We understand how you feel and what all concerns you have about various symptoms of your CP child. Can you relate to any of these?
Ans: We all have highly unstable eyeballs when we are newborn. This is because the orbital muscles are not yet developed and these muscles start developing only when the child starts looking around new things. Having no head neck control contributes to the problem making it difficult to establish good eye contact with the objects.
Ans: Poor control on head neck also triggers drooling of saliva from mouth. Child’s weak buccal cavity muscles, poor tongue movement from stiffness makes it difficult for the child to gulp the saliva and drooling becomes inevitable with poor head neck control. Saliva is most important digestive enzyme with strong immune power that fights the external infections for teeth to remain healthy and free from infections.
Ans: Your child has delayed milestones from a brain lesion that makes it difficult for him to easily and instantly connect to the gravity. Gravity topples him off and you have been supporting him so that he does not fall sitting, standing or walking. Your child is frightened of falling, when he cannot balance. Normally, when a child is born, he is always kept in supine position, close to the ground, which is the safest position (safety of COM); then he learns to turn over (whereby he learns to shift the COM), then he learns to sit (stabilize/control the COM), then he crawls (he can raise as well as shift the COM); then he learns to move forward and in that attempt he falls and again gets back to position. Same thing happens repeatedly whether we are learning to sit, crawl or walk (restoration of COM). So overall, we can say that milestone development or postural development is to maintain, control and restore the COM to safety. If you are going to keep your child in one corner just lying down, how is he going to have sight of the surrounding environment to explore and learn from it. This is one of the reasons why he becomes mentally retarded. Human brain is a highly PLASTIC, ACTION-REACTION, and solution finder organ. So unless it receives enough somato-sensory/visual/auditory input how do we think it is going to give its response?
Ans: Child with brain lesion has paresis in his muscles that makes muscles force-less and child has difficulty controlling his head neck in space. This becomes first critical constraint for the child to connect to the gravity. Poor control on head neck makes it difficult for the child to exploit major sensory organs like eyes, ears, nose, vestibule in the middle ear that could send huge amount of sensory inflow for motor outflow from the brain that helps hold head neck against the toppling force of gravity and locate an object in space, learn about environment and above all begin to get different postural centers its connectivity to get the ball rolling to be completely connected with gravity with ability to sit, stand and walk independently within 12 to 15 months post birth.
Ans: When the brain gets lesion, muscles are force-less and weak that gets the COM safety under threat, brain orders stiffness and contracture that does not allow joints to move and restricts movement that gives indirect safety to COM from not moving. In this process, the connective tissue which is widespread throughout the body gets stiffened to assure that there is no free movement of any limbs that could threaten safety with paretic limbs and body going haywire from gravitational force. Also the thoracolumbar fascia on the weaker side contracts, also the hip joint and knee joint go into flexion. Body becomes log like when the connective tissue wrapped over gets stiffened. This connective tissue is also present inside the lungs and also in the intercostal spaces (between the ribs), thus making the expansion of the chest cavity difficult. Also because of the stiffness everywhere, there is no adequate blood supply to the capillaries and hence due to lack of blood supply, the paleness or discoloration of skin is seen. As spasticity reduces, circulation increases the skin color turns pinkish.
Ans: Keeping in mind that the child is largely passive and lying, not active and walking, running like other normal kids and since there is poor digestion we need not over feed the child. The food that is above his requirement level acts as toxin as it is not digested and excreted on regular basis.
Ans: Toe walking or what we call plantar flexion is caused as a result of knee locking or knee jam which in turn happens due to the spasticity induced by the brain throughout the body to limit the degree of freedom of the extremities which causes destabilization of the body. There is also another point to it, that whenever we are lifting the child or even if a normal person is hanging in air, his toes are pointed towards gravity and for the safety concerns of COM toes attempt to reach the ground. And it is not possible to walk on toe because our BOS becomes normal, COM destabilizes and this causes the child to trip over.
Ans: Most of the time it is not seizures, they are muscle twitches. When the oxygen level in the body goes below threshold, the muscles contract to squeeze in more oxygen to the lungs (which are also not able to take in more oxygen because of negligible expansion of the thoracic cavity and also the lungs), which in turn will increase the oxygen level in the blood. It is the craving of muscles for oxygen. As far as epileptic attacks are concerned, we all know that dead cells in the brain which are not eliminated because of inactivity of the brain obstruct the electrical activity of the brain. So from the above given observation we can also interpret that if the brain is made active enough, it can take care of itself by eliminating the dead cells.
Ans:Food intake in such children should be carefully monitored since the child is not yet walking and is largely passive and lying all the time. Do not over feed them. This causes indigestion of food and also negligible uptake of nutritive values. The mucous or sticky thing which is thrown by the body in any possible form including cold abscess is nothing but the byproduct of indigestion. So, as you get it giving the child food supplement is going to be a waste. There is no breakdown of the food consumed into various vitamins and minerals. There is no absorption of sodium, potassium, etc. which increases the possibility of fractures in these children. Every system of such children is sluggish including the circulatory and lymphatic system, which causes symptoms like cold extremities as well as recurrent infectious diseases. Also it should be noted that if the digestive system is kept busy in digestion, the process of excretion of the toxins is hindered which then get collected in the body. To conclude, all ailments of a cerebral palsy child are mainly because of the fact that the various body systems are not working in tandem with each other.
Ans: Any medicinal drug given does not help reduce spasticity PERMANANTLY; besides that they also have their own toxic effects on the human body. Plastering also induces furthermore contracture.
Ans: Even normal human beings try to support their back each time possible for their comfort. But when this child wants to support his back and the action is repeatedly done, it becomes a habit and as the child grows the action becomes more powerful. Gravity also responsible for this to some extent as gravity always stimulates extension and not flexion. So we get to see severe back extension or throwing back tendency in these children. The involuntary limb movements are the spinal movements which are present normally in any infant. It just continues to be present in this child even as he grows.
Ans: There is no bowel and bladder control in your child because of the weak and paretic bowel and bladder muscles. Also, though many a times the parents or whoever is around are not able to interpret the gesture of the child even if he is trying to convey it to the parents. When the bowel and bladder muscles are excessively spastic, the process of excretion becomes strenuous.