What is Infantile Cerebral Palsy?
Infantile Cerebral Palsy (ICP) is a general term for various movement disorders caused by damage to the brain in early childhood. It is one of the most common physical disabilities in childhood. Brain damage can occur before, during, or after birth and is incurable. The causes are diverse and can affect different areas of the brain. Risk factors include brain malformations, strokes, infections during pregnancy, prematurity, head injuries, placental insufficiency, or drugs and medications consumed by the mother. Often, however, the exact cause cannot be determined. The diagnosis is usually not made immediately after birth, but within the first two years of the child’s life.
What symptoms occur with Infantile Cerebral Palsy (ICP)?
Depending on the affected region in the brain, a broad spectrum of symptoms appears. Typical are movement and posture disorders with spastic increase in muscle tone, which can affect the entire body or parts of it. In addition to spasticity, there may be ataxia, i.e., disturbed coordination of movements with balance disorders, and athetosis, i.e., the occurrence of screw-like, uncontrolled movements.
The cramped muscles lead to joint and spinal deformities as well as bone deformations. Typically, spinal curvatures, hip and leg malpositions, and pointed feet occur. Depending on the severity of the ICP, affected individuals may have only minor restrictions in walking or may rely on orthoses or a wheelchair. ICP is often accompanied by speech and visual disturbances, epilepsy, and intellectual disability.
How is ICP treated?
ICP is incurable. However, through close cooperation of various disciplines, it is possible to alleviate symptoms, train movement patterns, correct malpositions, and thus enhance the quality of life. This includes antispasmodic medications, surgical measures, extensive physiotherapy and occupational therapy, and speech therapy. Assistive devices such as orthoses can help prevent joint malpositions, improve the mechanics of the gait, and thus achieve the greatest possible mobility and independence.
What is the purpose of an orthosis in Infantile Cerebral Palsy (ICP)?
Affected individuals exhibit a pathological gait pattern, as the individual muscles do not work harmoniously. Additionally, paralysis can occur, further limiting the ability to move. Depending on the degree of disability, it may be sensible to use an orthosis to improve the gait pattern. The reason is that an orthosis provides support while standing and is additionally helpful in walking.
Of course, an orthosis is not an option for all affected individuals, but it is often a sensible solution if walking and standing are generally still possible. Then an improvement is conceivable, which is achieved through the correct provision.
The following advantages are offered by an orthosis:
Generally, orthoses provide:
- Support while standing
- Assistance in walking
- A correction of the position and posture
- Support for correct foot lifting
- An improvement of muscle function and movement sequences
- A regulation of muscle tension
Whether an orthosis is applicable depends on the individual condition of the affected persons. To prevent joint malpositions, it is advisable to use orthoses early. During growth, continuous individual consultation and regular adjustment of the orthosis are required.
Conclusion: More mobility and independence in everyday life thanks to an orthosis
Infantile Cerebral Palsy restricts the movement sequences of those affected in varying degrees. Orthoses offer, in addition to interdisciplinary treatment, the possibility to prevent and correct malpositions and to support the locomotor system. As a result, affected individuals regain a degree of independence and become more mobile in everyday life.
Bibliography
[1] Gulati, S., Sondhi, V., 2018. Cerebral Palsy: An Overview. Indian J Pediatr 85, 1006–1016. https://doi.org/10.1007/s12098-017-2475-1
[2] Kerkum, Y.L., Buizer, A.I., van den Noort, J.C., Becher, J.G., Harlaar, J., Brehm, M.-A., 2015. The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion. PLoS One 10, e0142878. https://doi.org/10.1371/journal.pone.0142878
[3] Lintanf, M., Bourseul, J.-S., Houx, L., Lempereur, M., Brochard, S., Pons, C., 2018. Effect of ankle-foot orthoses on gait, balance and gross motor function in children with cerebral palsy: a systematic review and meta-analysis. Clin Rehabil 32, 1175–1188. https://doi.org/10.1177/0269215518771824
[4] Meyns, P., Kerkum, Y.L., Brehm, M.A., Becher, J.G., Buizer, A.I., Harlaar, J., 2020. Ankle foot orthoses in cerebral palsy: Effects of ankle stiffness on trunk kinematics, gait stability and energy cost of walking. Eur J Paediatr Neurol 26, 68–74. https://doi.org/10.1016/j.ejpn.2020.02.009
[5] Michael-Asalu, A., Taylor, G., Campbell, H., Lelea, L.-L., Kirby, R.S., 2019. Cerebral Palsy: Diagnosis, Epidemiology, Genetics, and Clinical Update. Advances in Pediatrics, Advances in Pediatrics 66, 189–208. https://doi.org/10.1016/j.yapd.2019.04.002
[6] Novak, I., Morgan, C., Adde, L., Blackman, J., Boyd, R.N., Brunstrom-Hernandez, J., Cioni, G., Damiano, D., Darrah, J., Eliasson, A.-C., de Vries, L.S., Einspieler, C., Fahey, M., Fehlings, D., Ferriero, D.M., Fetters, L., Fiori, S., Forssberg, H., Gordon, A.M., Greaves, S., Guzzetta, A., Hadders-Algra, M., Harbourne, R., Kakooza-Mwesige, A., Karlsson, P., Krumlinde-Sundholm, L., Latal, B., Loughran-Fowlds, A., Maitre, N., McIntyre, S., Noritz, G., Pennington, L., Romeo, D.M., Shepherd, R., Spittle, A.J., Thornton, M., Valentine, J., Walker, K., White, R., Badawi, N., 2017. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA Pediatr 171, 897. https://doi.org/10.1001/jamapediatrics.2017.1689
[7] O’Shea, T.M., 2008. Diagnosis, treatment, and prevention of cerebral palsy. Clin Obstet Gynecol 51, 816–828. https://doi.org/10.1097/GRF.0b013e3181870ba7
[8] Vitrikas, K., Dalton, H., Breish, D., 2020. Cerebral Palsy: An Overview. Am Fam Physician 101, 213–220.
[9] Wright, E., DiBello, S.A., 2020. Principles of Ankle-Foot Orthosis Prescription in Ambulatory Bilateral Cerebral Palsy. Phys Med Rehabil Clin N Am 31, 69–89. https://doi.org/10.1016/j.pmr.2019.09.007
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