Cerebral Palsy is the damage to one or more parts of the brain that controls muscle tone and motor activity. It affects body movements, posture and balance. This usually occurs in early stages of life while the brain was under development and milestones like sitting, crawling, walking etc will be impaired. It can be due to any pathology during gestational period or a birth injury. Symptoms are exhibited depending upon the area of brain damage. The condition is not progressive. The management aims at improving the ability of child to perform his or her tasks better and also to stimulate brain functions.
- Reduced supply of oxygen to brain before birth or during birth or immediately after birth leading to damage of certain areas
- Infections that affect the brain during early stages of life like meningitis
- Premature delivery
- Low birth weight
- Complications during labour
- Untreated jaundice
- Genetic mutations during fetal development that cause brain malformations
- Multiple births (twins, triplets or more)
- Rh incompatibility
- Head injury
SIGNS AND SYMPTOMS
Each case of cerebral palsy may present differently depending upon the area and extent of brain damage. The following are the more common features exhibited:
- Poor muscle coordination
- Delayed milestones like rolling over, sitting, crawling, walking etc
- Abnormal movements and muscle tone (either too stiff or too flaccid)
- Difficulty to swallow and delayed speech
- Mental retardation may be present
- Impaired vision or hearing may be associated
- Attack of seizures
- Based on severity
- Mild: Daily activities of child are not affected and can move without assistance
- Moderate: Child requires support to perform daily activities
- Severe: Child meets with great challenge in performing daily activities
- No CP: Here, the child has signs of CP but the impairment has occurred after development of brain
- Based on body parts affected
- Monoplegia/monoparesis: only one limb is affected
- Diplegia/diparesis: lower limbs are more affected
- Hemiplegia/hemiparesis: arm and leg of one side of body is affected
- Paraplegia/paraparesis: lower half of body is affected
- Triplegia/triparesis: Any three limbs are affected
- Double hemiplegia/double hemiparesis: all four limbs are affected but one side of body is more affected than other
- Tetraplegia/tetraparesis: all four limbs are affected but three limbs are more affected
- Quadriplegia/quadriparesis: all four limbs are involved
- Pentaplegia/pentaparesis: all four limbs along with neck and head paralysis, eating and breathing difficulties may be associated.
(paresis means weakness and plegia means paralysis)
- Based on muscle tone
- Spastic CP: presents with increased muscle tone, more common, pyramidal tract is affected
- Non-spastic: presents with decreased or fluctuating muscle tone, also called extra-pyramidal CP
Involuntary movements are present
Non-spastic CP is of two types:
- Ataxic-coordination of movements, balance and posture are affected
- Dyskinetic-it is further classified as Athetoid where muscles of limbs are more affected and Dystonic where trunk muscles are affected more.
Sometimes features of both Spastic and Non-spastic CP may be exhibited and then it is called as mixed CP.
Diagnosing CP is a long process since there is no confirmatory test to diagnose it. In severe cases, early diagnosis can be made. In other cases, the diagnosis is made by monitoring the first two years of life and sometimes monitoring up to five years may be required. Detailed examination of reflexes, muscle tone, posture, balance etc will lead to proper diagnosis. Imaging of the brain by MRI, CT etc will help diagnosis. EEG, EMG and blood tests may also be conducted.
Cerebral palsy is a disorder of Vaatha dosha with considerable aavarana or entrapment of Kapha dosha. The five cleansing therapies of Ayurveda called as Panchakarma, especially Vasthi is the choice of management here. However, vasthi can be administered only after the first year of life. Suitable pre –cleansing procedures can be administered to the child.
Ayurvedic treatment modalities
Internal medications using drugs to improve brain function is used along with external therapies to rejuvenate the nervous system, increase circulation, reduce rigidity, augment muscle tone and activity. The following therapies will be beneficial:
- Udvartana or Rubbing of medicinal powder in body which destroys the obstruction to the channels in body.
- Abhyanga and ooshmasweda or oiling the body and steaming: They are very relaxing and soothing to the muscles, ligaments and tendons. It improves flexibility of joints.
- Kaaya seka or pizhichil: Pouring of medicinal oil from a short height all over body in a systematic pattern for a fixed duration along with light massage. It is a highly effective and widely applied procedure that can reduce inflammation, pain and improve mobility.
- Kizhi or application of a poultice filled with medicine: regular systematic application of the poultice on body, after heating it, is the procedure. It is a very efficient process to relieve pain, stimulate the nerve endings and improve circulation.
- Shiro lepa: Covering the scalp with medicinal paste of drugs that can improve brain function, for a fixed duration.
- Shiro pichu: A procedure where medicated oil is made to stay in the head by wetting oil to a cotton pad and placing it over shaved scalp is done which is a stimulating and nourishing therapy.
- Talam: Application of medicine to a point in the scalp where quick cutaneous absorption takes place resulting in fast action of the medicine.
- Visual problems can be managed in children by special procedures for ailments of eyes like Tarpana.
Although cerebral palsy is a condition for a life time, it can be managed adequately to improve quality of life. Hospitalization for a specific duration will be necessary and regular follow up is essential for considerable changes.