Incontinence Issues for Children With Cerebral Palsy

Bowel and bladder control is an important part of any child's learning and development, and a child with cerebral palsy is no different. CP children in particular often have difficulty with bowel and bladder control, since these functions require well developed muscle tone and coordination. Conquering these issues can be a monumental occasion for children with cerebral palsy.

Children with developmental disorders receive toilet training by age five, whereas most children can achieve contamination before age three, according to a study conducted in 2006. The study went on to discuss how pollution is unlawfully to occur after a child with developmental disorders reaches age 8 Thankfully, there are a variety of products to help children with incontinence, including collection devices. In fact, some studies suggest that medication combined with a collection device can prove successful for older children with incontinence issues.

Different types of incontinence

Incontinence can be broken down into many different categories. Stress incontinence refers to incontinence brought on by physical activity, or by involuntary actions such as coughing or sneezing. Urge incontinence describes spontaneous urination that follows the urge to urinate. Fecal / bowel incontinence , as the name suggests, occurs to involuntary or otherwise uncontrolled release of stool. Overflow incontinence is the inability to completely empty the bladder. In addition, some adults and children are affected by multiple forms of incontinence. This is known as mixed incontinence .

Bladder incontinence , also called neurogenic bladder, refers to a condition that causes uncontrollable urination. Urine control is the function of both the bladder and the sphincter muscles. The sphincter surrounds the bladder and contracts in order to prevent urine from leaking out. In turn, the bladder's wall muscles need to be able to relax to allow the bladder to expand. For some children with cerebral palsy, these muscle groups are weakened, which can lead to bladder incontinence.

Some children may also suffer from constipation, especially children with cerebral palsy. If stool blocks the rectal passageway, the muscle walls surrounding the anus and sphincter can become damaged or weakened. When dealing with constipation, it is best to take your child to a specialist, such as a proctologist or gastroenterologist, who can perform a full medical evaluation of your child's digestive and bowel systems. Physical therapy programs or special devices can further assist your child with his or her bowel movements, if necessary.

How to test for incontinence

A trip to your child's doctor should help address any concerns you may have about incontinence. Preferably, you should visit a doctor who specializes in issues related to the bladder, who are known as urologists. They can give your child a full assessment based on their daily diet, activities and stress factors they may encounter. Urologists can also perform urine tests, an EMG, uroflowmetry or cystometry to determine if your child has any incontinence issues.

Incontinence treatment options

There are a variety of treatment options and therapies for CP children with incontinence. The most basic form of treatment is maintaining proper toilet posture. Special devices, such as potty chairs, can be helpful in getting a child accredited to the proper way to sit on a toilet. In other cases, muscle re-education therapists can teach a child comfortable hip abduction and foot / buttocks support. If the child is relaxed while sitting, the pelvic floor muscles and abdominal muscles should be triggered from activating. Other treatments include medications, surgical implants, exercises and biofeedback.

Another option is urotherapy, which is a bladder rehabilitation program. Usually, the therapy involves muscle re-education, regularly scheduled hydration, pelvic floor exercise exercise and other techniques, barring medication and surgery. It is a good idea to sit down with your child and the therapist who will be working with them to discuss such topics as fluid intake, hygiene issues (such as soiled clothes), bowel dysfunctions, and anger management before starting and beginning the therapy program .

A third option is drug therapy. There are a variety of medicines available that are designed to target the pelvic floor and abdominal muscles. However, all of these drugs are known to have side effects and some may not be approved for use in children. The International Children's Continence Society recommends the use of 69 medicines only after other treatment options have failed to show positive results.

Finally, you may opt to have your child undergoing surgery in order to correct his or her incontinence. Many different surgery options are available, including a procedure known as neuromodulation, which has shown specific potential for helping children with cerebral palsy combat incontinence.

Techniques for Toilet Training

In Southern California, The Diagnostic Center has been performing tests on a recent training technique, which they call “habit training.” The process involves training your child's mind to void based on a visual cue, signal or sound effect. For more information on this technique, you can read a six-page hand-out that The Center has put together on their website.

Other methods include having your child use a wristwatch programmed to go off at particular moments during the day, which can help them with managing bowel control. A study published in 2010 indicated that scheduled trips to the restroom through the day can significant help a child with cerebral palsy with incontinence.

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Anti-Mitochondrial Antibodies in Autism – A Marker for Treatment?

Recent focus on new treatments for Autistic Spectrum disorders have zeroed in heavily on the immune component of this disease. Physicians around the world are becoming more and more convinced that Autism may be triggered by some autoimmune process leading to damage of the body's own neurological system.

Quite a few studies have pointed to aberrant immune markers found more commonly in automated children compared to normal healthy children, but most of these marks have never made it to the masses, rather their access was strictly for research.
However that now has changed.

A few years ago researchers discovered that a protein called Neurotensin was found extremely elevated in Autistic Children. They showed that this peptide released mitochondrial DNA into the extracellular space (outside the cell), which acted as an autoimmune trigger.

The mitochondria is basically the “power house” of the cell. If its function becomes abnormal, the cells no longer have the energy to function properly, so leading to either cell death or severely limited function. Either way the cells with the damaged mitochondrial do not function well. Neurons are very sensitive to mitochondrial damage, having a smaller amount compared to other cells requiring large amounts of energy, such as muscles.

