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| Volume 1, Issue 7 | JUNE 2002 |
| Inside This Issue | |||||
| 1 | Cerebral Palsy | ||||
| 2 | Spina Bifida | ||||
| 3 | Updates and Announcements | ||||
| 4 | Drug Fact Sheets | ||||
Medical Information Fact Sheet
Cerebral palsy is one of the most common congenital disorders. Congenital disorders are defined as disorders present at birth. Children who eventually develop cerebral palsy have experienced some kind of injury to their central nervous system either before delivery or at birth. The injury causes changes in the structure of the brain. The changes are called "static encephalopathy" (encephalopathy means "brain disease") because they seem to stop right after birth. It is the physical effects of the injury that families and health care workers need to be aware of as the child grows up. The physical effects may be muscle spasticity, inability to walk and possibly seizures.
Cerebral palsy can be caused by something that happens
- Before delivery (most common): such as infection, stroke and metabolic problems like diabetes or hyperthyroidism.
- During delivery: such as oxygen deprivation to the fetus.
- Just after birth: such as a stroke or infection in the baby.
Some children born with cerebral palsy are born early or with signs of infection, but often the cause of the injury is unknown.
Symptoms:
- Weak or tight muscles
- Balance difficulties
- Poor coordination
- Abnormal reflexes
- Delays in motor skills such as sitting or walking.
Half of the children will also have a seizure disorder. One quarter of the children will suffer from severe mental retardation. Many symptoms may take a while to develop or become noticed. Cerebral palsy can range from severe to mild to unnoticeable.
The brain injuries that cause cerebral palsy will not get worse over time but many of the symptoms may change over time. As the child grows and the brain further develops some symptoms may improve.
Cerebral Palsy can be diagnosed at birth or it may not be made until the child is older like two or three years of age. No one test can diagnose CP. Doctors may look at many different things. The doctor may test muscle strength, range of motion of different joints and compare the child's growth and development to those of normal childhood milestones. Before the diagnosis of CP the doctor may order some lab work to rule out other diseases that are similar in nature.
The awkward configuration of muscles in the child with CP can cause problems with bones, joints and muscles. A specialist (orthopedist) may be needed to look for problems such as abnormal positioning of the feet, dislocated hips and scoliosis.
Doctors may classify CP according to the type of abnormal muscle control the child has:
- Spastic. Children with spastic CP have increased reflexes, increased muscle tone, tight muscles and joint contractures.
- Hypotonic. This includes decreased muscle tone, resulting in weakness and joint instability.
- Athenoid. These children squirm and thrash about when they become upset or excited.
- Ataxic. These children generally don't have joint contractures, but they have problems with balance and tremors.
The condition may also be classified according to the area of the body infected.
- Hemiplegia (involvement of arm and leg on one side).
- Diplegia (involvement of either both legs or both feet).
- Quadriplegia (involvement of all four limbs).
The brain injury that causes CP cannot be repaired. They are however many things that can be done to control and improve symptoms.
Physical therapy is done to improve strength, range of motion and joint mobility and is the mainstay of treatment. Braces can be used to help keep joints in appropriate positions. Medications can also reduce symptoms. Recently physicians have begun using botulinum toxin (purified form of the bacterium that causes food poisoning) to relax overactive muscles. Injected into affected areas, this substance - marketed as Botox -can sometimes temporarily restore function. Finally, surgery sometimes can help to treat problems that may arise as the child grows.
A cure remains elusive, but early intervention by a well-coordinated team can often make a significant difference in quality of life for affected children.
Vitale, M. (2002, January 30). Cerebral Palsy: What it is, What can be done. WebMD with AOL Health. Retrieved on June 9, 2002 from the World Wide Web: http://aolsvc.health.webmd.aol.com/content/article/1680.54163?SRC=aolsearch&KW=cerebral_palsy
Spina bifida occurs when the bones (vertebrae) that make up a baby's spine do not form properly, allowing the spinal cord to bulge out of the spine. This can occur at any point along the spine.
Spina bifida develops in a fetus early on in the pregnancy, often before the woman even knows she is pregnant. It is one of the most common birth defects.
There are different severities of Spina bifida.
- Spina Bifida occulta, where the defect is hidden under the skin, is the mildest and most common form of spina bifida. If only one vertebra did not form, there are usually no symptoms. If more than one vertebra did not form, a dimple or depression may form over that area. A birthmark of hairy patch may also form over the area. This type of spina bifida rarely causes problems and is not usually discovered until later in life. It usually does not require treatment.
- Spina bifida manifesta is a rare and severe form of this birth defect. It often causes nerve damage that can result in problems with walking, bladder control and coordination. It is separated into two classes.
- Meningocele is a type of spina bifida in which fluid has leaked out of the spinal canal, causing a swollen area on the baby's spine.
