Posts from — February 2011

Children with Cerebral Palsy (CP)

by Natasha Boskic

Children with Cerebral Palsy (see full Glossary) have a movement and posture control disorder resulting from damage to the brain anytime during pregnancy or between birth and age 3 years. CP does not result from conditions that affect nerves or muscles themselves¹.

Cerebral Palsy may be caused by genetics disorder (see full Glossary) and other factors such as abnormal brain development or injury to the brain, including lack of oxygen during pregnancy or birth.

A baby’s brain can be injured by drug or alcohol exposure, lack of enough oxygen to the brain, maternal infections, infection in the infant or young child or head injury.

CP is a non-progressive disorder; that is, it does not get “worse.”

Description²

Children with CP have a range of movement disorders. These disorders are categorized depending on both the location on the body and the type of movement affected.

Cerebral Palsy may cause abnormal muscle tone, involuntary movements and/or lack of balance and or/coordination. This is why the description of CP includes the type of movements affected; e.g., ataxic, spastic, athethoid, or mixed CP.

Figure 1. Cerebral Palsy

For the spastic CP type (see full Glossary), depending on the location of the body that is affected, it is known as:

Monoplegia (one limb, arm or leg)
Diplegia (affects the legs, with spasticity and problems with balance and coordination );
Hemiplegia(affects one arm and leg on the same side of the body);
Paraplegia (lower limbs);
Triplegia(affects three limbs; e.g., one arm and both legs; similar to quadriplegia, but with arms less affected);
Quadriplegia (affects all four body limbs; it is often more severe than the other forms; sometimes with head and neck paralysis as well);
Double Hemiplegia (this term is one that is less specific so the definition is also less consistent. It is often used to describe cerebral palsy that affects all four limbs so both arms and legs are weak, but with asymmetry (see full Glossary) between the right and left sides).

The description of CP also includes where the damage or injury comes from in the brain¹; For example, CP may be pyramidal (Fig. 2), meaning the motor paths in the brain are damaged. Or it may be extra-pyramidal (Fig. 3), meaning areas in the brain that deal with motor function are damaged.

Figure 2. Pyramidal CP – The motor paths in the brain are damaged

Figure 3. Extra-pyramidal CP – Areas in the brain that deal with motor function are damaged

Intervention options

Intervention for children with CP usually requires the attention of different health, therapy and educational professionals. This is because, in addition to dealing with movement challenges, children with CP may also have other conditions, including vision and speech impairments. A large number of children with CP also have seizures.

Physiotherapist (PT): May address hypotonia or hypertonia difficultiesby trying to lessen the effects as early as possible.
Occupational Therapist (OT): May address quality of movements and how to use limbs affected by hypotonia or hypertonia ; in this way, effects are lessened and children are aware of how to utilize their working muscles.
Speech and Language Pathologist (SLP): May address delays in the development of language and communication skills as a result of either motor and/or cognitive difficulties.
Consultants in British Columbia’s early intervention and child development support programs, IDP and AIDP, and SCD and ASCD: Children birth to age 3 years may be referred to IDP/AIDP. Children 3 to 12 years, and who have a special needs or medical designation that requires special support, and who attend a center based program, may also be referred to SCD/ASCD.
Mental health specialist: May assist with any mental health difficulties a child with CP may experience.
Vision and hearing specialists: Vision and hearing should be checked on a regular basis.
Academic preparation-Learning Assistance teacher: Some children with CP experience cognitive and language delays. Getting them ready for school could be beneficial.

Assistive technologies: Some assistive technologies may be used to help to develop cognitive, social, academic and communication skills.

To learn about cerebral palsy in the middle childhood years, please visit the six to 12 part of this course.

1. Cerebral Palsy — The Dana Guide By Alexander H. Hoon, Jr. and Michael V. Johnston, March 2007.
2. Origins of Cerebral Palsy at http://www.originsofcerebralpalsy.com/

February 28, 2011 1 Comment

Children with Epilepsy

by Natasha Boskic

Epilepsy (see full Glossary) is a disorder where children experience seizures (Fig. 1). A seizure is abnormal electrical activity in the brain, that may cause convulsions. The cause is unknown but seizures can occur for many reasons. Epilepsy is a physical condition characterized by sudden brief changes in how the brain works. Epilepsy is a disorder, not a disease. Epilepsy is usually controlled, but not cured, with medication, although surgery may be considered in difficult cases.

Figure 1. The Anatomy of the Brain

Description¹

Figure 2. Part of the Brain

Seizures are classified depending on the area of the brain affected and the behaviors (Fig. 2) that happen during the seizure. Seizures vary depending on how they affect the brain. They are either generalized seizures or partial seizures (Fig. 3). Generalized seizures affect the whole brain and usually cause a loss of consciousness.

Figure 3. Partial Seizure

Generalized seizures include these forms:

Tonic-clonic (or “grand mal”) seizures – the child experiences a loss of consciousness and violent muscle contractions (Fig. 4);

Figure 4. Grand Mal Seizure

Absence(or “petit mal”) seizures – the child loses consciousness of their activity for a very brief moment.
Myoclonic seizures² (see full Glossary) – the child experiences involuntary muscle jerks caused by the seizures. These seizures may indicate the presence of other, more complex conditions or disorders.
Atomic (or “drop”) seizures –the child loses muscle tone.

Partial seizures affect specific areas of the brain. Partial seizures include these forms:

Simple partial seizures – with no loss of consciousness; children may experience changes in their vision, hearing, sense of smell and taste; these changes in their senses are called somosensory symptons. Children may also experience changes in their blood pressure, and nausea; these are known as autonomic symptoms, because they are related to the autonomic nervous system (Fig. 5). This system is in charge of heart and blood circulation, lungs and breathing functions and stomach and digestive functions.