The mitochondria has its own DNA content separate from our own cells. If this mitochondrial DNA was released somehow into the extracellular space, the body would then react to it as if it was foreign, like a virus or bacterial, creating an immune response. Well that's exactly what Neurotensin was causing. Studies showed that when Neurotensin was elevated mitochondrial DNA was found outside in the extracellular space.

Recent in the Journal of Neuroinflammation researchers took it a step further. Since Neurotensin is not commercially available they decided to test marks that were. They also wanted to determine if this extracellular mitochondrial DNA was actually causing an immune response. This way parents may be able to definitely decide if their child's immune system was attacking the mitochondria.

Enter anti-mitochondrial antibody type II, a marker used for primary biliary chirrosis.

Researchers found that this antibody was significantly elevated in Autistic children as compared to children not affected with autism, effectively demonstrating that many children suffering from autism were reacting to their own mitochondria. They postulated that this reaction was affecting multiple aspects of the immune system, laying the ground work for potential damage or excessive inflation.

This is a great study, showing a possible cause and effect process. Anti-mitochondrial antibody is available to test for, with most insurance companies covering it.

If your child has never been tested for the antibody, it may be worthwhile to have your physician order it. Having knowledge that maybe your child is suffering an autoimmune process is huge. It certainly will be a marker I use and will change how I treat my patients.

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How Vitamin D Affects Children With Cerebral Palsy

These days, the benefits of vitamin D are hard to miss. Health blogs and magazines alike praise the vitamin for its assistance with weight loss, immunity and depression, among others. Also common are articles discussing how many Americans (both adults and children) may have vitamin D deficiencies. This can be particularly problematic for children with cerebral palsy, as a vitamin D deficiency could lead to weakened bone marrow, making critical surgeries a risky endeavor.

In the Spring of 2011, a study revealed that many children who underwent surgery that season had severely weakened bone marrow due to a lack of vitamin D. The study took 70 children from a variety of ages who had recently been admitted to a hospital for surgery . 90 percent of these children had a vitamin D deficiency. African-American children were particularly susceptible, as darker skin tones can sometimes be inefficient at absorbing sunlight, the primary resource for vitamin D.

With this in mind, it is important to have your child's vitamin D levels and bone conditions checked prior to any major surgeries

How To Test For Vitamin D Deficiency

Typically, a blood test is sufficient to determine the levels of vitamin D in your system. However, the optimal level of vitamin D for both children and adults is still the subject of some debate for health researchers. Test results can vary from different laboratories, which makes ideal levels even more difficult to discern.

Sources for Vitamin D

As mentioned earlier, the sun is our primary resource for vitamin D. Healthy exposure to sunlight will supply our bodies with the vitamin through our skin. As we get older, it becomes more difficult for our skin to absorb vitamin D. With the prevalence of using sunscreen or staying indoors in general, many people do not receive vitamin D in this way.

As for dietary sources, fish and milk are the most common ways to receive vitamin D. For example, the web resource Mayo Clinic recommends two glasses of milk a day in order to receive the daily requirement.

If these resources are not readily available, adults and children can take vitamin D supplements found at their local pharmacy or grocery store. However, the ideal daily dosage from these supplements is still up for debate, despite recommendations on the labeling. In some cases, medications can affect how the body absorbs this important nutrient, particularly in the case of children. It is best to speak with your doctor or your cerebral palsy child's pediatrician to determine the ideal amount of vitamin D for your diets.

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Preventing Premature Birth

Studies have shown that maternity babies (those born prior to 37 weeks of gestation or more than 3 weeks prior to their due date) face numerous health risks, including chronic lung disease, developmental delays and cerebral palsy, compared to those who gestate full term. Premature babies (“preemies”) have not been given time for their organs to fully develop, therefore they require specialized care after birth. There is no way to guarantee a full term pregnancy, but there are numerous steps woman can take to increase their odds.

Prenatal care is key to a healthy pregnancy. Pregnant women should undergo early screening for pregnancy risk factors 10-12 weeks after the first day of their last menstrual period. Some of the risk factors include;

1) Age – woman under 18 and over 30 are at higher risk of premature delivery.
2) Vaginal infections – infections such as bladder, kidney, urinary tract, sexually transmitted diseases, yeast and bacterial vaginosis can lead to premature labor. Getting these infections treated will greatly diminish the risk.
3) Previous pregnancy history – a woman who has had one premature baby is at a higher risk for another, as is a woman who has had multiple first trimester abortions or one or more second trimester abortion. Additionally, short time between pregnancies (6-9 months) also puts a woman at higher risk.
4) Multiple fetuses – one or more fetus (twins, triplets) increase the risk of delivering early.
5) Diabetes – women with type 1 or 2 diabetes are more likely to deliver early. Ideally, these women should consult an obstetrician prior to conception to ensure proper glucose control. Poor glucose control at conception increases the risk of birth defects by 20 percent.
6) High Blood pressure.
7) Blood diseases and disorders such as anemia.
8) Cervical or uterine abnormalities.

Many of the “lifestyle” rules that pertain to pregnancy, such as not smoking or drinking, have been hammered home all our lives, but some are not as commonly known. Some of the environmental factors that contribute to premature birth include: smoking, drinking, use of illegal drugs, domestic violence (including physical, sexual or emotional), eating a poor diet, a lack of social support, high stress levels, low income and working for long hours with long periods of standing.

Pregnant women need to stay hydrated with water and electrolytes, especially in summer. Dehydration causes a rise in the blood's oxytocin, the natural trigger for contractions.