Myelomeningocele is the most severe form of spina bifida, where a segment of the spinal nerves has pushed against the underside of the skin. The nerves are often damaged. In the worst cases, the tissue and nerves are exposed outside the body. (See diagram). Spina bifida manifesta is more likely in those with origins from the British Isles. Having one child with spina bifida increases the likelihood of another child being born with it as well.
Higher amounts of folic acid (a vitamin found in green leafy vegetables) in a women's diet decreases her chances of having a child with spina bifida.
For folic acid to be most effective in preventing spina bifida and other neural tube defects, it needs to be consumed before a baby is conceived. For this reason, any woman of childbearing age should be getting enough folic acid every day. Most women need between 400ug to 4000ug each day. Women who have another child with spina bifida may need a higher dose. Some women find it hard to get enough folic acid through their diet, so taking multivitamins and enriched cereals are effective ways to get enough folic acid. Spina bifida is often present in babies born with fetal alcohol syndrome.
Appearance may depend on severity of the condition.
- If the spina bifida is mild, a birthmark, dimple or hairy patch may form over the defect. There are rarely ever signs.
- In severe cases there is usually a fluid filled swelling on the baby's spine. In the most severe cases, tissue and nerves from the spinal cord are exposed on the child's back.
Spinal cord damage may cause problems such as:
- Inability to control urine or bowel movements
- Constipation
- Little or no feeling in legs or feet. People who cannot sense pain may injure themselves and cause the following problems:
- Cuts going untreated (possibly resulting in an infection) because they are unnoticed.
- Blisters and sores developing as a result of not shifting body weight from one foot to the next.
- Poorly fitting leg braces rubbing on an area of skin, which could be rubbed raw because no pain is felt.
- Inability to move and/or feel (paralysis) of the legs and, less often, the arms as well
The person's ability to walk will depend on what part of the spine is affected. If defect is in the lower spine, the person:
- Usually is able to walk
- May need ankle/foot braces
- May need surgery to correct any foot deformities.
If defect is in the middle of the spine, the person:
- Will need leg braces to walk
- May need both braces and crutches later in life
- May need to use a wheelchair when long periods of mobility are required
- Will need a variety of corrective surgeries.
An important note: Many children with spina bifida develop an allergy to latex. The reason is not understood.
Tests can be done to determine if the fetus possibly has spina bifida. A maternal serum triple test may indicate a suspicion. An ultrasound or amniocentesis can be done to diagnose the condition. Later in life spina bifida can be seen if the person has a back x-ray. At birth an MRI or CT scan can be done to determine any swelling or abnormalities in the brain or spinal cord.
Spina bifida occulta rarely needs treatment.
Sometimes spina bifida manifesta can be surgically corrected before the baby is born. Women may need to have c-section or to deliver in a large medical center (rather than a small community hospital) if they know they are having child with spina bifida. If the baby has Myelomeningocele, the protruding nerves are protected after birth, antibiotics are given to prevent infection and surgery is usually performed within 36 to 48 hours after birth.
In the first few weeks of life the baby may need physical therapy to strengthen muscles of the arms and legs. Most babies with spina bifida manifesta may have increased fluid around the brain (hydrocephalus). Treatment for this involves placing a shunt in the head to drain excess fluid into the abdomen. The shunt may be necessary for the child's entire life.
Leg braces may be needed when the child is old enough to walk.
Frequent doctors visit are needed early on in the child's life. These visits will check if the treatments are working. Healthwise Incorporated. (2001, May 29). Spina Bifida. WebMD with AOL Health. Retrieved on June 9, 2002 from the World Wide Web: http://aolsvc.health.webmd.aol.com/encyclopedia/article/3609.5131
A picture of Myelomeningocele
Healthwise Incorporated. (2001, May 29). Spina Bifida. WebMD with AOL Health. Retrieved on June 9, 2002 from the World Wide Web: http://aolsvc.health.webmd.aol.com/encyclopedia/article/3609.5131 Image by Nucleus Communications, retrieved from site listed above.
HCPCFC PROGRAM UPDATES and ANNOUNCEMENTS!!!
For June I would like to take the time to welcome our new staff.
First I would like to Congratulate Kim Robitaille on her promotion to Supervising PHN of the Health Care Program for Children in Foster Care (HCPCFC).
I would like to Welcome Karen MacLeod. Karen will be covering the Indio Court and the Desert Region.
Coming on Board this month is Ruth Hardin & Susan Cho. Ruth will be covering the West Corridor. Susan will be covering the Mid County Region.
WELCOME!!!!!!
Editor: Kristen Thompson, PHN; Contributors: Hermia Parks, PHN, MA, Assistant Director of Public Health Nursing; and Judy Earp, MHA, Director of Public Health Nursing.
