Cerebral Palsy merupakan kelainan yang mempengaruhi kemampuan bergerak dan

mempertahankan keseimbangan pada anak

Cerebral Palsy disebabkan oleh perkembangan otak yang terganggu, sehingga mempengaruhi
kemampuan otak untuk mengontrol ototnya.
Gejala Cerebral palsy sangat beragam, namun tidak bertambah parah.
Anak dengan Cerebral Palsy berusia kurang dari 6 bulan :
Anak tampak kaku
anak tampak lemah




Signs and Symptoms
The symptoms and functioning of each person with CP varies. CP does not get worse over time,
but the exact symptoms can change over a person's lifetime. From birth to 5 years of age, a child
should reach movement goalsalso known as milestonessuch as rolling over, sitting up,
standing, and walking. A delay in reaching these movement milestones could be a sign of CP.
The following are some other early signs of CP.
A child with CP who is less than 6 months old:
o Might feel stiff
o Might feel floppy
o When held cradled in your arms, the child might seem to overextend his/her neck
and back, constantly acting as if he/she is pushing away from you
o When you pick the child up from lying on the back, his/her head might fall
backwards
o When you pick up the child, his/her legs might get stiff and cross or scissor
A child with CP who is more than 6 months old:
o Might not roll over in either direction
o Might not be able to bring his/her hands together
o Might have trouble bringing the hands to his/her mouth
o Might reach out with only one hand while keeping the other fisted
A child with CP who is more than 1 years old:
o Might not crawl
o Might not be able to stand with support
How can professionals who serve young children help?
You spend your day working with children, and you are probably already familiar with many
milestonessuch as pointing at objects, smiling, and playing with othersthat mark a child's
development. All children are unique, but sooner or later, you will see a child who is not
developing as he or she should. You are a valuable resource to families! They look to you for
information on their child, and they trust you. Encourage the families you work with to track
their child's development, including movement milestones, and get help if they are concerned.
You can also encourage the child's family to contact the local early intervention system (birth to
age 3 years) or local school system (3 years and older) for an evaluation.

It is also important to remember that a child with CP may have other conditions that can make it
difficult for him or her to carry out daily activities and participate at home, in school, and in the
community. Professionals who serve young children can help identify signs of CP as well as the
other developmental disabilities or neurological conditions that children with CP often have,
such as epilepsy and autism spectrum disorder. Identifying both cerebral palsy and other co-
occurring conditions early can help ensure that children are screened and connected to the
appropriate services and supports they need to address each condition.

Cerebral palsy facts
Cerebral palsy (CP) is an abnormality of motor function, the ability to move and control
movements.
Cerebral palsy is acquired at an early age, usually less than a year of age.
Cerebral palsy is due to a brain abnormality that does not progress in severity.
The causes of cerebral palsy include prematurity, genetic disorders, strokes, and infection
of the brain.
Taking certain precautions during the pregnancy might decrease the risk of cerebral
palsy.
Asphyxia, the lack of oxygen to the brain, at birth is not as common a cause of cerebral
palsy as had been thought.
There are different types of cerebral palsy based on symptoms -- spastic, hypotonic,
choreoathetoid, and mixed types.
The best approach for diagnosis, treatment, and management is through and
interdisciplinary team.
Cerebral palsy may be associated with many other medical conditions, including mental
retardation or seizures. Many of these conditions can be treated with improved quality of
life.
Many children with cerebral palsy have a normal intellect and have no seizures.
Treatment of cerebral palsy is for the symptoms only; there are few treatments for the
underlying causes.
There are many alternative medicines promoted for the treatment of cerebral palsy that
have never been proven to be helpful. Families and advocates of persons with cerebral
palsy should be aware of the lack of scientific basis for these treatments.
What is cerebral palsy?
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Cerebral palsy (CP) is an abnormality of motor function (as opposed to mental function) and
postural tone that is acquired at an early age, even before birth. Signs and symptoms of cerebral
palsy usually show in the first year of life.
This abnormality in the motor system is the result of brain lesions that are nonprogressive. The
motor system of the body provides the ability to move and control movements. A brain lesion is
any abnormality of brain structure or function. "Nonprogressive" means that the lesion does not
produce ongoing degeneration of the brain. It is also implies that the brain lesion is the result of a
one-time brain injury, that will not occur again. Whatever the brain damage that occurred at the
time of the injury is the extent of damage for the rest of the child's life.
Cerebral palsy affects approximately one to three out of every thousand children born. However,
it is much higher in infants born with very low weight and in premature infants.