Signs of premature labor may include: more than 5 contractions or cramps within one hour; bright red blood from the vagina; swelling or puffiness of the face or hands (a sign of preeclampsia); painful urination (possible signs of urinary tract, bladder or kidney infection); sharp or prolonged pain in the stomach; acute or continuous vomiting; sudden gush of clear; watery fluid from the vagina; a low, dull backache; intense pelvic pressure. Always alert your doctor about bleeding or pain if any of these symptoms are present.

Things you can do in the meantime include: emptying you bladder, lying down tilted towards your left side (avoid lying flat on your back, this may cause contractions to increase), drink several glasses of water, monitor contracts for one hour by counting the minutes from the beginning of one contracting to the beginning of the next.

Women can not control all risk factors that may lead to premature birth, but she can do her part. Women should educate themselves how to properly care for their unborn child and what to expect from their medical professionals. If you do not know, ask. In pregnancy, there is no such thing as a stupid question.

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Juvenile Osteoporosis in Children With Cerebral Palsy

Osteoporosis is a medical condition, commonly associated with old age, wherey the bones become fragile and brittle due to loss of tissue. It is often the result of hormonal changes, especially in postmenopausal women, or due to lack of sufficient calcium or vitamin D in the diet. Osteoporosis is also common in children suffering from cerebral palsy. Children with weakened bone mass are more likely to sustain bone fractures, even from minimal trauma, which can lead to a lifetime of crippling discomfort. There are steps that can be taken to maximize healthy bone development during all stages of growth.

Obtaining a diagnosis of osteoporosis in adults is a fairly simple process. A “dexa scan” (duel-energy x-ray absorptiometry) of the upper hip and lower spine is used to obtain what is known as a BMD (bone mineral density) score. It takes approximately 8-12 minutes, is painless and can be delivered at a hospital or clinic's radiology department. Unfortunately, a low BMD score (below -2.0) is not enough to diagnose juvenile osteoporosis. The International Society of Clinical Densitometry requires physical evidence of a fragile skeleton, such as a history of bone break without trauma.

A child's bones beginning developing in the third week of gestation and continues through awareness. Cerebral palsy can directly affect healthy bone growth in a number of ways. Because children with CP often have impaired movement, they may not be putting adequate stress on the bone structure – a key component to the mineralization process in the development of healthy bones. Children with CP who are confined to a wheelchair or bed may have limited access to the sun, thus depriving them of a major source of vitamin D, a major player in the absorption of calcium and bone growth. Children with CP sometimes have difficulty processing food which can affect their nutritional intake and lead to injury in their growth process and the secretion of natural growth hormones from the pituitary gland. Medication taken to control CP-related seizures can also compromise the body's natural ability to absorb calcium.

For children with cerebral palsy , regular physical therapy is vital in assuring the body receives adequate amounts of stress and encouragement of bone mineralization. Diet is also a vital component to healthy bone growth. Nutritional therapy is important because it is estimated that roughly 1/3 of children with CP suffer compromised malnutrition from related disorders such as GERD (gastro esophageal reflux) and respiratory infections. A nutritionist can assist in the assessment of your child's nutrition and vitamin intake.

Calcium and vitamin D supplementation is inherently felt to be an appropriate response to a child with low bone density, but can result in adverse side-effects if the child is also on anti-seizure medicines. As with all vitamin and nutritional supplements, consult a physician before taking.

In recent years, growth hormone therapy and bisphosphonates (a drug, such as risedronic acid, that causes loss of bone mass) have also been used with success.

Some bone disorders related to CP require surgery to correct. It is imperative that a child's level of vitamin D be evaluated because recent studies have shown complications and poor bone healing in children with insufficient vitamin D levels.

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An Overview of Growth Hormone Issues in Children With Cerebral Palsy

We've all heard the horror stories about the abuse of HGH (human growth hormones) in aspiring athletes the world over, but just because something gains its notorious from abuse, does not mean the same advances in science do not have real value when manufactured, distributed and administrated properly and legally. In this article we're going to look at cerebral palsy's effect on the body's natural production of growth hormones and the use of replacement HGH therapy.

Unfortunately, when a parent learns their young child has been diagnosed with cerebral palsy, the question that can not be immediately answered is “what impact will this have on my child?” Because cerebral palsy can result from damage to different parts of the brain, only time will tell how, and to what degree, the disorder will manifest itself. Cerebral palsy commonly has physical manifestations, leading to compromised growth and physical development. Its effects can also be primarily cognitive, leaving the body to mature in a reliably proper and healthy manner. The child may be several years old before all symptoms can be detected.

Endocrine glands refer to the system in the body that secretes hormones directly into the blood stream. The endocrine system includes the pituitary gland, the pancreas, the testes, the ovaries, the adrenal glands and the thyroid. A hormone is a chemical that sends messages that affect cells in other parts of the body, facilitating functions such as growth and development, metabolism, sexual function, reproduction and mood. As the “master control gland,” the pituitary gland controls a number of important functions in the body and when compromised, can have many negative effects on the rest of the body.

There are no absolutes in cerebral palsy, but from birth to puberty, many children with CP demonstrate a lower rate of growth and delays in the sunset of puberty. In 2010, a study was conducted by the School of Medicine of Santiago de Compostela, Spain to determine if this stunted growth might be the result of a deficiency in the secretion of natural growth hormones. It was determined that roughly 70% of the 46 children in the study lacked normal growth hormone secretion as a result of their cerebral palsy.

