Chapter 20 - Cerebral palsy

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Abstract

Cerebral palsy (CP) is a lifespan motor disorder arising from damage to the developing brain before or shortly after birth. People with CP may experience problems with muscle coordination and difficulties with the organization and processing of sensory information. Functional mobility is impaired and commonly influenced by spasticity and musculoskeletal system problems such as contractures or bony torsion. Around 60% of individuals with CP are able to walk independently or with aids when entering adulthood. However, many adults with CP experience increasing balance and mobility dysfunction associated with premature aging. Falls and reduced falls efficacy are commonly experienced, with associated physical and psychosocial consequences. There is evidence that ambulant adults with CP may be able to enhance their functional balance and mobility as a result of an individualized exercise program of sufficient duration and intensity. However, whether such programs result in a reduction in falls is unknown. Given the high number of falls with injury experienced by this population, attention to fall risk factors and provision of basic fall prevention strategies are warranted.

Section snippets

Background and epidemiology

Cerebral palsy (CP) is a common motor disorder, associated with lifelong disability. Traditionally regarded as a childhood condition, it is better recognized as a lifespan disorder, with adults with CP outnumbering children 3:1 in some countries (Australian Cerebral Palsy Register Group, 2013). The contemporary definition of CP defines it as a group of developmental conditions, rather than a single disease or disorder. An international consensus expert panel developed a widely adopted

Brain pathophysiology

CP can be the consequence of any event affecting the fetal and neonatal developing brain. Risk factors include congenital malformations, fetal growth restriction, multiple gestations, fetal or neonatal birth asphyxia, untreated maternal hypothyroidism, perinatal stroke, and thrombophilia (Stavsky et al., 2017). Preterm birth is recognized as the most important risk factor. The risk of CP increases with lower gestational age and lower birth weight, with the risk in infants born before 28 weeks

Balance disorders in people with cerebral palsy

People with CP may experience problems with muscle coordination, organization, and processing of sensory information, functional limitations influenced by spasticity or altered tone, and an underlying abnormal musculoskeletal system. Both primary impairments and longstanding and progressive secondary conditions may affect balance control in both sitting and standing positions. Balance dysfunction contributes to limitations in gross motor skills such as standing balance or gait, during

Gait in childhood

The understanding of gait across childhood for those with CP has been greatly enhanced by widespread adoption of a system to classify gross motor function with an emphasis on mobility – the GMFCS (Palisano et al., 1997). Mobility is reported as one of five levels, on the basis of self-initiated movement with emphasis on sitting, walking, and wheeled mobility. Distinctions between levels are based on functional abilities, the need for mobility devices (walkers, crutches, or canes) or wheeled

Therapies to address gait and balance disorders in people with cerebral palsy

Most research in CP is focused on optimizing mobility throughout childhood. There are well-established algorithms that assist the provision of evidence-based interventions such as physiotherapy, orthotic, pharmacologic, or surgical interventions at appropriate childhood stages relative to the child's GMFCS level (Novak et al., 2013).

With recognition of the need to provide effective interventions across the lifespan, a recent shift to research exploring effective therapies for gait and balance

Future directions

Arising from the previous emphasis on childhood aspects, adults with CP have struggled to identify suitable and knowledgeable health providers (Nieuwenhuijsen et al., 2008; Morgan et al., 2014b). There is now an emerging focus on transition programs targeted at adolescents and young adults with CP exiting childhood models of healthcare, to facilitate accessible and comprehensive health services throughout adulthood (Stewart, 2009). However, health service providers need education regarding

References (62)

  • R. Dewar et al.

    Exercise interventions improve postural control in children with cerebral palsy: a systematic review

    Dev Med Child Neurol

    (2015)
  • L.E. Dyet et al.

    Natural history of brain lesions in extremely preterm infants studied with serial magnetic resonance imaging from birth and neurodevelopmental assessment

    Pediatrics

    (2006)
  • H.K. Graham et al.

    Musculoskeletal aspects of cerebral palsy

    J Bone Joint Surg Br

    (2003)
  • H.K. Graham et al.

    Cerebral palsy

    Nat Rev Dis Primers

    (2016)
  • S.E. Hanna et al.

    Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years

    Dev Med Child Neurol

    (2009)
  • S.E. Hanna et al.

    Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years

    Developmental Medicine and Child Neurology

    (2009)
  • T. Heller et al.

    Promoting healthy aging in adults with developmental disabilities

    Developmental Disabilities Research Reviews

    (2013)
  • S. Hill et al.

    Biomechanics and prevention of body shape distortion

    Tizard Learning Disability Review

    (2010)
  • E. Himpens et al.

    Prevalence, type, distribution, and severity of cerebral palsy in relation to gestational age: a meta-analytic review

    Dev Med Child Neurol

    (2008)
  • F.B. Horak et al.

    The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits

    Phys Ther

    (2009)
  • K. Hsieh et al.

    Risk factors for injuries and falls among adults with developmental disabilities

    J Intellect Disabil Res

    (2001)
  • R. Jahnsen et al.

    Physiotherapy and physical activity - experiences of adults with cerebral palsy, with implications for children

    Advances in Physiotherapy

    (2003)
  • R. Jahnsen et al.

    Locomotion skills in adults with cerebral palsy

    Clinical Rehabilitation

    (2004)
  • R. Jahnsen et al.

    Gross Motor Function Classification System used in adults with cerebral palsy: agreement of self-reported versus professional rating

    Developmental Medicine and Child Neurology

    (2006)
  • I. Jeglinsky et al.

    Evidence on physiotherapeutic interventions for adults with cerebral palsy is sparse. A systematic review

    Clinical Rehabilitation

    (2010)
  • H. Lawrence et al.

    Effectiveness of exercise on functional mobility in adults with cerebral palsy: a systematic review

    Physiother Can

    (2016)
  • D.B. Maltais et al.

    Factors related to physical activity in adults with cerebral palsy may differ for walkers and nonwalkers

    American Journal of Physical Medicine & Rehabilitation

    (2010)
  • J.L. McGinley et al.

    Single-event multilevel surgery for children with cerebral palsy: a systematic review

    Dev Med Child Neurol

    (2012)
  • P. Morgan et al.

    Falls, falls risk and fear of falling in adults with cerebral palsy

    Developmental Medicine and Child Neurology

    (2013)
  • P. Morgan et al.

    Gait function and decline in adults with cerebral palsy: a systematic review

    Disability & Rehabilitation

    (2014)
  • P. Morgan et al.

    A systematic review of the efficacy of conservative interventions on the gait of ambulant adults with cerebral palsy

    Journal of Developmental and Physical Disabilities

    (2014)
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