5.  WHAT IS CEREBRAL PALSY (CP)?

  1.  What is cp and how does it affect children? Cp is caused by abnormalities in the brain usually before, during or soon after, birth. One in 400 babies is affected by cp, with approximately 1,500 babies in England and Wales being affected each year. It is not catching and, although the disability may become more noticeable with age, it is not progressive. Cp jumbles up the messages going from the brain to the muscles causing them to behave oddly. There are three types of cp corresponding to the three areas of the brain that can be affected.

  2.  The Cortex, in the front of the brain, controls thought, movement and sensation. When this is affected the result is usually the spastic form of cp. "Spastic" means "stiff" and the stiffness can affect the arms and legs. The muscles in the neck and trunk may also be involved. When all the arms and legs are affected the condition is called "quadriplegia". Sometimes the legs are very affected with the arms and hands only mildly involved, this is called "diplegia". Sometimes the arm and leg on one side of the body are very affected with the other side being mildly affected; this is called "hemiplegia". Quadriplegia is sometimes called "tetraplegia". In all these conditions the muscles are very tight and the arms and legs get pulled out of line by the tightness of the muscles.

  3.  The basal ganglia, in the mid-brain, help movement organisation and gracefulness. When this is affected the result can be the athetoid form of cp. Children with this kind of cp have floppy muscles and uncontrolled movements of their arms and legs. As children try to send messages to their arm or leg the muscles can change rapidly from being floppy to being tight causing the limb to fly outwards. Children may have problems with the fine motor movements of the mouth and tongue making speech and eating difficult.

  4.  The cerebellum, at the base of the brain, co-ordinates movement. When this is affected the result can be ataxic cp. Children with this kind of cp find it very difficult to balance. They have shaky, jerky movements particularly with fine motor movements. Walking may be unsteady.

  5.  Children may have some effects and not others. Some are only mildly affected while others are profoundly affected. Some may experience two or all three types of cp. There is no treatment to cure cp but some of the effects can be helped by therapy and teaching. Because the muscles pull abnormally they can cause the child to sit or lie in odd ways which can result in stiffness and pain. Correct relaxation of the muscles with correct positioning in sitting, standing or lying can go a long way to prevent these painful contractures.

  6.  Medical treatments: young children with cp often are away from education and other pre-school activities for long periods, or at home convalescing. Hence there is a need for a close co-operation between education, social services and health services. Often, drugs have to be administered during the day. Issues, including child protection issues, arise regarding a child with epilepsy for example: who administers the drug, the relevant training required, and who takes responsibility.