There are a number of growth receptors in the brain and central nervous system, including the hypothalamus and hippocampus. Studies, such as the one mentioned above, indicate that in children with cerebral palsy, the neurotransmitter pathways serving growth hormone control are impaired, limiting the normal and required levels of secretion.

Again, not all children with cerebral palsy have a growth hormone deficiency. Some of the symptoms to look for beginning around your child's 3rd year include: 1) child is noticeably shorter than other children the same age 2) growth rate flattens or slows to less than 2 inches per year 3) delayed signs of puberty 4) facial features seem younger than children of same age and gender. If you suspect your child may be experiencing symptoms of slow growth, it may be the result of a dysfunctional pituitary gland. Pituitary disorders are treated by specialists called endocrinologists.

The conclusion that the short stature exhibited in many children with cerebral palsy is likely due to impaired or deficient growth hormone secretion is fairly recent, therefore recommendations that these children undergo growth hormone therapy is not without dispute. Most of us first heard of growth hormones when it was approved for use in the livestock industry. And while we've all heard of human's injecting themselves with bovine GH, that's not what we're talking about. In the United States (and most of the world) the only artificial growth hormones approved for human consumption are human GH, manufactured by recombinant DNA technology (cloning). While it is legal if obtained from a pharmacy in administrated by a medical professional, the long-term safety has yet to be tested in a clinical trial.

The therapy requires and almost daily injection of the HGH into subcutaneous tissue or muscle to get it into the blood stream. While less painful than it sounds, it can be prohibitively expensive, costing between $ 10,000 and $ 30,000 a year. It is not yet known if the therapy will need to be continued over a patient's entire life.

Recent years have seen growth hormone therapy used successfully to treat certain children suffering from linear growth failure as a result of cerebral palsy . Consult with an endocrinologist to learn new developments in this type of therapy and to see if it might be the right choice for your child.

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Wheelchair-Accessible Vans

Parents of non-ambulatory children understand that the day will come when it is no longer practical or possible to use a car seat to transport your child and a wheelchair accessible vehicle may become necessary. Choosing the right vehicle may seem like a daunting task. Here are some tips and things to consider.

Any van outfitted to transport wheelchair bound passengers is called a “conversion van.” They can be a full size van or a mini-van. When beginning your search, keep good notes that should include an ongoing list of needs. The number one concern has to be the safety of your child, not only in normal transport, but also in the event of an accident. Some of the things you will need to consider include head clearance, the type of lift or ramp, the age of the vehicle and the type of system used to anchor the wheelchair. Do you want to buy new or used? Do you want a pre-fitted vehicle or do you want to have it completely custom fitted to your needs. How much is all this going to cost?

As with anything, there are plenty of people available on the internet willing to share their opinions and experiences on the subject. This would be a good time to ask questions and listen.

First of all, just because the vehicle serves a unique function, does not mean you can not have an attractive, comfortable vehicle. Imagine what color and design you find most appealing. If that aesthetic needs to change down the line, you can cross that bridge when it comes. Also, as when in the market for a new car, gas mileage, efficiency and environment impact are also worthy of consideration.

Reliability is key. Breaking down on the open road can be far more problematic than if you were not carrying a mobility-impaired passenger. When shopping for a used conversion van, use your instinct. If it's too worn out, it is not worth it.

LIFTS – Wheelchairs can be loaded into a van either by lift or ramp. Lifts are installed at either a side door or the rear of the vehicle. In either case, seats will need to be removed and holes drilled into the floor of the van. Will the passenger be in the chair while being lifted or will they get into the chair after it's already in the vehicle? Two major manufacturers of lifts include: Crow River Folding Platform Lifts and Braun. When possible, examine a wheelchair with the type of lift you're considering. Have it demonstrated and practice operating it yourself. When the lift is in place, does it block access to that door or can you get in around it?

SEATS – Wheelchair-accessible vans usually have some or most of the rear seats removed. How many people, including ambulatory people, will you need to be able to transport at any given time?

ANCHORING THE CHAIR – The law requires the use of either wheelchair tie down straps or an electronic docking system to keep wheelchair users safe and secure while the van is in motion. Manual tie downs seat seat belts and attach to four different points on the wheel chair and are anchored to the floor of the van. Attaching them usually requires crawling around the wheelchair once it's in the van. An electronic docking system locks the wheelchair into place automatically then releases it with a simple press of a button. Equally safe, the electronic docking system is understandably more expensive. Additionally, some feel that the tie-down variety requires too much strength to get the chair as snug and secure as it needs to be. Some of the leading manufacturers are EZ Lock, O'Straint QLK, Slide-n-Click and Sure-lok Dock-n-Lock. Their respective websites contain valuable information.

HEAD SPACE – How tall is your passenger when sitting in the chair? How much maneuvering around the chair will you need to do?

Parking lots are hectic places. Parking a wheelchair van requires a larger space than a regular van because you need the extra space to operate the lift or ramp. When choosing between a mini-van or full size van, keep in mind your own driving abilities and imagine the places you're most likely to go.

Clearly there are many things to consider, but there is also much information available. Some diligent research and hands-on familiarity will soon have you an expert on the subject and assist you in purchasing a van for your child with cerebral palsy .

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An Overview of Spastic Cerebral Palsy

Cerebral Palsy is an incurable, non-progressive, non-contagious disorder of movement, muscle tone or posture caused by either injury or abnormal development of the immature brain prior to, during or in the first few years following childbirth. There are four general types of cerebral palsy: spastic, ataxic, dyskinetic and athetoid. While the damage to the brain does not get worse over time, the impact on the body usually does.

