Technology is helping every aspect of human lives. For cerebral palsy patients, simple apps are being developed, which help to improve their communication if they are facing speech problems. High-end medical technology in the form of computerised gait analysis, as well as special implantable medication pumps, are helpful for patients with cerebral palsy.
On February 28, 2022, news broke out about the death of Zain Nadella the son of Microsoft Executive Chairman and CEO, Satya Nadella. Zain was only 26 six years of age at the time of his passing. Zain was born with cerebral palsy (CP). CP is a congenital disorder of movement, muscle tone, the posture that occurs due to the damage caused to the brain and accounts for the most common motor disability in childhood.
According to the Centers for Disease Control and Prevention (CDC), in the year 2000, the prevalence rate of cerebral palsy in the US was 3.1 per 1000 children. A report by the Indian Institute of CP states that in India approximately 33,000 people suffer from cerebral palsy. They also report that when looking at the worldwide incidence rate, one in 500 born babies suffers from cerebral palsy.
Early Detection Can Prevent Morbidity
Currently, there are no definitive tests to detect CP, but good nutrition, proper medical care and rubella vaccination before pregnancy can prevent the chances of the child developing cerebral palsy. There are also many soft signs of CP which can be picked up at early stages. If these are picked up on time and appropriate treatment is instituted, morbidity can largely be prevented.
“Early detection of cerebral palsy is crucial for early initiation of therapy which can significantly improve motor and cognitive outcomes in these children. Regular checkups by child healthcare nurses and paediatricians can help in picking up these patients early. This is helped by using various motor assessment or performance scales and neurological examination and where indicated (based on clinical evaluation) MRI(BRAIN),” said Dr Prashant Makhija, Consultant Neurologist, Wockhardt Hospital.
Morbidity of Cerebral Palsy with Other Disorders
Research is still ongoing for the treatment of CP, multidisciplinary treatment is currently most effective in managing CP. Dr Vaidehi Dande, shared, “Early intervention therapy improved the outcome to a great extent. This involves identifying babies at risk of CP as early on as possible and facilitating their brain function by stimulating special senses. This involves the provision of auditory, visual, smell and tactile stimulation. Facilitating postures and regular physiotherapy goes a long way in helping these children gain milestones faster. Hearing deficits can be dealt with using cochlear implants. Such children also commonly develop seizures and epilepsy and a lot of new drugs can be used to control the seizures. Various orthoses and prostheses are greatly helpful in enabling these children to do their day to day activities.”
Dr Nisha Deshpandey, added, “Caseness of other disorders is found more in patients suffering from cerebral palsy. Many children suffer from epilepsy and mental retardation. About 25 per cent of children with cerebral palsy might have an intelligence quotient (IQ) of less than 50. Typically, the infant or child might reach developmental milestones (like rolling over, neck control, sitting, crawling etc) later than other children. Autism spectrum disorder is also very prevalent among children suffering from cerebral palsy. Other mental health problems are also highly prevalent among them.
Assistive Tech Therapies in Treating CP
Technology is helping every aspect of human lives. For cerebral palsy patients, simple apps are being developed, which help to improve their communication if they are facing speech problems. High-end medical technology in the form of computerised gait analysis, as well as special implantable medication pumps, are helpful for patients with cerebral palsy.
Elucidating in detail about these assistive technologies, Dr Saurabh Chopra, mentioned, “Besides children with very severe damage or malformation of the brain, most patients with cerebral palsy benefit significantly from rehabilitation programmes and therapies including neurodevelopmental therapy. Although stem cells may hold promise as a research modality to prevent cerebral palsy currently there are no benefits of using stem cells in children already affected by cerebral palsy.”
“Technology in cerebral palsy is helpful mostly in rehabilitation. They have the potential to improve the ability of individuals with cerebral palsy to perform activities and increase participation. Robotics and virtual reality may improve movement by maximising exercise dose, providing feedback and motivating users. Augmentative and alternative communication technology is facilitating communication. Robots can help with self-care and provide motivation and instruction in rehabilitation programmes. Mobile applications can provide educating resources,” added Dr Darpan Thakre.
Commenting on how newer therapies are proving to be beneficial for children afflicted with CP, Dr Usha Mallinath, said, “Smaller, more portable rehabilitation technology has the potential to improve the ability of individuals with cerebral palsy to perform activities and increase participation. The application of advanced technologies in paediatric rehabilitation to improve performance and enhance everyday functioning has shown considerable promise. Robotics and virtual reality may improve movement by maximising exercise dose, providing feedback, and motivating users. Augmentative and alternative communication technology is facilitating communication. Robots can help with self-care and provide encouragement and instruction in rehabilitation programmes. Mobile applications can provide education and resources.
Many parents report that the condition of the child deteriorates with time. Cerebral palsy might be mistaken with other progressive neurological disorders because of the apparent change in pattern and severity of movement problems. However, in cerebral palsy, the underlying neurological problem does not worsen.
Most of the children with cerebral palsy are born with the condition. However, the symptoms might not necessarily be visible at birth. During the first few months of life, the symptoms may get more noticeable. Good nutrition, regular antenatal visits, hospital delivery, availability of neonatologists at the time of delivery please ensure the adequacy of feeding after birth and providing a clean and hygienic environment to the newborn. Prevention of prematurity and low birth weight, good medical and neonatal intensive care facilities to provide medical care for sick babies. Particular mention of babies who have Rh-positive blood group who are born to mothers who have Rh-positive blood group. These babies have a high risk of developing severe jaundice after birth which can affect the brain and cause CP later. This can be prevented by giving special injections to the mother when pregnant and also post deliveries. Babies born to these mothers should be cared for in the neonatal intensive care unit.
The most important thing to be kept in mind in the treatment of CP is that the earlier the detection, the better the results. By the time the child reaches 1-2 years of age, movement patterns (especially athetosis and spasticity) are strongly established and are resistant to change. Earlier efforts at shaping motor patterns yield greater benefit.
As science is advancing assistive technology along with specific therapy like stem cell treatments, repairing damaged brain cells, bio-medical advancements, assistive technology and surveillance are pondered upon for effective treatment. Doctors inform that early detection, intervention is key to preventing the prevalence of CP.
Dr Prashant Makhija,
Consultant Neurologist,
Wockhardt Hospital.