Interestingly, new treatment methods that resulted in an increased survival rate of low-birth
weight and premature infants actually resulted in an overall increase in the number of children
with cerebral palsy. The new technologies, however, did not change the rate of cerebral palsy in
children born full term and with normal weight.

What are causes of cerebral palsy?
The term cerebral palsy does not indicate the cause or prognosis of the child with cerebral palsy.
There are many possible causes of cerebral palsy.
In full-term infants the cause of cerebral palsy is usually prenatal and not related to events at
time of delivery; in most instances it is related to events that happened during the pregnancy
while the fetus is developing inside the mother's womb.
Premature birth is a risk factor for cerebral palsy. The premature brain is at a high risk of
bleeding, and when severe enough, it can result in cerebral palsy. Children that are born
prematurely can also develop serious respiratory distress due to immature and poorly developed
lungs. This can lead to periods of decreased oxygen delivered to the brain that might result in
cerebral palsy. A poorly understood brain process observed in some premature infants is called
periventricular leukomalacia. This is a disorder in which holes form in the white matter of the
premature infant's brain. The white matter is necessary for the normal processing of signals that
are transmitted throughout the brain, and from the brain to the rest of the body.
White matter abnormalities are observed in many cases of cerebral palsy. Nevertheless, it is
important to recognize that the vast majority of premature infants, even those born very
prematurely, do not suffer from cerebral palsy. There have been many advances in the field of
neonatology (the care and study of problems affecting newborn infants) that have enhanced the
survival of very premature infants.
Other important causes of cerebral palsy include accidents of brain development, genetic
disorders, stroke due to abnormal blood vessels or blood clots, or infections of the brain.
Even though it is widely believed that the most common cause of cerebral palsy is a lack of
oxygen to the brain during delivery (birth asphyxia), it is actually a very rare cause of cerebral
palsy. When cerebral palsy is the result of birth asphyxia, the infant almost always suffers severe
neonatal encephalopathy with symptoms during the first few days of life. These symptoms
include:
seizures,
irritability,
jitteriness,
feeding and respiratory problems,
lethargy, and
coma depending on the severity.
In rare instances, obstetrical accidents during particularly difficult deliveries can cause brain
damage and result in cerebral palsy. Conversely, it is very unlikely that cerebral palsy symptoms
would develop after a few years of age as a result of obstetrical complications.
Child abuse during infancy can cause significant brain damage which, in turn, can lead to
cerebral palsy. This abuse often takes the form of severe shaking from a frustrated parent or
caregiver, causing hemorrhage in or just outside the brain. To further compound the problem,
many children with developmental abnormalities are at risk for being abused. Thus, a child with
cerebral palsy may be made significantly worse or even killed by a single incident of abuse.
Despite the diversity of causes of cerebral palsy, many cases remain without a defined cause.
However, the enhanced ability to see the brain structure with magnetic resonance imaging (MRI)
and CT scans as well as improved diagnostic capabilities for genetic disorders has made the
number of such cases much lower.
What are symptoms and signs of cerebral palsy?
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The predominant symptoms and signs of cerebral palsy are related to motor difficulties, which
are the consequence of the brain damage. The extension and severity of the brain lesion is the
leading factor in the magnitude of the motor deficit. Many of the symptoms observed in these
children are related to the primary problem that is impaired motor functions. For example,
developmental motor delay, gait disorders, poor fine and gross motor coordination, swallowing
disorders, or speech delay are all the result of the basic motor disorder. The way they present
varies from child to child. For that reason, it is difficult to describe a clinical picture that will
satisfy every child with cerebral palsy. The clinical presentation, even though with many
common features, is very much unique for a particular child. In addition, the comorbid
conditions add more to the uniqueness of the presentation of the child with cerebral palsy. For
example some children may be blind, while others may have normal vision; or some children
may have severe cognitive delay while others may have normal or near normal cognitive level.
What are the types of cerebral palsy?
Based upon the form of motor impairment, cerebral palsy can be divided into types:
spastic cerebral palsy,
dyskinetic cerebral palsy (according to the predominant symptoms dyskinetic CP may be
either dystonic or choreoathetotic), which includes ataxic cerebral palsy, and
hypotonic cerebral palsy.
These categories are not rigid, and the majority of patients most probably have a mixture of
them.
What is spastic cerebral palsy?