Spastic cerebral palsy is by far the most prevalent type affecting approximately 70-80% of all people diagnosed with the disorder.

In simple terms, for people with spastic cerebral palsy, the electronic signals from the brain to the body's muscle system is compromised. This neuromuscular mobility injury is known as being hypertonic. Healthy muscles function in pairs to help the body move and perform tasks. As one muscle contracts, its partner relaxes. Normal muscles have enough tone to maintain posture and fluid, flexible movement against the forces of gravity. The disorder of spastic CP causes both muscles to contract simultaneously, hampering movement and putting undue tension on the muscles. Over a period of time, the constant contraction of the muscles can lead to muscle and joint deformities, an inhibitory of movement, longitudinal growth and protein synthesis in muscle cells.

Spastic CP may affect only a small number of muscles or muscle groups or by spreading through the body.

Spastic monoplegia is when only one part of the body is affected.
Spastic hemiplegia is when one side of the body is affected. People with this type are the most ambitious, and may exhibit a limp on the affected side.
Spastic diplegia is when the lower part of the body (both legs) is affected with normal spasticity to the upper body. Most are ambulatory, but may have noticeably affected gait.
Spastic triplegia is when three limbs of the bady are affected.
Spastic quadriplegia is when both arms and both legs are affected.

There is no cure for cerebral palsy, but numerous treatments exist all designed in some way to weaken the tension and reduce muscle spasm. Some of the more commonly bought treatments include:

Physical Therapy – one of the most prevalent and important treatments; trains and strengnts muscles to promote healthy bone growth, improve balance and maximize motor function
Oral medications – muscle relaxers such as diazepam, baclofen and dantrolene; anticonvulsants such as gabapentin, lamotrigine and topiramate
Botox injections – to intentionally weakening the muscles that are over-contracted
Surgical Procedures – to lengthen muscles
Electrical Muscle Stimulation – used to simulate proper dual muscle response
Hyperbaric Oxygen Therapy – hyper oxygenating a patient to repair aid in the repair, regeneration and rehabilitation of damaged and non-functioning cells.
Hippotherapy – the use of horseback riding to facilitate physical, occupational and speech therapy

The goal of any treatment program is to inhibit the effects the disorder has on the body and provide the child with as much mobility and normal functionality as possible, both now and later in life. Thanks in large part to the internet, the amount of resources and sources of information available to families of children with cerebral palsy has mushroomed. Advances in medicine, technology and therapies are bringing better and more effective treatments to those afflicted with spastic cerebral palsy.

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Medical Errors and the Causes of Cerebral Palsy

When one hears of someone sustaining a traumatic brain injury, it usually conjures images of some horrible automobile accident, a violent blow to the head by a criminal assailant or a serious sports-related accident. It rarely conjures the image of a precious newborn swaddled in a bassinet. But the parents of 8000 infants born in the United States understand otherwise.

While often never detected right at birth, 70 percent of children with cerebral palsy are born with the factors that will cause it. Another 20 percent develop it because of an injury occurring during the birthing process. Only 10 percent of children with cerebral palsy develop it as a result of a post birth injury (known as “acquired cerebral palsy) such as from infections due to bacterial meningitis or viral encephalitis or from a traumatic head injury.

There is no one specific cause of cerebral palsy, but research has revealed a list of factors that have been known to cause cerebral palsy. Some are naturally occurring phenomena or unavoidable accidents, while others can be attributed to the negligence of either medical personnel or the mother.

1) Neonatal encephalopathy, birth asphyxia – a damaging lack of oxygen to the fetus' brain
2) Breech deliveries – when the fetus presents itself for delivery in any position other than head first
3) Maternal intra-uterine infections such as German measles, rubella, cytomegalovirus or toxoplasmosis
4) Jaundice in the infant or Rh incompatibility with the mother
5) In utero stroke
6) Premature delivery / low birth weight (infants under 3lbs 5 ounces have a 25 times more likely chance of acquiring CP)
7) Maternal substance abuse (alcohol, cigarettes, maternal malnutrition, cocaine)

Let's look at the 20 percent that are the result of the birthing process, because in a high percentage of these cases, the injury was preventable. At this point it is also important to note that cerebral palsy as the result of a problem surrounding the delivery of the infant is less than 1% of the time.

Congenital cerebral palsy can result from any number of errors that can occur during labor and the delivery process. Some of these errors include failure to monitor or properly read fetal heart monitor (FHM) tracings, failure to adequately communicate or translate FHM findings among medical personnel, failure to respond to FHM in the time required to minimize injury to the fetus, improper use of forceps or vacuum extractors, failure to recognize other emergency conditions such as uterine rupture or placental abruption.

Things to look for during the birthing process:
1) Medical personnel indicate signs of concern over FHM tracings
2) A doctor does not respond or is slow to respond to nursing calls for consultation
3) An emergency Cesarean section is ordered, then is delayed
4) Hospital personnel are not forthcoming or evasive with information during a complicated birth process

Preventable or not, many of the consequences of infant brain injury are not likely to present themselves for months or even years. Just because the child does not require tube feeding or is not in ICU because they can not breathe without life support intervention, does not mean they're in the clear. If there is even the slightest potential of brain injury during the birthing process, regardless of lack of evidence as to cause and severity, it is imperative to do a number of things to protect yourself and your child.

