Cerebral Palsy (CP) refers to a series of disorders affecting a person's ability to move and maintain posture. "Cerebral" means brain-related, while "palsy" means difficulties using the muscles. Abnormal brain development or damage to the developing brain causes CP, compromising a person's ability to use the muscles. With CP occurring before, during, or shortly after birth, medical professionals concur that the quality of prenatal care influences the condition's occurrence.
CP occurring due to abnormal brain development or brain damage before or during birth is known as congenital CP. Congenital CP accounts for about 85 percent to 90 percent of all CP cases globally. CP resulting from abnormal brain development or damage occurring 28 days after birth is called acquired CP. Doctors attribute Acquired CP to an infection such as meningitis or head injury.
According to the Centres for Disease Control and Prevention (CDC) affects 1-4 children in 1000 children globally. CDC considers CP as the "most common motor disability in childhood." The World Health Organization (WHO) notes that after declining cases of CP globally, the numbers are now rising in both developed and developing nations. The health body attributes this trend to maternal age, survival of preterm babies, and falling birth rates.
In Kenya, there are no official statistics on the prevalence of CP. However, experts estimate that one in 100 children live with the condition.
Signs and Symptoms of CP
All persons with CP have movement and posture problems. However, the symptoms of the problem vary from person to person, depending on the severity of the condition. For instance, a person with severe CP might not walk at all, thus requiring life-long care. On the other hand, a person with mild CP might walk with little or no support at all.
Persons with CP often suffer from other related conditions such as spinal problems, intellectual disability, and seizures. Other conditions include hearing, visual, and speech impairments. The symptoms of CP can change over time. However, the condition is not degenerative.
One of the early signs that a child could be having CP is delayed movement or motor milestones such as sitting, standing, rolling over, and walking. In children below six months, the common CP signs are:
- Feeling of stiffness and floppiness.
- Lagging head when you pick the child from a lying-on-back position.
- Overextended back and neck when cradling the child in your arms.
- Legs that stiffen and cross or scissor when baby is picked up.
In children above six months, the signs of CP are:
- Failure to roll over in any direction.
- Inability to bring hands together.
- Difficulty bringing hands to the mouth.
- Reaching out with only one hand while the other one is fisted.
CP symptoms in children above ten months are:
- Crawling in a crooked manner – pushing off with one hand and leg while dragging the opposite limbs.
- Scooting on buttocks or hopping on knees instead of crawling on all fours.
Types of Cerebral Palsy (CP)
Doctors classify CP depending on the dominant type of movement disorder involved. These include:
- Stiff muscles (spasticity)
- Uncontrollable movements (dyskinesia)
- Poor balance and coordination (ataxia)
There are four main types of CP
1. Spastic Cerebral Palsy
Spastic CP is the most common type of CP and affects at least 80 percent of people with the condition. This type of CP is characterized by increased muscle tone, meaning stiff muscles. Consequently, people with spastic CP can have awkward movements. Spastic CP is described depending on the affected body part.
- Spastic diplegia/diparesis-mainly affects the legs.
- Spastic hemiplegia/hemiparesis affects one side of the body. Usually, the leg is more affected than the leg.
- Spastic quadriplegia/quadriparesis-this is the most severe form of spastic CP as it affects all four limbs, the face and the trunk. Persons with this condition cannot walk and often have other disabilities such as hearing, speech, and visual impairment; seizures; and intellectual disability.
2. Dyskinetic Cerebral Palsy
Persons with this kind of CP have difficulties controlling the movement of their hands, arms, legs, and feet, making it hard for them to stand or walk. Their movements are usually uncontrollable and can be slow, jerky, writhing, or rapid.
The tongue and face may be affected in some instances, making it hard to chew, suck, swallow, and talk. The muscle tone of a person with Dyskinetic CP can frequently change as soon as daily.
3. Ataxic Cerebral Palsy
Persons with ataxic CP struggle with coordination and balance. They may have an unsteady walk and trouble controlling hands when reaching something. In addition, such persons may have difficulties with quick movements or those that need control, like writing.
4. Mixed Cerebral Palsy
Some persons with CP may exhibit a mixture of the various types. According to CDC, the most common type of mixed CP is spastic-dyskinetic CP.
The diagnosis of CP is a systematic process that involves developmental screening, developmental screening, and developmental and medical evaluations.
Developmental screening, also called surveillance, involves tracking a baby’s growth and development over some time. If any concerns are raised during this stage, the diagnosis process moves to the screening stage.
In developmental screening, the child is given short tests to determine if they have any particular delays, such as motor or movement delays. If the screening results cause concern, the doctor refers the parent/caregiver to take the child for developmental and medical evaluations.
Developmental and medical evaluations help determine the specific type of CP affecting a child.
Cerebral Palsy is an incurable condition. However, treatment interventions can alleviate the symptoms of the condition, improving the quality of life of persons with CP.
Support for Persons with CP in Kenya
Support of children and adults with cerebral palsy in Kenya has improved over the years. In the past, stigma and discrimination were major barriers for persons with CP. Such challenges were due to a lack of awareness and the attribution of CP to witchcraft. Consequently, many children with CP were hidden and excluded from society. These actions resulted in minimal government support, budget allocation, society outreach, and products /services for the intervention. However, persons with CP are now coming out and interacting with society.
With increased access to information, Kenyan society is more aware and willing to include persons with CP. Similarly, both the public and private sectors in the country are offering more affordable and accessible interventions to improve lives for persons with CP. As a country, we appreciate that we are not where we used to be.
- However, we are not yet where we need to be in supporting persons with CP in Kenya. There are still gaps in healthcare, education, employment, support, and social participation that need to be bridged. In addition, there is a need for continued effort in the following areas to improve the lives of persons with CP and their families:Awareness - increasing the distribution of information about cerebral palsy will make the society more aware and inclusive. It will also make the caregivers better equipped to support the children.
- Access to interventions - increasing the availability and affordability of cerebral palsy interventions, quality assessments, therapy services, assistive devices, medications and basic essentials. The inaccessibility of interventions contributes to delayed milestones.
- Availability of support systems - increasing availability of support systems enables and empowers the families to care for the persons with CP. Support systems can be financial, physical or psychosocial provided by government or private sectors. Managing cerebral palsy is a multi-disciplinary approach and requires collective effort.