Chapter 20 - Cerebral palsy
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
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