Spastic cerebral palsy refers to a condition in which the muscle tone is increased, causing a rigid
posture in one or more extremities (arm(s) or leg(s)). This rigidity can be overcome with some
force, ultimately giving way completely and suddenly -- very much like the familiar jackknife
(or clasp knife). The spasticity leads to a limitation of use of the involved extremity, largely due
to the inability to coordinate movements. Often the spasticity occurs on one side of the body
(hemiparesis), but it can also affect the four limbs (quadriparesis) or be limited to both legs
(spastic diplegia). When the condition occurs in both legs, the individual often has a scissoring
posture, in which the legs are extended (straightened) and crossed.
Besides the increased muscle tone there is also increased deep tendon reflexes, impaired fine and
gross motor coordination, muscle weakness, and fatigability among other problems.
Spasticity is often the result of damage to the white matter of the brain, but it can also be due to
damage of gray matter.
The degree of spasticity can vary, ranging from mild to severe. Children who are mildly affected
may experience few limitations of their function while severely affected children may have little
to no meaningful use of the affected limb(s). Spasticity, if not properly treated, can result in
contractures, which are permanent limitations in the ability of joint movement. Contractures can
be greatly limiting in the care of children with cerebral palsy. Spasticity can also be quite painful,
requiring medication to relax the muscle tone.
The same fundamental processes that influence spasticity of the limbs can also result in
abnormalities of movement and muscle tone in other body systems. In the muscles of the head
and face, for example, cerebral palsy can greatly limit the coordination and production of speech,
even when the child is perfectly capable of understanding speech. There can also be limitations
of chewing, swallowing, and facial and eye movements. These symptoms can be particularly
troubling for afflicted children and their families.
Many patients with spastic cerebral palsy cannot control their output of urine. This inability is
not necessarily due to problems in thinking but is caused by heightened reflexes of the bladder.
When the bladder fills in these children, it is just like tapping on it with a reflex hammer, thus
making it contract more vigorously than normal and causing a spilling of urine. This
incontinence can be quite embarrassing, especially in a cognitively intact child.
What other conditions are associated with cerebral palsy?
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Since cerebral palsy is indicative of damage to or malformation of the brain, it stands to reason
that other symptoms that are associated with brain dysfunction can be present in children
afflicted with cerebral palsy. In fact other disorders, besides the motor dysfunctions already
described, are almost always seen in these patients. Some of them such as poor speech,
swallowing disorders, drooling, and poor fine or gross motor coordination are the result of the
motor disorder affecting specific muscles involved in those functions. Other conditions are the
results of simultaneous injuries in areas of the brain besides the motor areas.
Cognitive disabilities, sometimes referred to as developmental delay, are often associated with
cerebral palsy. Up to 50% of patients with cerebral palsy have cognitive disabilities. However,
many of these children can be educated and lead productive lives. It is also just as important to
note that many children with severe motor impairment due to cerebral palsy, as is the case with
many children with the choreoathetotic or the diplegic form of cerebral palsy, are only mildly or
not at all intellectually impaired.
Virtually all testing of a young child's cognitive development involves some sort of motor
activity on the part of the child. If a child is capable of complex thoughts, but incapable of motor
activity, the observer will not be able to detect his or her mental aptitude. Therefore, one must be
very careful in assigning labels to patients with cerebral palsy. Certain features, however, are
more likely to be associated with significant cognitive disabilities in the patient with cerebral
palsy. These include extensive damage occurring on both sides of the brain, children with spastic
quadriplegia, microcephaly (small head size), a documented genetic disorder, and a documented
prenatal infection.
Seizures are a common finding in patients with cerebral palsy. Perhaps a third of all cerebral
palsy patients have seizures. Seizures are caused by abnormal electrical activity of the neurons in
the brain. The damaged or malformed brain is more prone to seizures. Moreover, cognitive
disability is frequently associated with epileptic seizures.
The symptoms of seizures can vary depending on where in the brain they originate. Generalized
seizures engage the entire cerebral cortex at once, while partial seizures only involve part of the
cerebral cortex. Often, generalized seizures begin as partial seizures but spread throughout the
brain rapidly. Generalized seizures may take the form of true convulsions ("grand mal"), in
which the entire body jerks in a rhythmic fashion, or the form of absences ("petit mal"), which
interrupt the patient's activities for a brief period, but does not cause a fall.
Other forms of generalized seizures can occur in the cerebral palsy patient. Atonic seizures cause
the patient to slump suddenly to the ground or forward in their chair, resembling a marionette in
which the puppeteer suddenly cut the strings. Tonic seizures are just the opposite and cause the
entire body to suddenly stiffen. Both tonic and atonic seizures can result in drop attacks in which
the patient falls to the ground, often resulting in injury.
