Cerebral Palsy

Cerebral Palsy

Cerebral Palsy

The Better Health Channel describes cerebral palsy as "a range of disabilities associated with movement and posture. 'Cerebral' refers to the brain and 'palsy' means weakness or lack of muscle control. Although cerebral palsy is a permanent condition, a child with this condition can achieve greater control over movement, as he or she learns and practices motor skills. Cerebral palsy affects about 7,500 Victorians and more than 20,000 people Australia-wide." Cerebral palsy can affect different people in different ways, some may find that they have minor motor skill problems whilst other are totally physically dependent.

Cerebral Palsy can be categorised into four main categories, according to the parts of the body it affects the:
Quadriplegia- all four limbs are affected and the muscles of the face and mouth may also be affected.
Diplegia- all four limbs are affected, but legs more so than arms.
Hemiplegia- one side of the body is affected.
Paraplegia- both legs, but neither of the arms, are affected.

There are four main types of cerebral palsy:
Spastic cerebral palsy - this is the most common type of cerebral palsy. Spasticity means stiffness or tightness of muscles, which is most obvious when the person tries to move.
Athetoid cerebral palsy - athetosis means uncontrolled movements, which often lead to erratic movements.
Ataxic cerebral palsy - this is the least common type of cerebral palsy. Ataxia means a lack of balance and coordination. It often presents as unsteady, shaky movements called tremors.
Mixed type cerebral palsy - may involve a combination of types of cerebral palsy.

For the first time, the long term effects of surgery aimed to correct the bone and muscular defects of children with cerebral palsy has been described.

The results of single event multi-level surgery five and ten years down the track show that:
  • children who have had more substantial surgery do better than those who have had minor surgery - in other words, size does matter
  • the make-up of the multidisciplinary team is important
  • surgical skills counts.

    Single event multi-level surgery is a single operation, which tries to correct all bone and soft tissue deformities at the same time. It aims to improve mobility and reduce the time spent in rehabilitation.

    These results were presented by Professor Kerr Graham, an orthopaedic surgeon at The Royal Children's Hospital in Melbourne, he specialises in the care of children with cerebral palsy.

    Dr. Iona Novak is the head of research at the Cerebral Palsy Institute of Australia she commented on the research presented by Professor Kerr Graham and spoke about the current research the institute is undertaking. What are your thought about the research presented by Professor Kerr Graham?

    Dr. Iona Novak : The research has been long-term. Professor Kerr Graham is one of the leading surgeons in the world. His present data has tracked the long-term outcomes of the natural history of Cerebral Palsy and the benefits of good surgical follow-ups. Professor Graham has shown how important a good follow-up is to maintaining and protecting the patient. Professor Graham uses the term 'fall off the curve' if there is no, or a bad follow up. There is data from the Cerebral Palsy Institute to show this. If a patient has regular follow-ups and is monitored with therapy they will 'stay on the curve', those who do not actively participate in therapy and follow-ups will 'fall off the curve' and ultimately have a worse outcome.


    Has Professor Kerr Graham's Cerebral Palsy conferences been well recieved?

    Dr. Iona Novak : I attended the key note speech. The audience hangs on every word he says mostly because he is such a innovative presenter and his research in regards to surgery is solid. Professor Graham leads the world with this solid research and actively supports those having surgery and those on the Cerebral Palsy register. Those on the Cerebral Palsy register have their outcome monitored. 99% of those on the register provide their surgery results for research. The register helps with the research as it shows what works and what doesn't work.


    What does this mean for the future development of Cerebral Palsy?

    Dr. Iona Novak : It is all linked. The Cerebral Palsy Institute is meeting with the doctors who are involved in the Sweden Cerebral Palsy registry. In Sweden they have been able to show that no children have hip dislocations, whereas in Australia 30% of those with Cerebral Palsy have hip dislocations. Because of the Swedish surveillance they have been able to eliminate hip dislocations from occurring. The Cerebral Palsy Institute in Australia have a partnership with the Swedish lavatory to achieve our vision of children not having hip disolations or curvature of the spine. With good monitoring it is possible to intervene early.

    Professor Graham believe that if you have a knee problem you would go to a knee specialist so those with Cerebral Palsy need to go to a specialist who sees lots of patients with Cerebral Palsy such as a an orthopaedic surgeon. An orthopaedic surgeon who specialises in Cerebral Palsy will have the skill and be able to understand the similarity and differences of the muscle functions involved with a patient who has Cerebral Palsy.

    The research presented shows that the after care is just as important and a specialist has to work with the patient after the operation due to muscle weakness and they have to be immobilised in a cast. For a person suffering from Cerebral Palsy if the muscle is weakened and not immbolised in a cast the outcome can be significantly changed. This is why Professor Graham believes it is vital that a person with Cerebral Palsy sees a team of knowledgeable specialists, otherwise the outcome can be worsened.


    Do you think results like this mean we are getting closer to curing and preventing Cerebral Palsy?

    Dr. Iona Novak : These results are classified as 'secondary prevention'. Someone with Cerebral Palsy's muscles, bone and skeleton can change over time; intervention can prevent secondary impairments worsening. We are also involved in research around curing Cerebral Palsy but as it occurs from a brain injury the prevention and cure is at a brain level they look at the injured brain and factors in the environment, in the mother, during pregnancy and the placenta.

    Secondary prevention helps improve quality of life and reduce pain whilst maintain mobility, it will prevent 'falling off the curve'.