Associated Disorders / Complications in Cerebral palsy

Please note, all children with CP have some or the other associated problems. There are three types of co morbidities have been identified. The three co morbidity categories are cocausal, complications, and co‐occurring.

• Cocausal: Disorders caused by the same injury to the developing brain that caused CP (i.e. epilepsy and cognitive impairment)
•  Complications: Disorders that are complications of the main CP condition (i.e. scoliosis and hip dislocation)
•  Co‐occurring: Disorders not caused by the injury to the developing brain, nor are complications of the main CP condition

In actual sense these associated factors are considered the basis of prognosis (outcomes from the treatment). Coping with these disabilities may be even more of a challenge than coping with the motor impairments of cerebral palsy. There is a common saying “Lesser the number of associated problems-more the chances of better future”.
If you have a child with cerebral palsy, you must look for the following associated problems / co-morbid conditions and start its management as soon as possible. It is said that the treatment / management of these factors should be started before you start physiotherapy / occupational therapy.   
Epilepsy / Seizures / Convulsions
Children with CP can have focal / partial seizures, generalized seizures, petit mal / absence seizure, myoclonic seizure, tonic-atonic seizure (drop attacks), etc
Management / Treatment Options

• Medicinal Treatments- Anti-epileptic Drugs (AED) based on the types of seizure
•  Neuro-surgery to remove the part of the brain responsible for the seizures (lobotomy)
•  Vagus Nerve Stimulation
•  Ketogenic-a special diet, etc

Visual Impairments-eye problems
Children with CP may have cerebral visual impairment (CVI), Eye Visual Impairment, Strabismus, Poor visual acuity (Myopia or Hypermetropia), Nystagmus, Lazy eye, etc
Treatment / Management options

• Visual Aids-SpectaclesLow-vision Aids are designed to improve visual performance in children with visual impairment or low vision. These aids can be optical, electronic and in combination
  Examples: Telescope, Microscope, Hand Held Magnifier, Video Magnifier System
  
• Eye Surgery
• Vision therapy

Hearing Impairments / Deficits
Children with CP may have hearing loss (conductive hearing loss, sensorineural hearing loss),etc
Treatment / Management Options

• Hearing aids
  
  A hearing aid is a small electronic device that a child wears in or behind his ear. The device makes some sounds louder so that the child with hearing loss can listen, communicate, and participate more fully in daily life
• Surgeries to correct malformation or injuries
• Cochlear implant
  
  A cochlear implant is an electronic device that is surgically placed in the affected ear to improve hearing. Cochlear implant is a good choice for children who have severe hearing loss from inner-ear damage and can't hear well with hearing aids.
•  Auditory Training, etc

Speech impairments
Children with CP can have problems such as aphasia, dyspraxia, dysprosody , dysarthria, stuttering,
dysphagia, resonance disorders, etc
Treatment / Management Options

• Use of Bliss Board
•  Speech and language therapy, etc

Feeding disorder
Very common problems in the form sucking difficulties, swallowing difficulties, chewing difficulties, drooling etc
Treatment / Management Options

• Combination therapy
• Nutritional modifications
•  GERD is managed with medication

Drooling-excessive production of saliva (Sialorrhea)
Drooling can be in the form of posterior drooling or anterior drooling
Treatment / Management Options
1.  Optimizing positions and conditions
2.  Oro-motor and oro-sensory   therapies
3.  Behavioral therapies
4.  Oral appliances
5.  Anti-cholinergic agents
6.  Botulinum toxin Injections
7.  Surgical intervention

Mental Retardation-Intellectual Disability-Low Intelligence-Low cognition
33% children with CP may have low / subnormal cognition or poor mental ability. They have average or lower than average IQ. 
Treatment / Management Options

•  Medications
• Occupational therapy
• Cognitive therapy
• Special Education
•  Vocational / Life Skills training

 Bladder Related Issues
Children with CP have urinary incontinence or enuresis, Urinary infections, and indication issues
Treatment / Management Options

•  Medicinal Management-
• Specialized Exercises- Kegel  Exercises
• Toilet Training Program

Bowel Related Issues
Incidence: 40% to 57% children with CP may have bowel related issues 
Treatment / Management Options

•  Medications
• Physical therapy

Constipations
Incidence: Around 74% children with CP have constipation
Treatment / Management Options
1. Encourage foods that contain fibers
2. Encourage a good intake of Fluids
3. Limit the period of idle sitting
4. Encourage to change posture regularly
5. Assist with medications to maintain good bowel habit

