Physical And Health Disorders

The complexity of the problem of cerebral palsy leads to confusion regarding the term, for it is comprised of medical, psychological and social aspects. Historically, the identification of the symptomatology of cerebral palsy has been documented as early as the 19th century. Cerebral palsy was initially called Little’s Disease, in reference to its initial identification by British physician, William Little (1810-1894) (Venes, 2005). Little described a number of concomitant traits observed, such as impaired intellect, problems of speech, convulsions, irritability, and impulsive nervous condition.

As scientific investigations continued, abnormalities of the brain became suspect as causative agents, at least in part, for these impairments. Little’s Disease, then, became more commonly known as cerebral palsy. The term “cerebral” refers to the largest part of the brain, the cerebrum. The cerebrum is divided into two cerebral hemispheres, and is concerned with sensations and the interpretation of sensory impulses, and all voluntary muscular activities. The term “palsy” is defined as paralysis resulting from developmental defects in the brain or trauma at birth (Venes, 2005).

Due to its lack of specificity, cerebral palsy has further come to be termed static encephalopathy. Venes (2005) defines “static” as in equilibrium or not in motion. “Encephalopathy” is defined as a dysfunction of the brain. Static encephalopathy is further delineated in terms of specific motor and other deficits. Nevertheless, “cerebral palsy” continues to appear in medical literature and is widely used in the general community, and will be referred to as such throughout the paper. Incidence and Prevalence

In the United States today, more people have some form of cerebral palsy than any other developmental disability, including Down’s syndrome, epilepsy, and autism (Cerebral Palsy International Research Foundation, 2008). Across many studies, the estimated incidence of this most common, permanent childhood physical disability is varied, but nonetheless noteworthy (Kuban & Leviton, 1994). Currently in the United States, “about 800,000 people have some form of cerebral palsy. Each year 10,000 infants are diagnosed with cerebral palsy. About 2-3 children per 1,000, have cerebral palsy” (CPIRF, 2008).

Although Parkes et al. (2002) report a stable prevalence rate, the prior 20 years demonstrated an increase in the incidence and prevalence of cerebral palsy. The most common impairments include spasticity, which occurs in 80% of the cases; hemiplegia, occurring in 30% of the cases; and diplegia, occurring in approximately 20% of all people with cerebral palsy (Odding et al. , 2006). The incidence of cerebral palsy is 30% higher in males than females, although the reason is uncertain. Males with cerebral palsy also tend to have an increased level of disability and lower cognitive scores (Johnston & Hagberg, 2007).

Definition Cerebral palsy (CP) is a term used to describe a group of chronic conditions affecting neuromuscular movements and coordination that result from irreversible lesions or abnormalities in one or more areas of the brain (Bobath, 1980). This damage to the brain occurs during fetal development or during infancy. Brain “incidents,” including stroke and other damaging events that occur after two years of age, are not considered cerebral palsy even though the resulting neuromuscular deficits may be the same (Krageloh-Mann, 2005).

Correlations have been drawn between cerebral palsy and preterm infants, infection, multiple pregnancy, and genetic factors (Keogh & Badawi, 2006). Motor involvement is seen 100% of the time. The World Health Organization states that utilizing a common delineation system (in this case the WHO’s model of human functioning and disability) is critical because “it provides a common language for describing health, functioning, and disability that is increasingly gaining worldwide acceptance” (Rosenbaum & Stewart, 2004, p. 6). Similarly, Bax et al.

(2005) argued that it is important to examine the classification of cerebral palsy and develop a common language to reference it. The authors state that “the need for reconsideration of the definition and classification of cerebral palsy (CP) has become evident” (p. 571). A clear definition of and common language regarding cerebral palsy benefits physicians, researchers, health officials, and others working with this population. Deriving from this need, and as a result of the formation of the Executive Committee for the Definition of Cerebral Palsy, the following definition was developed.

Cerebral palsy (CP) describes a group of disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behavior, and/or by a seizure disorder. (Bax, et al. , 2005, p. 572) Cerebral palsy can vary in severity and in the degree of involvement of cognitive and sensorimotor functioning (Carlson, 2005).

Children with cerebral palsy may experience physical, motor, language, cognitive, and social challenges in everyday settings (Nabors & Lehmkuhl, 2006). They may not be able to walk, talk, eat or play as most other children do. Acquisition of gross motor skills, fine motor skills, and language development are often delayed and the most frequent disabilities occur in mobility, activities of daily living, and communication (Lepage et al. , 1998). No formal scale has yet been created to measure how any potential physical or cognitive limitations impact desired full participation in society (Bax, et al.

, 2005). Because there is neither an identified single cause nor a characteristic course, the classification of cerebral palsy is difficult. Moreover, the description of the motor disability may not give insight into cognitive and emotional dysfunction (Jackson & Saunders, 1993). Jackson and Saunders (1993) outlined the following basic classifications of clinical motor dysfunction in cerebral palsy (pp. 23-5): Spastic: The most common form of cerebral palsy, accounting for 70% to 75% of all cases, it manifests as increased tone or contractions of muscles causing stiff and awkward movements.

Hypotonia, or decreased muscle tone lasting a few weeks to a year, are the earliest clinical signs. Affected children often walk on their toes due to heel cord tightness. Strabismus, speech problems and feeding difficulties are common. Athetoid (dyskinetic): Caused by lesions in the basal ganglia. A condition in which slow, involuntary, irregular, twisting, snake-like movements occur that are aggravated or intensified by emotional tension or stress. All extremities are usually affected.

There is a tendency for the eyes to converge toward the midline with an upward displacement, producing a conjugate upward gaze. High frequency hearing losses and deafness are common. Dysarthria (imperfect speech articulation) and drooling, in combination with hearing loss, make communication challenging. Atoxic: Least common form of cerebral palsy, caused by damage to the cerebellum. It is manifested by a loss of balance, coordination and kinesthetic sense. Typically, the gait is wide-based, staggering and unsteady.

Hearing, vision, position, and touch are affected. Development is slow during the first three to five years of life, but cerebellar coordination has been demonstrated to improve as the child grows. Rigid: Uncommon form of cerebral palsy, stiffness of the body and extremities resulting from damage to the cerebral cortex anterior horn cells. Muscle tone is in a constant state of high tension and resistance, which results in deformity and a deficit in action movement.

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