World Cerebral Palsy Day: What You Need to Know

6 October marks the global movement which highlights cerebral palsy (CP). In South Africa, it is estimated that for every 1 000 babies that are born in a specific year, about 10 babies will have CP. World Cerebral Palsy Day celebrates the achievements of individuals who live with CP. It is a developmental disability that affects children’s capacity to control their movements and posture. Children with CP have weak muscles during their first few months of life and later these muscles stiffen. They can also have repetitive movement, shakiness, and problems with balance.

According to Dr Thembi Katangwe, a paediatric neurologist at Tygerberg Hospital and Stellenbosch University: ‘CP occurs when there is injury to the developing brain either during pregnancy, during birth or during the first few years of life, especially less than two years. This injury causes problems with brain development in parts that are responsible for muscle movement in different parts of the body.’

Some examples that may result in CP:

• The foetal brain does not develop properly during pregnancy.
• A baby is born prematurely when the brain is not fully developed.
• An expectant mother is exposed to certain infections during pregnancy.
• A baby has a stroke during pregnancy or shortly after birth.
• A baby gets a severe brain infection shortly after birth.
• A baby does not get enough oxygen and blood flow during birth.
• A child experiences injury during the early years of life, i.e., the child is involved in a motor vehicle accident, the child nearly drowns in a pool or falls from a height.

Types of Cerebral Palsy

There are different types of CP. Most children with CP usually have a combination of two or more types:

• Spastic CP: These children have stiff and tight muscles. This stiffness results from the failure of messages from their brain that instruct their muscles on how to work smoothly. The messages are not properly delivered. This is the most common type of CP.
• Dyskinetic CP: These children have lots of involuntary movements, either twisting or writhing, that are often repetitive. This makes it challenging for these children to do normal things, like eating by themselves, picking up a toy or even talking. These movements can be worsened by anxiety or pain. This is the second most common type of CP.
• Ataxic CP: These children have shaky and unsteady movements. They struggle to balance. They may also have tremors.

‘Detecting early signs of CP in a child that has had brain injury is very important. Studies have shown that children that have been diagnosed with CP before the age of one year, have a better prognosis than those that are identified later. This is because the children who have been diagnosed early have the benefit of starting therapy early. As a result, these children may not have severe CP compared to children that have started their therapy later. CP can be confirmed from as early as 6 months. It is therefore essential that children with suspected CP are assessed early so that they can start their therapy promptly,’ said Dr Katangwe.

Symptoms of CP in babies (3 to 6 months) include:

• Delayed development – these babies tend to be slower than other babies of the same age when it comes to e.g., holding their head up or sitting on their own.
• Poor head control – the head falls back when picked up.
• Feeding problems.
• Early hand preference
• Overextended back and neck when cradled, stiffening.

Symptoms of CP in babies (more than 6 months) include:

• No rolling over
•  Cannot bring hands together
• Continued single hand preference
• Fisting of hands
• Scissoring of legs when lifted

‘When a baby has any of these features, it is important to take them to your nearest clinic so that he or she may be assessed,’ Dr Katangwe concluded.

What are Cerebral Palsy Registries?

Cerebral Palsy (CP) registries are computerised databases that contain information regarding persons with CP in a particular area. These databases have sets of common data elements. The information in the database can be analysed and be used to motivate for interventions that improve the livelihood of persons with CP within that area. Participation of many centres would result in a very large database to study. CP registries were first introduced in high-income countries (HIC) to monitor the prevalence of CP. Today, these registries have an important role in studying the causes of CP, evaluating the best therapeutic interventions, assessing patients' quality of life, and driving the organisation of healthcare services for children and adults with CP. The most imminent issues that we would like the initial hospital-based CP registry in the Western Cape to address, is the current scanty prevalence data for CP in South Africa, and inform better health services for children with CP and their families in South Africa, a setting with unique challenges.