Dental Problems
More than 50% children with CP have Dental problems in the forms of, mal-alignment of the upper and lower teeth, excessive gagging, gingivitis due to seizure medications, etc
Treatment / Management Options

•  Dental care
• Oral hygiene, etc

Failure to Thrive
Incidence:  as many as 33% - 40% children with CP may have failure to thrive situation
Failure to thrive is a condition which is considered in children who are consistently underweight.
Management / Treatment Options

• Special Diet-Nutritional supplements
• Managing other medical conditions

Obesity
There is worldwide tendency of increasing prevalence of obesity in children.
Treatment / Management Options

• Diet Modification
• Weight reduction program

 Poor Muscle Growth
Incidence: Very common in hemiplegic Cerebral Palsy
Treatment / Management Options

• Nutritional supplements-Protein rich food
• Activity oriented exercises, etc 

Breathing Problems
Incidence: Children with cerebral palsy are very prone to respiratory complications like upper respiratory infections (URTI), aspiration, and pneumonia. Breathing difficulties have been seen due to spinal curvature (scoliosis)
Treatment / Management Options

•  Symptomatic medications
• Breathing exercises

Visual -Perception Impairments / Perceptual Disorder
Incidence: About 50% Children with CP may have visuo-perceptual disorders
Treatment / Management Options

•  Ophthalmological support
• Vision therapy
•  Occupational therapy
• Special education, etc

 Delayed Maturation
Incidence: Very rare. Sometimes puberty begins earlier but ends later in white children with CP, compared with general population
Treatment / Management Options

•  Symptomatic medical and surgical management
• Transitional Management
• Sex education, etc

Abnormal sensations-sensory loss
Incidence: Rare, mostly with hemiplegic CP
Treatment / Management Options

• Medications
•  Physical therapy
• Occupational therapy, etc

Sensory dysfunction
Incidence: Around 40% children may have sensory dysfunction
Treatment / Management Options

•  Sensory Integration therapy

Hydrocephaly (Water in the brain)
Incidence: Around 17.3%.
Treatment / Management Options

•  Symptomatic medical management
•  Need based surgical procedures, insertion of shunt, Endoscopic third ventriculostomy,

Microcephaly (Small size head)
Incidence: Lot children with cerebral palsy may have Microcephaly. Around 26.5%
Treatment / Management Options

• Regular monitoring
• Surgery may be helpful if there is craniosynostosis

 Skin disorders
Incidence: Skin infection and irritation is very common in CP
Treatment / Management Options

• Symptomatic treatment
• Personal hygiene
• Skin care, etc

Behavioral Issues
Incidence: 1 in 4 children with CP have behavioral disorders.
Treatment / Management Options

• Behavioral therapy-ABA, BMT, CBT, etc
•  Medications

Congenital Heart Disorder
Incidence: Very rare. Commonly PDA
Treatment / Management Options

•  Symptomatic medical and surgical treatments

Hormonal Imbalance
Incidence: Poor growth or delayed puberty due to multiple pituitary hormone deficiency hormone deficiency (MPHD)
Treatment / Management Options

•  Hormonal Therapy

Sleep disturbance
Incidence:  Difficulty in initiating and maintaining sleep, sleep wake transition, sleep breathing disorders, sleep bruxism, excessive day time sleeping, nightmares and sleep talking , etc
Treatment / Management Options

• Modification environment like light system, temperature and bedding used for the child
• Maintaining  sleep diary and diet modification
• Medications, etc

Pain
Incidence: Pain is very common with children with CP. Adults are more prone to pain due to poor postures and joint immobility
Treatment / Management Options

• Medications-  Antispasmodic medications, Anticholinergic drugs
• Botox Injection
• Muscle massage, acupuncture, ice packs and heat therapy, hydrotherapy, and cognitive behavioral therapy.

Issues with Secondary Sexual Characters
Incidence: Very common with severely affected adults
Treatment / Management Options

• Sex education
• Behavior therapy
• Medications, etc

Psychological Issues
Incidence: Mental health and psychological problems, in the forms of depression, anxiety and conduct disorders, generally triggered by pain, discomfort or sleep disturbances.
Treatment / Management Options

• Psychotherapy
•  Medications

If you want to get screening and treatments of any of the above conditions in your child, we are here to help you. Please contact us:-
Mail ID: helpicd@gmail.com   Whatsapp@ +91-7838809241  Voice Call @ +91-11-41012124

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