Children with cerebral palsy are some of the most marginalised within the cradles across the African continent. People see them as outcasts, often depriving them of the fundamental human rights that other children enjoy. They consider such children a disgrace to society. The ignorance and stigma surrounding cerebral palsy in the various rural settings have reached humanitarian crisis levels that we ought to intervene and increase awareness. It may halt the ever-increasing premature deaths among children with cerebral palsy in resource-limited settings and decrease the stigma surrounding the family of such a child. In today’s article, we highlight the salient facts you ought to know. They will help you increase its awareness and decrease the stigma associated with it.
We celebrate world cerebral palsy day every 6th October of every year. The aim is to unmask every child and increase awareness about the condition and its management to enable such children and their families to blend in such that they can achieve inclusiveness without discrimination. We celebrated this year’s day at Kiwatule Recreation Centre.
Cerebral palsy represents a set of movement disorders that occur following a non-progressive insult to the brain of a foetus or an infant. Such injuries may occur before, during, or after childbirth. At a prevalence of 1.5 to 2.5 per 1000 live births, cerebral palsy is the leading cause of childhood disability globally.
Besides impaired movement, the children often have associated co-morbidities. These include communication and hearing difficulties, impaired vision, intellectual disability, feeding difficulties, musculoskeletal problems, and epilepsy. For treatment, cerebral palsy is not a one doctor’s show. It requires a multimodality approach that involves physicians, psychiatrists: occupational, physical, and speech therapists, behavioural therapists, counsellors, among others. Astonishingly, such experts are few within the remote areas where the vast number of these children live.
In high-income countries, prematurity and low birth weight are the most common culprits predisposing children to cerebral palsy. In low-income countries, severe (neglected) obstructed labour remains the overwhelming cause of birth asphyxia – one of the risk factors for the condition. However, prematurity and low birth weight have worsened the situation further in these nations.
As said earlier, the causes of cerebral palsy can occur before, during, or after childbirth, i.e., prenatal, perinatal, and postnatal, respectively. Prenatal insults are congenital brain malformations, intrauterine infections, stroke, and chromosomal abnormalities.
Perinatal causes include hypoxic-ischaemic injury, central nervous system infections, stroke, and kernicterus. And postnatal causes are trauma, neonatal central nervous system infections, stroke, and anoxic insults.
Prematurity increases the risk of cerebral palsy. Prematurity may lead to periventricular leukomalacia, intraventricular haemorrhage, and periventricular infarcts.
Besides prematurity, several other risk factors include preeclampsia, multiple gestations, intrauterine growth restriction: substance abuse, genetic susceptibility, meconium aspiration syndrome, perinatal hypoglycaemia, chorioamnionitis, and abnormal placentation.
Cerebral palsy is a clinical diagnosis, i.e., clinicians rely on history and physical examination findings to delineate the diagnosis. It, therefore, becomes prudent that such a diagnosis is prompt to enable early interventions to halt the disease process. It may help the child to achieve some developmental milestones earlier. It also helps arrest several complications like seizures before they predispose the child to more sinister catastrophes like epilepsy. Initially, due to the non-progressive nature of the disease, experts recommended that a diagnosis of cerebral palsy be made after 18 to 24 months, as this could allow clinicians to rule out all other possible mimics that could be treated and aptly cured. However, such an endeavour often delayed critical interventions, such as physical, occupational, and speech therapies, which eventually led to poorer outcomes. Several expert panellists have since recommended an earlier diagnosis – or suspicion as early as six months to enable interventions at the earliest possible time.
Any child with features of cerebral palsy should undergo evaluation by an experienced clinician. Ideally, such children ought to be seen by the paediatricians – their availability is a topic to discuss some other time.
With history and physical examination, clinicians can categorise the condition into specific types that often have overlapping clinical features. It often dictates different treatment modalities and their urgency.
Much as early detection is crucial, prevention of cerebral palsy must take centre stage. Why should pregnant women develop obstructed labour? We can address and mitigate the disease by using proven interventions like labour monitoring charts (partographs), skilled birth attendants. As well as improving the transport systems in case a mother requires an urgent referral. Appropriate antenatal care is critical to safe obstetric and neonatal outcomes.
We should probably re-echo the fact that treatment of cerebral palsy requires a multi-disciplinary team – it’s not a one doctor’s show. Once any clinician suspects cerebral palsy in the child, they must consult with all the relevant specialists to expedite treatment. It often helps the child live a more comfortable life.
In a nutshell, we applaud everyone that joined us in commemorating world cerebral palsy day at Kiwatule recreation centre. You can use it as an opportunity to create and increase awareness within society.
For more information about cerebral palsy, click here.