Partial seizures may involve the jerking of the arm and leg on the same side of the body.
Alternatively, they may be associated with strange sensory phenomena, such as flashing lights,
or emotions, such as fear, depending on where in the brain the seizure occurs.
Vision deficiencies are frequently seen. Some of them, for example, strabismus ("lazy eyes") can
be corrected by surgical procedures in the muscles of the eyes. Some can be corrected with eye
glasses (that may be difficult to implement in non-cooperative children). In other children the
visual deficiencies are the result of brain injuries to the areas of the brain that are associated with
vision, rendering the child blind ("cortical blindness") even if the eyes themselves are perfectly
normal. At the present time there is no treatment to improve this condition.
Children with cerebral palsy can have speech disorders of many types. Some, like poor word
pronunciation (dysarthria), are the result of impairment of the peripheral mechanism of speech
(poor lips, tongue, or palate coordination). In another circumstance there is brain injury in the
gray matter of the brain that controls the central mechanism of speech (aphasia).
It is difficult for children with cerebral palsy to gain weight and they frequently have delayed
growth. This is the result of several factors including feeding disorders, gastroesophageal reflux,
and in some instances, for example, children with choreoathetotic disorders, excessive caloric
consumption. On the other, hand obesity could be a problem in those children with cerebral palsy
that have limited mobility.
Individuals with the choreoathetotic form of cerebral palsy might have compressed nerves or
damage to the neck bones that can lead to damage to the spinal cord.
Other issues to be aware of are dental diseases, respiratory problems, urinary tract infections,
osteoporosis and subsequent fractures, enuresis, encopresis, and constipation.

How is a child evaluated for cerebral palsy?
Most of the information leading to the diagnosis of cerebral palsy is generally obtained from a
thorough medical history and examination. The most critical tasks of the health care professional
are to identify potentially treatable causes of a child's impairment. The health care professional
evaluating the child with possible cerebral palsy should be experienced in neurological
examination and assessment of impaired children and well-versed in the potential causes of
cerebral palsy. Often, but not necessarily, this practitioner should be a pediatric neurologist.
Once the examination is complete, depending on the findings, the practitioner may order
laboratory tests to help in the assessment.
There is no single test to diagnose cerebral palsy. But since cerebral palsy is the result of
multiple different causes, the tests performed are used to identify specific causes when possible.
Other tests will be performed to assess the condition of the child (nutritional status for example)
or to assess other concomitant conditions that the child might have.
Blood and urine tests may be used to identify some of the more common inborn errors of
metabolism. Blood tests may also be used for chromosomal or other genetic studies. Brain
imaging studies can also be used to detect structural changes in the brain. The most sensitive
brain imaging study is the MRI examination. Nuclear medicine neuroimaging studies such as
SPECT or PET have no place in the initial evaluation of a child with cerebral palsy, but may
prove very useful in the assessment of selected candidates.
Despite all of these tests, it may not be possible to answer some of the burning questions in the
mind of a parent of a neurologically impaired infant, such as "Why does my child have cerebral
palsy?" or "Will my child be normal?" This is particularly true if a specific diagnosis is not
reached and the child is under one year of age. Some severely impaired young infants can grow
up to be independent, productive members of society, while other children, seemingly less
impaired, may require care throughout their lives.
Once the diagnostic evaluation is complete, further testing may be needed in order to define the
specific needs of any individual child. For example, if seizures are present or suspected, an EEG
(electroencephalogram) is performed. However, this test is not needed if there are no signs of
epilepsy.

How is cerebral palsy treated?
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Most of the causes of cerebral palsy do not have specific, curative treatments. However, children
with cerebral palsy present many medical problems that can be treated or prevented. The initial
stage of treatment involves an interdisciplinary team, consisting of a pediatrician, preferable one
with experience in neurodevelopmental disorders, a neurologist (or other neurological
practitioner), a mental health practitioner, an orthopedic surgeon, a physical therapist, a speech
therapist, and an occupational therapist. Each member of the team has important, independent
contributions to make in the care of the affected child.
The physical therapist evaluates muscle tone, strength, and gait (walking).
The occupational therapist reviews the child's ability to perform tasks of self-help and
care -- from feeding to manual dexterity.
The speech therapist evaluates the child's ability to speak and understand speech.
Most children with neurological impairment have significant emotional distress and also require
therapy from a mental health practitioner.
