Disabilities that are secondary to motor deficits are weakness of external eye muscles causing strabismus or difficulties in normal swallowing leading to alnutrition. Malnutrition is an important cause of retarded brain growth and myelination. Lastly, deprivation handicaps occur. The child who cannot move is deprived of peer interaction and stimulation through play. Psychosocial problems develop as a result. Check for the presence of associated problems and get appropriate referral for treatment. Correct these problems as much and as early as possible to prevent the development of deprivation handicaps.

Intellectual impairment

Cognition refers to specific aspects of higher cortical function; namely, attention, memory, problem solving and language. Cognitive disturbance leads to mental retardation and learning disability. The prevalence of moderate, severe and profound mental retardation is 30 to 65% in all cases of CP. It is most common in spastic quadriplegia. Visual and hearing impairments prevent the physician from accurately assessing the degree of
intellectual impairment. Children with intellectual impairment need special education and resources to stimulate the senses for optimal mental function.

Epileptic seizures

Seizures affect about 30 to 50% of patients. They are most common in the total body involved and hemiplegics, in patients with mental retardation and in postnatally acquired CP. Seizures most resistant to drug therapy occur in hemiplegics. Seizure frequency increases in the preschool period. Electroencephalograms are necessary for the diagnosis of seizure disorder.

Vision problems

Approximately 40 % of all patients have some abnormality of vision or oculomotor control. If there is damage to the visual cortex, the child will be functionally blind because he will be unable to interpret impulses from the retinas. In severe cases, the optic nerves may also be damaged. Loss of coordination of the muscles controlling eye movements is very common. The child cannot fix his gaze on an object. In half of the cases, binocular vision does not develop. Myopia is a concomitant problem. Screen for visual deficits because some are preventable and they contribute to the movement problem.

Hearing

Sensorineural hearing loss is seen in 10 % of children. Children born prematurely are at high risk for hearing loss. It is generally not diagnosed early because of other handicaps. Test all babies for hearing loss because appropriate hearing devices prevent many future problems resulting from loss of hearing ability.

Communication problems and dysarthria

Dysarthria refers to speech problems. The child has difficulty producing sound and articulating words. Dysarthria occurs in 40% of patients. The causes are respiratory diffi culties due to respiratory muscle involvement, phonation diffi culties due to laryngeal involvement, and articulation diffi culty due to oromotor dysfunction. Spasticity or athetosis of the muscles of the tongue, mouth and larynx cause dysarthria. It is important that every child is provided with an alternative means of communication as early as
possible to avoid further disability .

Oromotor dysfunction

Sucking, swallowing, and chewing mechanisms are impaired. Drooling, dysarthria and inability to eat result in failure to thrive, delayed growth and nutrition, poor hygiene and impaired socialization.This condition bring teeth problems

teeth problems

Dentin Primary or hyperbilirubinemia
Malocclusion Spasticity
Tooth decay Feeding, swallowing problems
Gingival hyperplasia Antiepileptic drug use

 

Gastrointestinal problems and nutrition

There is a general deficiency of growth and development. Children with dyskinesia and spastic quadriplegia fail to thrive.  This is related to inadequate intake of food, recurrent vomiting with aspiration secondary to gastroesophageal refl ux and pseudobulbar palsy. Difficulties in swallowing (dysphagia), hyperactive gag reflex, spasticity or loss of fine motor control impair feeding. Gastroesophageal reflux and impaired swallowing cause aspiration pneumonia. Many children with CP have high basal metabolic rates. Increase in basal metabolic rate coupled with feeding difficulties cause malnutrition. Malnutrition may be severe enough to affect brain growth and myelination in the fi rst 3 years of life. There is immune system suppression and increased risk of infection.

Respiratory problems

Aspiration in small quantities leads to pneumonia in children who have difficulty swallowing. Premature babies have bronchopulmonary dysplasia. This leads to frequent upper respiratory tract infections. Respiratory muscle spasticity contributes to the pulmonary problems.

Bladder and bowel dysfunction

Loss of coordination of bowel and bladder sphincters results in constipation and/or incontinence. Enuresis, frequency, urgency, urinary tract infections and incontinence are common problems. The causes are poor cognition, decreased mobility, poor communication and neurogenic dysfunction. Urodynamic assessment has demonstrated bladder hyperreflexia, detrusor
sphincter dyssynergia, hypertonic bladders with incomplete leakage and periodic relaxation of the distal sphincter during filling. Constipation is a common but overlooked phenomenon. It causes distress in the child, increases spasticity and results in poor appetite. It is a result of many factors, including poor diet and decreased mobility. Establishing a routine for bowel training and encouraging upright posture help reduce constipation.

Psychosocial problems

A diagnosis of CP is extremely stressful for the family and the child when he grows up. This causes various reactions ranging from denial to anger, guilt and depression. Coping with the emotional burden of disability is easier if the family has strong relationships, financial security, and supportive members of the community. The child and the family need to find ways to
connect to each other. A healthy relationship between the mother and the child forms the basis of future happiness. Prevention or appropriate treatment of associated problems improves the quality of life of the child and the family. The severely involved mixed quadriplegic child

occupational therapist asadi