What is Cerebral Palsy?
Cerebral palsy (CP) is a group of movement and postural disorders associated with brain damage or disorders that develop before, during or after the birth of a child. This disorder affects a person's movement, balance and posture. CP is a lifelong disease that strikes a person early in life, but does not progress over time.
The main cause of CP is brain damage or impaired brain development, especially in the part responsible for controlling body movement and coordination. Brain damage can be caused by several factors, including:
- Brain development disorders caused by genetic problems or chromosomal abnormalities.
- Disorders of brain development during pregnancy, for example due to infection, hypoxia (lack of oxygen) or exposure to certain toxins.
- Disorders that occur during birth or postpartum, such as asphyxia (significant lack of oxygen) or birth trauma.
- Brain damage that occurs early in life, such as infection, brain hemorrhage, or head injury.
Signs and Symptoms
Cerebral palsy can present with different symptoms in each person, depending on the location and severity of the brain injury. The most common symptoms of CP include:
- Movement Disorders:
- Disorders in the control of body movements, such as muscle stiffness (spasticity), uncontrolled movements, tremors or difficulty coordinating movements.
- Balance and Posture Problems:
- Difficulty maintaining proper posture and balance when standing or walking.
- Delay in motor development:
- Children who have CP may experience delays in reaching motor developmental milestones, such as crawling, walking, or speaking.
- Speech and Language Disorders:
- Beberapa orang yang mengalami CP mungkin mengalami kesulitan berbicara dan mengekspresikan diri.
- Sensory Issues:
- Sensory perception disorders, including difficulty responding to visual, auditory, or tactile stimuli.
- Impaired Cognitive Development:
- Some children with cerebral palsy may have impaired cognitive development, but many others have normal intellectual abilities.
Cerebral Palsy Classification
Cerebral palsy (CP) is a condition that can take different forms depending on the type of movement disorder and the clinical characteristics of the individual. The types of CP are classified according to the dominant type of movement disorder. Here are some common types of CP:
This type is the most common form of CP and around 70-80% of CP sufferers experience spasticity. In spastic CP, the body's muscles become stiff, resulting in limited and sluggish movements. The types of spastic CP can be subdivided depending on the part of the body affected, for example:
- Hemiplegia: Only one side of the body is affected, either the arm or the leg.
- Diplegia: Involves the legs more than the hands.
- Tetraplegia: Affects both hands and feet, more severe injury.
2. Dyskinetic or Dysmetric
Also called athetoid or dyskinetic CP, this type of CP is characterized by uncontrolled and irregular body muscle movements. Individuals with this type may have difficulty maintaining the desired body position, and their movements may be awkward, exaggerated, or correct.
Ataxic cerebral palsy causes impaired balance and coordination of movements. People with this type may have difficulty controlling fine, regular movements and have difficulty balancing or making proper movements when walking.
Some CP patients may experience a combination of several main types of symptoms, such as mixed spasticity and dyskinetics or spasticity and ataxia. The Mixed Category describes cases in which characteristics of several main types are present in an individual.
Apart from that, CP can also be classified based on the severity or extent of the movement disorder, such as mild, moderate, or severe. Symptom-based classification may also include the degree of language, cognitive, or sensory impairment that each person with CP may have.
Factors That Influence the Occurrence of Cerebral Palsy
Cerebral palsy (CP) is caused by brain damage or disorders that develop before, during or after birth. Although the exact cause is uncertain in most cases, several factors have been identified that may cause CP. Following are some factors that can cause CP:
1. Brain damage during pregnancy
Various diseases that occur during pregnancy can cause brain damage to the developing fetus. Risk factors include maternal infections (such as rubella, cytomegalovirus or toxoplasmosis), exposure to certain toxins, bleeding in the placenta, and genetic problems or chromosomal abnormalities.
2. Complications during childbirth
A complicated or difficult birth can damage the newborn's brain. For example, asphyxia (lack of oxygen at birth) in newborns can cause brain damage and CP.
3. Postnatal Infection or Trauma
Infections such as meningitis or head injury from an accident or severe CP after childbirth can also cause brain damage and contribute to the development of CP.
4. Premature birth or low birth weight
Babies born prematurely or with low birth weight are at higher risk of brain damage because their brains are not yet fully developed or are at greater risk of complications during the neonatal period.
5. Disorders of brain development without clear causes
In some cases, CP may occur without a specific cause identified. In this situation, the condition is called idiopathic CP. It is important to remember that some of these risk factors do not always cause CP. Many babies with the same risk factors do not develop CP, while there are babies born without certain risk factors who are later diagnosed with the condition. The causes of CP can be very complex and in many cases there is an interaction of several risk factors.
The Effect of Cerebral Palsy on Daily Life
Cerebral palsy (CP) can have a significant impact on the daily lives of people affected by the condition. The effects can vary depending on the severity and type of CP a person suffers from. Here are some ways CP can affect your daily life:
1. Mobility and Movement Difficulties
People with cerebral palsy may have difficulty performing normal body movements, such as walking, running, crawling or writing or picking up objects with their hands. Some people may need the assistance of a walker or wheelchair to get around.
2. Difficulty speaking and communicating
In some cases of CP, speech may be affected. Speech disorders can make communication difficult. Communication equipment or speech therapy may be needed to support communication.
3. Difficulty taking care of yourself
Depending on the level of independence of a person with CP, activities of daily living such as eating, dressing, or bathing may require the assistance of another person.
4. Impaired balance and coordination
Poor balance and decreased coordination can affect a person's ability to perform certain tasks, including writing, drawing, or using certain tools.
