Mixed Cerebral Palsy_ An Overview

1. Mixed Cerebral Palsy: An Overview

2. Understanding Mixed Cerebral Palsy Cerebral Palsy refers to a group of neurological disorders that affect movement, muscle tone, coordination, and motor skills caused by damage or abnormalities in the developing brain. It is a non-progressive condition that occurs due to brain damage sustained before, during, or shortly after childbirth. The four types of Cerebral Palsy are: • Spastic CP • Ataxic CP • Hypotonic CP • Athetoid CP Mixed Cerebral Palsy is a combination of more than one of the above. It accounts for around 15.4% of all Cerebral Palsy cases, making it the second most common type of Cerebral Palsy. With mixed Cerebral Palsy, there is damage to multiple motor control centers in the brain. The symptoms depend on where the damage has been sustained.

3. Symptoms of Mixed Cerebral Palsy Children will typically exhibit a mix of the symptoms of two or more types of CP that include: • Abnormal reflexes • Exaggerated muscle tone • Jerky / floppy movements • Tremors in the limbs • Poor posture and/or gait • Lack of coordination • Muscle pain • Missing key developmental milestones Depending on the extent of the brain damage, mixed Cerebral Palsy may exhibit in either the upper or lower limbs, along one side of the body, or in all four limbs.

4. How Mixed Cerebral Palsy occurs In general, the types of brain damage that someone with mixed CP may have include: Brain damage Damage to the motor cortex: The motor cortex transmits signals to parts of the brain responsible for motor function. Such damage is linked with Spastic Cerebral Palsy, and can cause muscle and joint spasticity. Damage to pyramidal tracts: Associated with Spastic Cerebral Palsy, this type of damage disrupts the motor cortex’s ability to properly send signals to the pyramidal tracts. Children may experience a variety of mobility issues, including exaggerated muscle tone. Damage to the cerebellum: The cerebellum is located at the bottom of the brain, close to the brainstem. Such damage is linked with Ataxic or Athetoid types of Cerebral Palsy. Children may experience trouble with fine motor skills, posture, and gait. Damage to basal ganglia: A group of multiple neurons located in the center of the brain – process signals from the motor cortex before sending them on to the brainstem. Such damage is linked to Athetoid Cerebral Palsy. Children may experience issues like lack of control over voluntary muscle movement, and problems with involuntary muscle movement.

5. Causes and risk factors for Mixed Cerebral Palsy Mixed Cerebral Palsy occurs due to brain damage during pregnancy or at birth. Factors include: • Lack of oxygen at birth • Infections sustained at or shortly after birth • Severe jaundice shortly after birth • Stroke at birth • Certain maternal infections • Head injury sustained in the first months of life • Exposure to toxins such as methylmercury • Placental infection or failure

6. Diagnosing Mixed Cerebral Palsy It is generally recommended that your child undergoes a developmental screening at 9, 18, and 24 months of age. A pediatrician will examine your child and ask questions about their medical history – when the symptoms first began, how frequently they occur, how mild or severe they are, and so on. You also need to mention any important developmental milestones they have missed. If the pediatrician suspects mixed CP, they will recommend you to a team of specialists – a neurologist, a geneticist, a developmental behavior specialist, and an orthopedic surgeon. The neurologist will assess your child for signs of brain damage and use a variety of tests to evaluate their reflexes, posture, muscle tone, gait, and coordination. Often, the symptoms of mixed Cerebral Palsy mimic other movement or neurological conditions. Getting a final verdict, may take considerable time.

7. Treatment for Mixed Cerebral Palsy Treatment involves therapy options to manage the pain and ensure as much mobility and independence. The doctor will design a tailored treatment program depending on your child’s symptoms. A program for mixed CP typically includes: • Stem Cell Therapy: A relatively new form of treatment – it involves drawing stem cells from within the patient’s body and using them to replace damaged brain cells. Studies continue on its applications, and it can potentially be a cure for Cerebral Palsy someday. • Physical Therapy: Physical therapists use a variety of flexibility and strength training exercises along with massage therapy to reduce muscle pain and improve limb and joint mobility. Early intervention through Physical Therapy helps to avoid the risk of limb deformities later. • Occupational Therapy: The goal is to help your child gain as much functionality as possible, especially with everyday tasks and skills that require bilateral coordination and motor control. The therapist will use a variety of exercises, games, and toys to impart the skills necessary.

8. Treatment for Mixed Cerebral Palsy • Speech and Language Therapy: Therapists will guide them through safe swallowing practices, articulation exercises, and special breathing exercises to help them speak more clearly and chew their food better. This helps with intelligible communication and ensures adequate nutrition. • Cognitive Therapy: Some children with mixed Cerebral Palsy face cognitive issues like learning disorders. Trained therapists will teach them their letters and numbers through cue cards, visual learning aids, communicative devices, special games, and other appropriate tools. • Assistive devices: These can help your child communicate better and move around more independently. There are several options depending on the the symptoms, from crutches and walkers, to motorized wheelchairs and handheld communication devices. • Surgery: Children with severe symptoms may benefit from surgery to correct especially painful contractures or floppy joints, or to prevent further deformities or dislocations later on. In addition, surgery can correct complications associated with Cerebral Palsy, such as hearing impairments or vision problems.

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