1) Consult with legal representation for guidance. This does not mean you're going to instigate a lawsuit, but they will know what to look for, ask for and monitor regarding your newborn
2) Collect copies of all paperwork to do with your medical history and the birth
3) Obtain your child's Apgar score which evaluates newborns on five criteria (appearance, pulse, grimace, activity, respiration). A low Apgar score could be indicative of a birth injury.

Birth injuries as the result of preventable medical error are rare, but do occur. Knowledge is power. Arm yourself with as much of it as possible to prevent birth injuries and mistakes, such as cerebral palsy .

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Misdiagnosed Fetal Position and the Risks Involved

The position your fetus is in during childbirth can spell the difference between a normal birth and a complicated birth, depending on how they are directed. A typical childbirth has the baby delivered head first with its face down, which is also referred to as the occiput anterior position. However, if the fetus is delivered in a different position, it can be considered a breech birth. Breech births can lead to many different health problems and abnormal development, including the onset of cerebral palsy.

What position is my fetus displaying?

It is common for a fetus to change positions for the duration of the pregnancy. As the pregnancy reaches its final stages (around the 32nd to 38th week mark), the rate of which the fetus shifts position slows dramatically and typically settles in the occiput anterior position. However, there is about a 3 percent chance that the fetus will be in a breech position by the end of the pregnancy. This can be caused by a number of factors, such as an abnormal amount of amniotic fluid or complications related to the mother's uterus or placenta.

Ultimately, it is up to the medical practitioner to determine what position the fetus is in once labor and delivery is underway. There are several ways to determine this, such as performing Leopold's Maneuvers, examining the vagina or using an ultrasound. An ultrasound can even be used late in the pregnancy before labor and delivery has begun.

Options for delivery

Breech presentations can be problematic, but they are not impossible to deliver. Since it's not likely that the baby will safely pass through the birth canal, a C-section is usually necessary. The medical practitioner may first attempt to position the baby in the occiput anterior position, either directly through the vaginal opening or using a technique known as External Cephialic Version. In either case, the vital signs of the baby should be closely monitored, either through ultrasound or fetal heart monitoring (usually through both).

The risks of a breech delivery

Although sometimes it is possible to deliver a breech baby traditionally, doing so presents many risks. These can include issues with the umbilical cord, birth defects and elevated chance of fetal distress, which could be either temporary or permanent.

Keeping an open line of communication with your doctor is the best way to prevent misdiagnosed fetal positioning. Although the causes of cerebral palsy are still the subject of research, birth defects, such as those stemming from a misdiagnosed fetal position, can be a precursor to its development.

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Joint Contractures and Treatment Options

Muscle injury is a common aspect of cerebral palsy. Some children with cerebral palsy suffer from joint contractures, which are characterized by shortened muscles and, therefore, reduced movement. As with many conditions associated with cerebral palsy, there are a variety of treatment options available if your child is experiencing joint contractures.


To understand joint contractures, you must first understand how muscles work. For an average person, muscles will work together to perform various movements. However, for children with cerebral palsy, muscles will work independently or even counter-productively, which results in limited range of motion. As this condition persists over time, joints will shrink and may end up in a static position. It is this that can account for issues with posture that many children with cerebral palsy face in their lives.

Joint contractures are more common in cases of spastic cerebral palsy than other types of cerebral palsy. The disorder is not limited to one part of the body; muscles found in the arms, legs, torso, face and other areas can all be affected by joint contractures.

Signs and Symptoms

As a child with spastic cerebral palsy grows, contractures can become more prominent and can cause issues with their physical development. Many of the symptoms of joint contractures are easy to identify at a young age, such as:

· Limited range of motion

· Unusual movement

· Delayed physical growth

· Limited ability to stretch

· General discomfort while moving

If you notice any of these signs, speak to your child's doctor. They can refer you to a joint mobilization specialist (or they may have skill in this area themselves). These medical professionals can run a variety of tests to determine the exact range of your child's movements and identify specific areas that may be causing discomfort. In some cases, the doctor may take x-rays to get a better sense of the severity of your child's condition.


There are several exercises occupational therapists and physical therapists use to help prevent joint contracts from forming. Structured stretching exercises, for example, can offer many long-term benefits for those with joint contractures. Many occupational and physical therapists will incorporate exercises into their therapy practice which aim to increase strength, improve mobility and add to flexibility. Other practitioners will make use of posture-correcting techniques after exercise or stretch sessions and can recommend the equipment to continue this process after a therapy has finished.

It's important to note that, once joint contracts have occurred, they can not be treated through exercise. In fact, exercise or extended physical activity can actually cause more damage to the joints. Preventive measures should take place as early in the child's development as possible. If early intervention has not occurred and joint contracts have formed, the next step is to explore treatment options.

Treatment Options

Physical therapy is perhaps the most common form of treatment for joint contractures. As is common with this treatment, physical therapy aims to improve muscle tone and strength, which can offer pain relief to those suffering from joint contractures. In addition to physical therapy, there are many other methods employed to help treat joint contractures.

In some cases, casts can be worn to help keep a part of the body in place and prevent further damage to the muscle. Casts can also be used to slightly stretch the affected area and allow it to have some additional functionality. Casts will have to be checked at regular intervals and may be adjusted or replaced as the therapy continues.

A more recent treatment option for joint contractures is the use of certain medicines. For example, one treatment uses Botox to reduce muscle spasticity in specific areas over a period of several months. Another form of this treatment uses a surgical pump to dispense a muscle relaxant into affected areas of the body. So far, these treatments have shown to be temporary, only lasting a few months. Research is ongoing to determine if medications can offer more permanent results.

