at a high risk of CP. Goals should be set that are task and context-specific and clinicians should impart knowledge and educate the parents and caregivers about the role of positive parent-child relationships.
There is no curative treatment for cerebral palsy beyond symptomatic and supportive care. Comprehensive multi-disciplinary approach is recommended in the management to maximize rehabilitative efforts to make children more integrated academically and socially. Non-pharmacological measures include physical, occupational and speech therapies, orthotics and optimal nutrition. Constraint-induced movement therapy and bimanual therapy improve the function of upper limbs in children with unilateral CP. For children with emerging verbal communication and those suspected of being non-verbal, the benefits of Hanen approach (Parent-child transactional programs) must be explained to improve expressive language acquisition. The use of softer food consistencies and upright supported positioning may help to promote eating in children with dysphagia. Oromotor techniques, postural management and certain medications can take care of excessive drooling seen in these kids. Children with CP are five times more likely to have sleep issues when compared to a child developing typically. A structured age-appropriate bedtime routine and dark and quiet environment should be promoted. Watching television or vigorous play must be avoided prior to bedtime. Bone health is also of utmost importance in these kids and vitamin D and calcium supplementation may be essential for severely affected children.
There are various medical (incl. Botulinum toxin) and surgical therapies (Baclofen pump, selective dorsal rhizotomy) available to relieve the movement abnormalities associated with CP. It is suspected that the children with CP develop persistent inflammation of central nervous system and subsequent apoptosis as a result of hypoxia-induced damage. Hence stem cells are being studied for their regenerative and anti-inflammatory properties. While the safety profile for stem cell therapies in children with CP is encouraging, there is a need for more adequately powered PHASE 3 studies, before using them as a therapeutic option in children with CP.
Hence, the bottom-line is stem cell therapy cannot be used as a cure for many neurodevelopmental conditions such as Cerebral Palsy and Autism spectrum disorder unless robust clinical evidence develops in near future.
Dr. S. Bhanu Deep
Pediatric Neurologist, Apollo Hospitals,
Jubilee Hills, Hyderabad.
