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Cerebral Palsy Sign up for Our Quarterly Newsletter PATIENTS OR CAREGIVERS ADVOCATES PROVIDERS OR RESEARCHERS DONORS Home Sign Up for Newsletter Who We Are What We Do Contact Donate Now Disorder Directory: Learn from the Experts EDUCATIONAL ARTICLES PLUS FAMILY STORIES AND RESOURCES INDEX A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Cerebral Palsy Sign Up for Our Quarterly Newsletter ARTICLE FAMILY STORIES RESOURCES Get “Families First” plus updates on grants, family resources and more. Sign Up Now KENNETH F. SWAIMAN, MD Dr. Kenneth Swaiman is an internationally known child neurologist and Find Us On Emeritus Professor of Neurology and Pediatrics at the University of Minnesota Medical School where he was the director of the Division of Child Neurology for several decades. He also served as Interim head of the Department of Neurology. During his tenure there, he was involved in the training of almost Recent Tweets 100 pediatric neurologists from the United States and Canada, as well as many other countries. His biography is cited in “Who’s Who in America”, “Who’s 2/25/16 - Great read! Who in the World”, “Who’s Who in Science and Engineering”, and “The Best @disabilityscoop In Bid To Doctors in America”. Understand Autism, Scientists Turn To Monkeys https://t.co/5t9uz6NhWu Dr. Swaiman was the Chairman of the organizing committee and first https://t.co/5t9uz6NhWu President of the Child Neurology Society (CNS). He received the Hower award, the highest award of that society and the Founder’s Award at its 25th 2/25/16 - Informative read! @mnt Anniversary meeting as well as The Lifetime Achievement Award for Epilepsy and marijuana: could Neurologic Education by the American Academy of Neurology. As the cannabidiol reduce seizures? chairman of the organizing committee of the Professors of Child Neurology, he https://t.co/E3TlMqTQpy was its first President and a prime mover and also first president of the Child https://t.co/E3TlMqTQpy Neurology Foundation. He was a member of the organizing committee of the International Child Neurology Association (ICNA), on many National Institutes of Health Study Sections and visiting professor and lecturer at medical schools in the United States and throughout the world including Canada, South America, Asia, Mexico, Europe, and Africa. http://www.childneurologyfoundation.org/disorders/cerebral-palsy/ 2/25/16, 5:36 PM Page 1 of 15 Dr. Swaiman has been the Editor and a primary contributor to the textbook titled Practice of Pediatric Neurology (2 editions) and Pediatric Neurology: Principles and Practice (5 editions). He is the founding editor and immediate past Editor-in-Chief of Pediatric Neurology, an international journal devoted to the basic and clinical aspects of the diagnosis of children with neurologic impairment. He has served as a member of the Editorial Boards of the Annals of Neurology, Brain and Development, Neuropediatrics, and the Chinese Journal of Pediatrics. His investigative endeavors have included research into brain energy metabolism, the effect of malnutrition on the developing brain, and the metabolic effects of iron and other metals on metabolism of various portions of the brain. He has been particularly involved in studies of Neurodegeneration with Brain Iron Accumulation (NBIA) and other movement disorders of children. SUMMARY Cerebral palsy consists of a group of brain disorders involving movement and posture causing limitation of activity. The condition is most commonly evident in the early months of life, but usually dates back to the neonatal period. Although muscle tone (ranging from floppy to stiff) and abnormal postures (body and limb positions) may become more pronounced during early childhood, changes in type are uncommon. The condition is always non- progressive. There is a wide range of involvement, from mild to severe. Although life expectancy may be decreased, acute death is extremely rare. Intellectual, sensory, and behavioral difficulties may accompany cerebral palsy, but are not necessary for diagnosis. Because cerebral palsy is an umbrella term that includes a wide range of movement dysfunction, causes are varied and are discussed later in this article. It is important to know that children with cerebral palsy often have accompanying intellectual delay, hearing impairment, and speech and language disorders. Additionally, epilepsy occurs in many children with cerebral palsy. The definition of cerebral palsy in research studies often varies depending on the research plan; therefore, the definition varies depending on the citation. In spite of all the various definitions, designating cerebral palsy as a single entity is valuable because affected children commonly have similar needs for medical care, rehabilitation, and social services. DESCRIPTION Cerebral palsy can be