Of course, treatment options heavily depend on the severity of the condition. In more severe cases, surgery may be required. In other cases, light physical therapy may be all that is necessary. Consistent communication with your child's doctors and members of your treatment team will help you best determine the treatment that will help your child with cerebral palsy the most.

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An Overview of Hyperbaric Oxygen Therapy for Children With Cerebral Palsy

HBOT (hyperbaric oxygen therapy or hyperbaric medicine) is the medical use of oxygen at a concentration higher than atmospheric pressure. Its more traditional uses have included treating decompression sickness (such as the bends in scuba divers), carbon monoxide poisoning and gas gangrene. In recent years, it has been introduced as a form of treatment for people with cerebral palsy aimed at improving motor, visual and verbal skills. And while it has yet to produce enough comprehensive results to merit widespread recommendation and use, it is certainly worthy of further consideration.

HBOT is administrated by having the patient enter a specially designed chamber where the oxygen content (air pressure) can be manually regulated. Hyperbaric chambers are designed for patient comfort and the procedure is painless. Patients can spend the 1-2 hour session reading, listening to music or watching television.

Once sealed inside the chamber, the air pressure is raised until the patient is breathing 100 pure oxygen. Regular air is only about 20% oxygen. Inside the chamber, the lungs take in roughly three times the normal amount of oxygen. The higher intake is believed to aid in the regeneration and rehabilitation of damaged or non-functional cells.

HBOT is not without risk. Extreme changes in air pressure can result in damage to the inner ear or pulmonary system (barotrauma). Oxygen toxicity, fatigue, earaches, headaches and changes in vision can also be experienced during or just after HBOT. The level of risk is not extreme, especially under qualified supervision.

While HBOT has proven invaluable in some medical situations, when it comes to using it to treat cerebral palsy, the results have proven inconsistent and controversial. Two well-publicized studies declared the procedure to have positive results. The first was a Canadian study during the late 80's that gathered 473 children suffering from spastic CP. 230 of the children were administrated 20 HBOT sessions. Six months later, 75 percent of the “treated” children were found to exhibit a better sense of balance and a lower rate of spastic convulsions. The remaining 243 children were called the “control group.” They also experienced 20 HBOT sessions over the same period of time, only at a lower atmospheric pressure. The expensive study was criticized and dismissed because of their failure to present a true placebo / control group. The second major study, a 1999 study by researchers at McGill University, treated 25 children with CP in a series of 20 HBOT sessions over a 30-day period and concluded that 16 of the children (approximately 67%) displayed noticeable improvements in muscle spasticity and movement.

Like other newer treatments and procedures, because hyperbaric oxygen therapy does not actually cure cerebral palsy and even its positive effects are deemed impermanent, it has been dismissed by many who believe the tremendous expenditure involved with HBOT could better be used exploring therapies that can be made available to a wider population of children with cerebral palsy . In the end, it comes down to what you and your doctor think are the right therapies to improve the quality of life for your child.

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Overview of Epilepsy in Children With Cerebral Palsy

Epilepsy is a neurological disorder characterized by seizures. Approximately one third of people with cerebral palsy also have some degree of epilepsy. It is accepted that in people with both conditions, the etiology is related; that is, the same brain injury / disorder responsible for the cerebral palsy is most likely the cause of the epilepsy. Although epilepsy can not be cured, with proper medication, it can be controlled with the same degree of success in children with CP as in those without.

Medical professionals are associated to diagnosis someone as having epilepsy until they've experienced more than one unprovoked seizure. In its simplest explanation, an epileptic seizure is the result of an overload of electronic signals to the brain that results in a disruption of normal brain functionality. In varying degrees of severity, a seizure can result in a loss of consciousness, convulsions, involuntary muscle spasm, loss of memory, loss of attention, sleepiness and / or emotional outbursts.

A seizure (or series of seizures) are categorized as “symptomatic” if they have an identifiable cause such as a brain injury, disease or other abnormality. They are categorized as “cryptogenic” (or “idiopathic seizures”) if there is no readily identifiable root cause. Doctor's may look for a genetic predisposition to seizures.

If your child has experienced an event you feel may indicate a seizure, he or she needs to be seen by a doctor as soon as possible. An electroencephalogram (EEG) can be performed that will scan and record your child's brainwaves providing information that a neurologist can analyze for indications of epilepsy.

Seizures can not be stopped once they begin. The most important thing to do in the event you are with someone in the throes of a seizure is to ensure their environment is safe and comfortable. Do not try to hold them still or restrict their movements. Do not put anything in their mouths. Instead, quickly move away nearby furniture with sharp, hard edges or any other potential hazards that could have caused harm to someone experiencing uncontrollable movement. Surround them with soft pillows and blankets for both the episode itself and the recovery period that will follow.

As previously mentioned, a single seizure is not necessarily indicative of a seizure disorder, but it is cause for concern. Your doctor should advise you on how to monitor your child's seizure should a second one occurs, including: the time and duration, the body parts affected, the eye movements, control of the bladder or bowls, loss of consciousness, confusion and general appearance. You should also know that if your child experiences breathing problems, a seizure lasting 10 minutes or longer, a noticeable change in their color (extreme pallor or blueness) or if they experience repetitive seizures without recovery, you need to call 911 without hesitation.

If it determined that your child has a seizure disorder, he or she will probably be put on medications aimed at controlling future seizures. In extreme cases, surgery can be performed to either remove the area of ​​the brain producing the seizures or to interrupt the nerve pathways through which the seizure impulses spread through the brain.