Virtually all states have federally-mandated programs for the assessment and treatment of
children with cerebral palsy and other developmental conditions. In many states, these programs
are termed "Regional Centers" and can be found in local phone books. Also Children's Hospitals
usually have special clinics with experience with children with cerebral palsy. Furthermore,
when a child reaches the age of 3 years, the school district may become formally involved in the
review of at-risk children. These programs protect children up to the age of 21 years.
At the present time there is a vacuum in the provision of medical care for adults (young and old)
with cerebral palsy living in the community settings. There are a limited number of services in
adult hospitals geared to the treatment of adults with cerebral palsy or developmental disabilities.
Penyebab Cerebral Palsy adalah:
Ibu yang menderita infeksi selama masa kehamilan
Kekurangan oksigen saat persalinan
Kerusakan otak
Menderita Stroke Pada Janin
Mutasi genetik
Sebelumnya pernah menderita sebentuk Jejas Otak Traumatik
Cerebral Palsy dapat dicegah bila Anda:
Calon ibu harus mendapatkan perawatan kehamilan secara rutin
Selalu mengawasi anak anda setiap saat
Cerebral palsy (CP) is a disorder that affects muscle tone, movement, and motor skills (the
ability to move in a coordinated and purposeful way). CP is usually caused by brain damage that
occurs before or during a child's birth, or during the first 3 to 5 years of a child's life.
The brain damage that leads to cerebral palsy can also lead to other health issues, including
vision, hearing, and speech problems, and learning disabilities.
There is no cure for CP, but treatment, therapy, special equipment, and, in some cases, surgery
can help a child who is living with the condition.
About Cerebral Palsy
Cerebral palsy is one of the most common congenital (existing before birth or at birth) disorders
of childhood. About 500,000 children and adults of all ages in the United States have the
condition.
The three types of CP are:
1. spastic cerebral palsy causes stiffness and movement difficulties
2. athetoid cerebral palsy leads to involuntary and uncontrolled movements
3. ataxic cerebral palsy causes a disturbed sense of balance and depth perception
Cerebral palsy affects muscle control and coordination, so even simple movements like
standing still are difficult. Other vital functions that also involve motor skills and muscles
such as breathing, bladder and bowel control, eating, and learning may also be affected when
a child has CP. Cerebral palsy does not get worse over time.
Causes of Cerebral Palsy
The exact causes of most cases of CP are unknown, but many are the result of problems during
pregnancy in which the brain is either damaged or doesn't develop normally. This can be due to
infections, maternal health problems, a genetic disorder, or something else that interferes with
normal brain development. Problems during labor and delivery can cause CP in some cases. but
this is the exception.
Premature babies particularly those who weigh less than 3.3 pounds (1,510 grams) have a
higher risk of CP than babies that are carried full-term, as are other low birth weight babies and
multiple births, such as twins and triplets.
Brain damage in infancy or early childhood can also lead to CP. A baby or toddler might suffer
this damage because of lead poisoning, bacterial meningitis, malnutrition, being shaken as an
infant (shaken baby syndrome), or being in a car accident while not properly restrained.
Continue

Diagnosing Cerebral Palsy
CP may be diagnosed very early in an infant known to be at risk for developing the condition
because of premature birth or other health problems. Doctors, such as pediatricians and
developmental and neurological specialists, usually follow these kids closely from birth so that
they can identify and address any developmental delays or problems with muscle function that
might indicate CP.
In a baby carried to term with no other obvious risk factors for CP, it may be difficult to diagnose
the disorder in the first year of life. Often doctors aren't able to diagnose CP until they see a
delay in normal developmental milestones (such as reaching for toys by 4 months or sitting up by
7 months), which can be a sign of CP.
Abnormal muscle tone, poorly coordinated movements, and the persistence of infant reflexes
beyond the age at which they are expected to disappear also can be signs. If these developmental
milestones are only mildly delayed, the diagnosis of CP may not be made until the child is a
toddler.
Preventing Cerebral Palsy
In many cases the causes of CP are unknown, so there's no way to prevent it. But if you're having
a baby, you can take steps to ensure a healthy pregnancy and carry the baby to term, thus
lowering the risk that your baby will have CP.
Before becoming pregnant, it's important to maintain a healthy diet and make sure that any
medical problems are managed properly. As soon as you know you're pregnant, proper prenatal
medical care (including prenatal vitamins and avoiding alcohol and illegal drugs) is vital. If you
are taking any medications, review these with your doctor and clarify if there are any side effects
that can cause birth defects.