classified by the following qualities: Movement abnormalities: Muscle tone abnormality (increased or decreased) and type of movement disorder (e.g., ataxia, dystonia, choreoathetosis) Severity of the handicap Anatomic: Parts of body affected (e.g., hemiplegia, diplegia, quadriplegia) See later in this article for classification PREVALENCE http://www.childneurologyfoundation.org/disorders/cerebral-palsy/ 2/25/16, 5:36 PM Page 2 of 15 The precise number of affected individuals with cerebral palsy in a population is not known. Most likely, cerebral palsy occurs in 1.2 to 3.6 children per 1000 live births. Numerous cerebral palsy registries exist throughout the world. Widespread regional prevalence rates have remained consistent over several decades. Based on current figures, approximately 8,000 children with cerebral palsy are born annually in the United States. SYMPTOMS In most children with cerebral palsy, delay in attaining developmental milestones is the most distinctive symptom of the condition. A detailed history as well as thorough physical and neurologic examinations are critical in the diagnostic process. Records of the mother’s pregnancy and delivery and records of the infant’s early neonatal period can prove invaluable. Physical and neurologic abnormalities may be subtle and professionals should be reserved about diagnostic statements unless the findings are unequivocal. Signs and symptoms of birth asphyxia or neonatal encephalopathy are strongly predictive of cerebral palsy in a child. For instance, full-term infants whose immediate postpartum course is comprised of a 5-minute Apgar score of 5 or less, with continuing neurologic abnormalities and seizures in the first days of life, constitute a high-risk group for developing cerebral palsy. PHYSICAL ABNORMALITIES The initial clinical findings may change with maturation and severity may change, but distribution is only occasionally altered. A child with cerebral palsy who has been hypotonic may become hypertonic. Although unusual, some infants with mild abnormalities subsequently manifest a decrease or, in rare instances, a disappearance of motor dysfunction. The clinical pattern should not include evidence of progressive disease or loss of previously acquired skills. Progression of disability (qualitatively and quantitatively) requires review of the diagnostic possibilities to explain the progression. History-taking should focus on identification of a specific cause and should particularly investigate familial or metabolic disease. Such information may have value for determining treatment or family counseling. The diagnosis of cerebral palsy often is suggested by the persistence of primitive reflexes, the presence of pathologic reflexes elicited by the clinician, abnormal muscle tone, and the failure to develop maturational reflexes in a timely fashion. These maturational reflexes include the traction response and the parachute response. The use of standard developmental screening tests (e.g., the Denver Developmental Screening Test II) may provide quantitative evidence of motor delay, as well as evidence of delay in acquisition of other skills. CAUSATION Premature birth is the single most important risk factor for cerebral palsy. The risk of cerebral palsy in very-low-birth-weight infants (birthweight below 1500 grams) is as high as 4% to 10%, whereas the risk in term infants is only 1 to 1.5 per 1000 live births. Infants born at 24-26 weeks gestation may have as high as a 20% chance of developing cerebral palsy. In some pertinent studies, prematurity accounts for approximately half of all infants with cerebral palsy. http://www.childneurologyfoundation.org/disorders/cerebral-palsy/ 2/25/16, 5:36 PM Page 3 of 15 An increase in the prevalence rate of cerebral palsy among preterm infants during the mid-1980s was attributed to increased survival of low-birth-weight infants. Later studies suggest that the rate of cerebral palsy among preterm infants has not changed. Nonetheless, it is noteworthy that term infants represent more than half of all cases of cerebral palsy. The prevalence of cerebral palsy among term infants, 1- 1.5 per 1000 live births, has not changed during the past 3 decades. The common use of electronic fetal monitoring and the pronounced increase in births by cesarean section appear to have had little affect. The unchanged prevalence is disappointing in view of the fact that perinatal deaths, stillbirths, and birth asphyxia as measured by low Apgar scores have dropped dramatically in recent decades. Male infants have a greater risk of cerebral palsy than female infants. Twins, who constitute 2% of the population, also carry a higher risk and contribute 10-12% to the overall prevalence of cerebral palsy. The increased risk of cerebral palsy among multiple birth babies
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