There are also lifestyle choices that can be made to minimize the onset of seizures such as maintaining a healthy diet, getting regular exercise and keeping to a consistent sleep schedule. The good news is that by following the advice of doctors and remaining vigilant, epilepsy is as manageable in persons with cerebral palsy as it is in those without.

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Electrical Muscle Stimulation Treatments for Cerebral Palsy

Ninety percent of children with cerebral palsy have muscle spasticity as their dominant or exclusive impairment. EMS (electrical muscle stimulation) is the elicitation of muscle contracture through electronic stimulation and is sometimes used to treat children with spastic cerebral palsy. When combined with the right physical therapies, experts have demonstrated that EMS can improve overall motor function, increasing the child's ability to perform physical tasks such as walking.

There are two ways of approaching EMS. The first is called NMES (neuromuscular electrical stimulation) or FES (functional electrical stimulation). The procedure, done only by a medical professional, involves giving specific muscles or muscle groups short bursts of electrical impulses designed to mimic the normal communication between the brain and the muscular system. Hopefully this can retrain the muscles to respond appropriately to the desires of the brain in a way they frequently do not in someone suffering from spastic CP.

TES (threshold electrical stimulation) is very different. It involves much lower voltage and can be directed at a specific muscle or muscle group over a long period of time. It can be administrated by the patient or a family member and can even take place overnight while the patient sleeps. It does not mention contraction, but instead is used to treat patients of some of the discomfort and pain that comes with spasticity.

The way that NMES works is that electrodes are placed onto the skin in the vicity of the muscles that are either in atrophy or have weakened due to spasticity. The electrodes are connected to a small generator. The current is low and rarely causes discomfort to the patient. The intent is to force the muscle to contract in a way that the brain is failing. The response is not dissimilar to having your reflexes induced by tapping on the knee. With TES, the procedure can be administrated by a parent at home.

Unfortunately, with spastic cerebral palsy, any improvements brought about by EMS are temporary. The damage to the neuromuscular system is irreversible and the brain really can not be trained to stimulate the muscles appropriately on its own. In most cases, full-time relief from the injury of muscle spasticity requires approximately 2 hours of EMS every day of the week. Even then, any prolonged break from treatment will probably result in the abnormal spasticity returning to pre-treatment levels. For many, the benefits, however temporary, are worth a lifetime of daily treatment.

Because of the temporal nature of the benefits, many experts in the cerebral palsy world consider electrical muscle stimulation only as a supplement to standard treatments. Exercise and physical activity are still seen as having more enduring benefits to the ultimate health and well-being of children with cerebral palsy. But the debt is ongoing. Other experts believe that with further advances, EMS alone may be used to treat and improve, at least, the smaller muscle groups such as in the forearm or wrist. Whether or not EMS can one day stand alone as a treatment for EMS remains to be seen, but it is at least worth consideration as an element of your child's physical therapy.

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An Overview of Birth Asphyxia As a Cause of Cerebral Palsy

Many people associate the term “asphyxia” with suffocation, which is accurate. More broadly, it reflects to a greater depletion of oxygen to the body. Asphyxia causes a condition known as hypoxia, which can quickly cause damage to the body's tissues and organs. During the birthing process, asphyxia can lead to damage of the infant's brain, potentially causing lifelong complications and conditions such as cerebral palsy.

The unborn fetus receives highly oxygenated blood via the mother's placenta through the umbilical cord. The term “birth asphyxia” specifically refers to that supply of blood / oxygen either being lost or severely reduced for a period of time sufficient enough to cause hypoxia to the infant (or “anoxia” if the supply is completely cut off). This can occur if the umbilical cord becomes either compressed or restricted. If such compromises to the proper functioning of the umbilical cord during the birthing process are not immediately corrected, the depleted oxygen flow creates a high risk of brain injury, cerebral palsy or even death to the unborn child.

Without the steady flow of oxygen to the infant's brain, blood gas (oxygen, nitrogen and carbon dioxide are naturally present in blood) and pH levels (the measure of acidity or alkalinity of a solution, in this case blood) can quickly become imbalanced. Fetal acidosis (caused by overly acidic blood) and carbon dioxide poisoning may result and cause brain damage.

Some of the maternal or neonatal events that can lead to asphyxia include: 1) umbilical cord prolapse – an obstetric emergency whereby the umbilical cord precedes the fetus' exit from the uterus, usually requiring an emergency Caesarian section. 2) induced labor – the artificial stimulation of contractions by using drugs such as Pitocin can cause fetal distress 3) breech deliveries – when a fetus presents itself in any position other than head-first, the umbilical cord can get wrapped around the fetus or crimped 4) forced extracts – when forceps, vacuums or other mechanical devices are used to facilitate delivery, you increase the chances of damage to the placental umbilical cord attachment.

The best way to prevent fetal asphyxia and fetal distress is to consistently and accurately monitor the fetal heart rate. The medical history of the mother as well as the health of the pregnancy itself are strong indicators of potential risks faced during delivery. Sometimes the mother is supplied supplemental oxygen during delivery to maintain pH and prevent acidosis. Effective, managed labor is key to minimizing stress to the fetus and preventing asphyxia.

In high-risk situations, proper monitoring and interpretation of fetal heart data has saved many infants from neurological damage during birth. Misreading the data can lead to not recognizing fetal distress in time or causing undue stress and trauma to both mother and child when a forced extraction or C-section is performed unnecessarily.

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