5. Muscle Function Disorders
Muscle spasticity or stiffness can cause spasms and tightness that can cause discomfort or difficulty moving.
6. Impact on Education
Children with cerebral palsy may require special teaching methods and extra support in the classroom to ensure they can access and participate in learning.
7. Mental Health Effects
Living with CP can cause emotional challenges such as frustration, depression or low self-esteem. Psychological and social support is very important to overcome this problem.
8. Limited Social Participation
Physical or communication limitations may affect participation in social activities and interactions with peers. Social support and an inclusive environment can help solve this problem.
The Role of Physiotherapy in Cerebral Palsy Cases
Physiotherapy plays an important role in the management and management of cerebral palsy (CP). The main goal of physiotherapy in CP cases is to improve physical function, mobility, balance and muscle strength, as well as helping CP patients achieve maximum independence in daily activities. The following are some of the important roles of physiotherapy in CP:
1. Development of motor skills
Physiotherapy helps develop gross and fine motor skills that may be delayed in people with CP. Some physical exercises and games are designed to improve the ability to crawl, walk, or use other body parts.
2. Reduces spasticity and muscle stiffness
Physiotherapy uses a variety of techniques to reduce muscle spasticity and stiffness, such as passive movement or massage techniques, which help increase range of motion and improve motor function.
3. Better Balance and Coordination
Physiotherapy includes exercises to improve balance and coordination, which helps CP patients gain better stabilization and control of body movements.
4. Procurement of walking aids
A physiotherapist can help select and use a walking device that suits individual needs, such as a cane, walker or wheelchair to improve mobility.
5. Recruitment and training of auxiliary equipment
A physiotherapist can help select and train the use of posture and movement aids, such as leg braces or orthotics.
6. Education and support for families
Physiotherapists also play a role in educating and supporting families of CP patients. They support families in education and care at home and provide advice to optimize children's development and independence.
7. Long Term Care Program Planning
Physical therapists work with a multidisciplinary treatment team that includes occupational therapists, speech therapists, and physicians to design and develop long-term treatment programs that meet the needs of people with cerebral palsy.
The Role of Physiotherapy in Cerebral Palsy Cases
The physiotherapy program is tailored to each individual's specific needs based on the severity, type and physical condition of CP. Following are some common physiotherapy procedures for CP:
1. Gross Motor Training
Physiotherapists work with children or people with CP to develop motor skills such as crawling, walking, or running. The aim of this exercise is to improve muscle strength, movement coordination and balance.
2. Fine motor skills training
Fisioterapi juga membantu mengembangkan keterampilan motorik halus, seperti kemampuan menulis, menggambar, dan mengambil benda dengan tangan. Latihan dan aktivitas fisik tertentu dapat membantu meningkatkan kontrol otot dan ketangkasan.
3. Passive movement therapy
To reduce muscle spasticity and stiffness, a physiotherapist can perform passive movements on the affected area. Techniques such as circular movements or light strokes increase range of motion and muscle flexibility.
4. Massage Therapy
Therapeutic massage can help relieve muscle tension, improve circulation, and stimulate muscle function.
5. Balance and Coordination Therapy
Physiotherapists offer special exercises to improve body balance and coordination. These exercises include a variety of activities that help CP sufferers become more stable and have more control over their body movements.
6. Use of assistive devices
Physiotherapists help select and use assistive devices such as walkers, canes, or wheelchairs that help CP patients move more efficiently and independently.
7. Water therapy (hydrotherapy)
Hydrotherapy can help reduce stress on muscles and joints and support the body to allow smoother and more comfortable movement.
8. Strength and Flexibility Training
Physiotherapists develop special training programs aimed at increasing muscle strength and flexibility, thereby improving movement control and motor skills.
9. Exercise Independence
In addition to direct intervention, physiotherapists help individuals and families understand and apply physiotherapy exercises at home and support them to achieve as much independence as possible in daily activities.
Physiotherapy procedures should be integrated into multidisciplinary care that includes a treatment team consisting of occupational therapists, speech and language therapists, orthopedists, physicians, and others. With the support of a comprehensive care team, physiotherapy procedures can help improve the quality of life and independence of CP patients.
Also read: Bell’s Palsy – Penatalaksanaan Fisioterapi
- Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: a clinical overview. Transl Pediatr. 2020 Feb;9(Suppl 1):S125-S135. doi: 10.21037/tp.2020.01.01. PMID: 32206590; PMCID: PMC7082248.
- Hallman-Cooper JL, Rocha Cabrero F. Cerebral Palsy. [Updated 2022 Oct 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538147/
- O’Shea TM. Diagnosis, treatment, and prevention of cerebral palsy. Clin Obstet Gynecol. 2008 Dec;51(4):816-28. doi: 10.1097/GRF.0b013e3181870ba7. PMID: 18981805; PMCID: PMC3051278.
- Paul S, Nahar A, Bhagawati M, Kunwar AJ. A Review on Recent Advances of Cerebral Palsy. Oxid Med Cell Longev. 2022 Jul 30;2022:2622310. doi: 10.1155/2022/2622310. PMID: 35941906; PMCID: PMC9356840.
- Das SP, Ganesh GS. Evidence-based Approach to Physical Therapy in Cerebral Palsy. Indian J Orthop. 2019 Jan-Feb;53(1):20-34. doi: 10.4103/ortho.IJOrtho_241_17. PMID: 30905979; PMCID: PMC6394183.
- Anttila H, Autti-Ramo I, Suoranta J, et al. Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review. 2008. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK76292/