adminHer first-born child, a two-month-old infant, was presenting stiffness of the legs and arms and head persistently turned to one side. She looked harassed because she had difficulties dressing the infant. The lady is one among hundreds of women in Zimbabwe who find themselves having to care and support children affected by cerebral palsy.
From my experience dealing with children affected by cerebral palsy, I have realised that many parents have serious misconceptions about the condition. They suspect witchcraft and demons and you find most of the babies with incisions (ukucaba/nyora) on the legs and all over the body. From this experience, I really felt compelled to explain more about cerebral palsy.
Let me start by defining a few key words to help you understand this topic.
Cerebral palsy is a non-progressive disorder of movement resulting from damage to the brain, before, during and immediately after birth. The most common disability is a spastic paralysis. It results in lack of balance, intelligence, posture and speech are frequently impaired.
Therefore cerebral palsy is a disability in infants associated with damage to certain parts of the brain (central nervous system) leading to infants becoming paralysed and presenting stiffness of the body, mental retardation and delays in crawling, walking and speech development — delayed milestones.
Experts also say cerebral palsy includes disorders of the central nervous system characterised by paralytic symptoms and disorders of motor in infancy. The damage to the brain occurs before, during and after birth.
Let us briefly look at the predisposing factors that may lead to the disability of infants during pregnancy.
Infections like syphilis during pregnancy, taking of harmful drugs, malnutrition, injury and exposure to X-ray radiation and other genetic abnormalities.
The following are some of the predisposing factors that could lead to the infant becoming disabled during delivery — prolonged labour, breach delivery, low birth weight, pre-term babies, forceps delivery and others like when a baby is delivered with an umbilical cord around the neck.
High body temperature which may result in the baby developing fits, jaundice, malnutrition, brain tumour and infections like meningitis and TB are other pre-disposing factors immediately after birth.
There are some ways that can be taken to prevent disability in infants. It is recommended that pregnant women should come early for booking at health centres for blood pressure, sexually transmitted infection, HIV and other check-ups so that some of these problems could be identified early and treatment could be instituted accordingly.
Good nutrition is recommended for pregnant mothers to avoid complications; women must avoid drinking too much alcohol and smoking during pregnancy. Teenage pregnancy may result in complications during delivery. Pregnant women should be immunised against tetanus.
All pregnant women are encouraged to deliver in a health centre to avert complications that may arise during delivery. For example, a woman could bleed to death while delivering at home and there are other complications like high blood pressure that may arise during the time of delivery at home, which may lead to the infant having some brain damage and death of the mother, hence the emphasis to deliver at a
health centre.
There are some tips on the behaviour of a normal infant. At birth the baby has the competence to survive. For example, for breast feeding the baby uses the rooting, sucking and swallow reflexes. When you place a finger in the palm of the baby’s hand, the baby will respond with an automatic grasp. If you introduce a finger into the baby’s mouth, the baby will suck it vigorously (oral reflexes).
To avoid suffocating, the baby turns his head to one side when lying in the same prone position. These reactions are called protective reflexes. The posture of the full-term baby is one of bending of the arms and
legs. When lying with the face the head turns to one side the arms close to the chest bending the elbow and hands closed. Within a week the baby will differentiate the smell of his mother from that of a stranger.
The baby can also differentiate tastes, for example he will suck sugar coated finger. The baby can be startled by a sudden noise and he turns to the source of the sound. Therefore, a normal baby will not slip through fingers unlike what happens with a cerebral palsy baby who is floppy and passive or stiff and spastic and the head is pushed to the back and has a high pitched cry.
The early recognition of abnormal signs in a baby has important implications for the baby, the family and the early interventions.
One way in which a baby communicates is by way of crying but excessive and constant high-pitched cry is a sign of abnormality. The baby may be passive and present with poor quality of wakefulness and absence of crying. Often the head, trunk and neck control are poor. The baby is floppy and the head falls backwards.
Other babies with cerebral palsy present with stiffness and rigidity.
Experts say the stiffness is increased when the baby is upset or excited or when the baby is in a certain position. When the baby is stiff, the head may twist to one side, there is stiffness of arms, and legs and the knees are pressed together. Some babies may present with shoulders and head pressing backwards, fists gripping the thumbs and legs turned inward. Often when you try to stand the baby the legs stiffen and cross like a pair of scissors. Some of the babies present with uncontrolled movements of the arms and legs.
About half of the infants with cerebral palsy are mentally retarded. The baby may not exhibit primitive reflexes like sucking and rooting, hand grasp reflexes.
The abnormal findings in a baby with cerebral palsy are indicative of the brain damage which occurred before, during birth and immediately after delivery of the baby. Management of an infant with cerebral palsy requires a multi-disciplinary approach in a hospital, the mainstay of which are the physiotherapy, speech therapy and use of appropriate appliances.
- Gift Moyo is a practising medical rehabilitation technician in Matobo District, Matabeleland South Province. He is the author of a book, Handbook for Staff Recruitment and Selection, published in December 2010.
Online Reporter