Defining Cerebral Palsy? By Andrew Brereton
Cerebral palsy has many varied definitions, which have probably confused parents with their ambiguity, lack of clarity and complexity. I know when I first came across the term as a parent; I was confused by the varying definitions. The medical world seems particularly good at generating technical explanations of this sort; - explanations, which precisely because of the embedded technical jargon, parents find inaccessible and worrisome.
Cerebral palsy has many varied definitions, which have probably confused parents with their ambiguity, lack of clarity and complexity. I know when I first came across the term as a parent; I was confused by the varying definitions. The medical world seems particularly good at generating technical explanations of this sort; - explanations, which precisely because of the embedded technical jargon, parents find inaccessible and worrisome. Let's examine some of the explanations, all from professionals, which have been passed to us by parents. You will note in the following definitions that the word 'brain' is mentioned only once and that is in the form of brain 'abnormality: -'
Cerebral palsy is a term used to describe any disorder of movement and posture that results from a non - progressive abnormality of the immature brain.
A term for a non - progressive impairment of muscular function and weakness of the limbs.
A loss or deficiency of motor control with involuntary spasms.
A congenital disease, usually non-progressive and dating from infancy or early childhood, characterized by a major disorder of motor function.A condition with various combinations of impaired muscle tone and strength, coordination, and intelligence.
Consider these five definitions: - what strikes you about them? - They are all descriptions of the symptoms of cerebral palsy. Not once is the true cause of cerebral palsy even mentioned. (one even refers to CP as a disease; - Wow!)
What is the cause of cerebral palsy?
The brain is very delicate. Muscles can briefly utilise energy in the absence of oxygen, - the brain cannot. The brain is totally dependent upon its oxygen supply, which it obtains from the blood supply to the brain. A disruption in the blood supply to the brain of just 1 second, will see all the available oxygen in the environment consumed. A 6 second disruption produces unconsciousness. Within minutes, permanent damage is taking place. (Carlson, 2007).
The cause of cerebral palsy therefore needs no complicated definition. It is simple and easy to understand. The cause of cerebral palsy is brain-injury. It is that simple! The brain-injury may have occurred in one of many ways; - oxygen starvation at birth, alcohol abuse or abuse of other drugs, infection, jaundice, malnutrition, or one of many other causes. The important and simple thing to remember is that cerebral palsy is caused by brain-injury; in fact, cerebral palsy is an expression of brain-injury.
What do you mean by an expression of brain-injury?
When I speak of cerebral palsy being an expression of brain-injury I am leading you down a path, which will hopefully allow you to see your child's problems in a new light. Let us take this a little deeper and say that cerebral palsy is also a symptom (or set of symptoms), of brain-injury; - it is the way in which your child's brain-injury expresses itself. There are other expressions of brain-injury, some of which are used interchangeably with cerebral palsy! I put the idea to you that cerebral palsy is a symptom of brain-injury in exactly the same way that a cough may be a symptom of a chest infection. The only reason for the existence of the term 'cerebral palsy' is that it, itself is a convenient marker for specific groups of sub-symptoms; - yes sub-symptoms of brain-injury! These symptoms might include spasticity, athetosis, ataxia, epilepsy, poor visual, auditory and tactile development, impaired motor function, poor language development, difficulties of socialisation, learning difficulties, or many others.
Isn't this just 'nit -picking' over terminology?
No! It is important that this situation is both clarified and simplified. I have misgivings over the continued use of the term 'cerebral palsy,' (as I have misgivings over the continued use of many other labels such as 'autism,' for example). These are terms, which merely describe the symptoms. I believe it is misleading and overly-complex. It is much easier to understand the concept and the possible ramifications of brain-injury, than it is cerebral palsy. Although for the moment, I will continue to use the term 'cerebral palsy' interchangeably with brain-injury, because that is the 'currency' in which you have been dealing, I feel it is important that you should be aware of the problem with terminology and how it has encouraged the development of a focus upon symptoms as opposed to the cause.
I believe that in the case of brain-injury the medical world has fallen into the trap of merely trying to offset the worst effects of the symptoms. In some cases, as in the case of epilepsy, controlling symptoms is a necessary step, but this should be done alongside attempts to treat the cause of those symptoms, as in some cases the focus on treating symptoms can have the effect of making them worse.
Consider this example: A child of one of my clients took her son Michael, to see an orthopaedic specialist. Michael's brain-injury was very severe, he had what the medical establishment calls severe spastic quadriplegia, (again, this is a description of symptoms; - essentially all four limbs were very stiff). Because the excessive stiffness in Michael's left leg was beginning to distort the limb and would have dislocated it, the orthopaedist decided to place a splint on the leg, to keep it fixed in a flexed position. The splint was left on all day, every day for six months and then Michael was taken back to see the orthopaedist to see how the limb was progressing. When the orthopaedist took the splint off Michael's leg, he was horrified to find that the rigidity in the leg was no better; in fact, it was a great deal worse! Why was this do you think? Quite simply, it was because the treatment was focused on a symptom and not the cause, which was producing that symptom.
The signals, which Michael's brain was sending to the leg, were having the effect of making the leg rigid. As far as the brain, in its injured, malfunctioning state was concerned; this was the desired state of affairs. When the orthopaedic consultant placed a splint on Michael's leg, in order to try to relax it, this sent feedback to the brain that the leg was not in the state, which the brain desired (the brain was trying to keep the leg rigid). Therefore, the brain reinforced the signals, which were making Michael's leg stiff, so that when the splint was eventually taken off, the stiffness was worse than before! I instituted a programme of vestibular stimulation in order to correct the chemical imbalance in Michael's lower brainstem, which I thought was causing this problem and within a few weeks, Michael was a more relaxed, more comfortable little boy.
So a primary principle of treatment is, whilst we take note of the symptoms and where they are an imminent threat to the child, we need to see that they are treated, we also concentrate on the cause of those symptoms, the injured brain! The reason those symptoms exist is because brain-injury has prevented the normal developmental processes from taking place, in the brain and consequently in the body. Consequently, to achieve success, we must provide assistance to those normal developmental processes! That is precisely what neuro-cognitive therapy does.
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