Figure 5. Spinal Cord and Spinal Nerves

Children may also experience uncontrolled movements, or motor symptoms; and psychicsymptoms, where their cognitive skills get altered (e.g., attention, memory); these symptoms are related to their central nervous system (Fig. 6).

Figure 6. Central Nervous System

Complex partial seizures– children who have complex partial seizures experiences the same things as in a simple partial but with loss of consciousness. This type of seizure may start as a simple partial seizure or become a complex seizure after the onset); these may also become generalized seizures later on.
Seizures impact on children’s development in different ways; for example, depending on the area of the brain affected and the severity, duration and frequency of the seizures.

Intervention Options

Medication: Epilepsy is usually treated with anti-convulsant drugs/antiepileptic drugs (see full Glossary) to control or stop the seizures.

Recent studies have found that anti-convulsant medications³ have severe side effects for children, especially in their cognitive development.

Consultants in the IDP/AIDP and SCD/ASCD: The development of children with epilepsy needs to be closely monitored; they may be referred to IDP/AIDP as soon as the condition is identified. At age three, if they attend a center-based program, they may be referred to receive services from SCD/ASCD consultants.
Mental health: Children may need mental health services, such as counseling or psycho-therapy.
Academic preparation (e.g., Learning Assistance Teacher or Support): Children with epilepsy may need help getting ready for school because seizures may affect their cognitive skills and/or academic performance. These children may require special adaptation for different activities; for example, not engaging in PE activities that require climbing to high altitude or monitoring use of computers because light stimulation from monitors may induce seizures.

To learn about epilepsy in the middle childhood years, please visit the six to 12 part of this course.

1. Mayo Clinic http://www.mayoclinic.com/
2. Child Brain: http://www.childbrain.com/seizure1.shtml
3. Phenobarbital (Luminal, Solfoton) and traditional benzodiazepines are associated with the greatest risk of cognitive side effects.

February 27, 2011 1 Comment

Cephalic Disorders

by Natasha Boskic

Cephalic disorders¹ relate to defects that occur during the first trimester of pregnancy and that relate to the formation of the central nervous system. These include neural tube defects (Fig. 1). When they survive, infants with cephalic disorders will live with major disabilities, physical and/or cognitive. Anencephaly (see full Glossary) is one of the most common cephalic disorders.

Figure 1. Folding of the Neural Tube – Neural tube defects begin during the folding of the neural plate

Other types of cephalic disorders involve neuronal migration disorders that may be linked to genetic abnormalities. These will cause for major areas of the brain (see full Glossary ) or the central nervous system central nervous system (see full Glossary ) not to fully develop. Children with neuronal migration disorders appear to be typically developing; other may have facial or skull features that a neurologist will identify.[2]

This type of damage causes major disorders for infants and young children, often leading to death. Cephalic disorders may be influenced by hereditary or genetic conditions or by environmental exposures during pregnancy. The more scientists gain an understanding of the normal development of the human nervous system, the better the understanding of cephalic disorders they may acquire.

Treatment

Since this type of condition cannot be cured, treatments for cephalic disorders depend upon the particular type of disorder. For most cephalic disorders, managing the condition includes the following:

providing medical treatment like anti-convulsant medications
inserting a shunt. This is a procedure (Fig. 2) to release pressure from liquid build up in the brain through a specialized medical
providing physical therapy (PT).

Figure 2. Ventriculoperitoneal Shunt Placement

Expected recovery

How a child will fare with this disorder depends on the severity of the disorder. Many children experience some cognitive delays, a number of children die or may be greatly impacted and live with multiple disabilities.

1. http://www.medic8.com/neurological-disorders/cephalic-disorders.htm

2. Source: National Institute of Neurological Disorders and Stroke, available at http://www.ninds.nih.gov/disorders/neuronal_migration/neuronal_migration.htm

February 26, 2011 No Comments

Children with Spina Bifida (SB)

by Natasha Boskic

Spina Bifida (SB)¹ is a congenital neural tube defect (Fig. 1) where part of the spinal column does not close completely. When this happens, the membranes covering the spinal cord or the membranes and the spinal cord are exposed. Sometimes the membrane and the cord protrude out the back of the spine.

Figure 1. Congenital Neural Tube Defect

Description

The extent of the damage depends on the location and degree of the exposure or opening of the spinal column. Difficulties can range from no obvious damage to paralysis and severe brain damage. Hydrocephalus, or the buildup of CSF fluid (Fig. 2) after a leak insidethe brain, often occurs with Spina Bifida. The exact cause is unknown, but it is thought that there are many contributing factors, including, for example, the presence of a tumor.

Figure 2. CSF FLuid

Characteristics associated with Spina Bifida include the following:

Arnold-chiari malformation (see full Glossary) (Fig. 3);
Curvature of the spine (Fig. 4), or scoliosis;
Foot malformations or anomalies (Fig.5);
Heart problems;
Problems with kidneys, bladder, rectal and anal sphincters

Figure 3. Arnold-chiari Malformation

Figure 4. Scoliosis

Figure 5. Foot Malformation

There are four forms of Spina Bifida that have to do with how parts of the brain “come out” or protrude (protrusion), or are not formed at all, as shown in this image (Fig. 6):

Figure 6. Spina Bifida

The medical description of each one of these forms is as follows²:

Spina Bifida occulta – In this form, the vertebral arches are absent, but there is a hairy patch of skin over the defect.
Meningenocele – In this form thereis a bulge in the lumbosacral area consisting of a meningeal sac protruding through the bone defect.
Myelomeningocele – In this form, the sac contains malformed spinal cord tissue.
Encephalocele – This is a protrusion of brain through a defect of the skull, usually in the occipital area.