Controlling diabetes, anemia, hypertension, seizures, and nutritional deficiencies during
pregnancy can help prevent some premature births and, as a result, some cases of cerebral palsy.
Once your baby is born there are actions you can take to lower the risk of brain damage, which
could lead to CP. Never shake an infant, as this can lead to shaken baby syndrome and brain
damage. If you're riding in a car, make sure your baby is properly strapped into an infant car seat
that's correctly installed if an accident occurs, the baby will be as protected as possible.
Be aware of lead exposure in your house, as lead poisoning can lead to brain damage. Remember
to have your child get his or her immunizations on time these shots protect against serious
infections, some of which can cause brain damage resulting in CP.
How Cerebral Palsy Affects Development
Kids with CP have varying degrees of physical disability. Some have only mild impairment,
while others are severely affected. This depends on the extent of the damage to the brain. For
example, brain damage can be very limited, affecting only the part of the brain that controls
walking, or can be much more extensive, affecting muscle control of the entire body.
The brain damage that causes CP can also affect other brain functions, and can lead to other
medical issues. Associated medical problems may include visual impairment or blindness,
hearing loss, food aspiration (the sucking of food or fluid into the lungs), gastroesophageal reflux
(spitting up), speech problems, drooling, tooth decay, sleep disorders, osteoporosis (weak, brittle
bones), and behavior problems.
Seizures, speech and communication problems, and mental retardation are more common among
kids with the most severe forms of CP. Many have problems that may require ongoing therapy
and devices such as braces or wheelchairs.
Treatment of Cerebral Palsy
Currently there's no cure for cerebral palsy, but a variety of resources and therapies can provide
help and improve the quality of life for kids with CP.
Different kinds of therapy can help them achieve maximum potential in growth and
development. As soon as CP is diagnosed, a child can begin therapy for movement, learning,
speech, hearing, and social and emotional development.
In addition, medication, surgery, or braces can help improve muscle function. Orthopedic
surgery can help repair dislocated hips and scoliosis (curvature of the spine), which are common
problems associated with CP. Severe muscle spasticity can sometimes be helped with medication
taken by mouth or administered via a pump (the baclofen pump) implanted under the skin.
A variety of medical specialists might be needed to treat the different medical conditions. (For
example, a neurologist might be needed to treat seizures or a pulmonologist might be needed to
treat breathing difficulties.) If several medical specialists are needed, it's important to have a
primary care doctor or a CP specialist help you coordinate the care of your child.
A team of professionals will work with you to meet your child's needs. That team may include
therapists, psychologists, educators, nurses, and social workers.
Many resources are available to help and support you in caring for your child. Talk to your
doctor about finding those in your area.

What is the long-term outlook for patients with cerebral palsy?
The answer is complex. Since cerebral palsy is actually a set of symptoms associated with a
variety of causes, potential treatments will have to be diverse. Many scientists are now focusing
on recent discoveries that suggest we will be able to replace lost or damaged brain cells. While
such therapies are not yet available, it is likely that real clinical trials will begin in the next 5 to
10 years.
The more we know about the causes of cerebral palsy, the more we can do to prevent it. For
example the use of folic acid in sexually active women may prevent central nervous system
malformations that might lead to cerebral palsy. Avoiding the use of certain drugs during the
pregnancy whether legal, such as prescribed medications, alcohol or tobacco, or illegal such as
cocaine and crack, will also decrease the changes of cerebral palsy in a child.
It cannot be overemphasized that the most important person in the lives of children with cerebral
palsy is their caregiver. The caregiver, whether a parent or other person, must be able to
recognize a child's needs and provide for him or her in a loving, positive environment. Because
of the difficulty that many children with cerebral palsy have in expressing their needs, they are at
great risk for unintentional and intentional neglect as well as overt child abuse. Often, the care of
children with cerebral palsy can be quite taxing emotionally and financially on the family. The
appropriate care for children with cerebral palsy, therefore, must take into account mental health
and financial support for families and caregivers. Many state-run programs provide out-of-home
schooling as well as respite care for the caregivers, but these services often fall short of what is
truly needed. Health care professionals can very simply improve the lives of their patients by
taking some extra time to listen to the concerns and hopes of the caregivers and provide
thoughtful answers to their questions.
We must recognize that many, and possibly most, children with cerebral palsy can lead full,
meaningful, and happy lives. The team of parents, caregivers, and health practitioners has the
responsibility to help the child with cerebral palsy achieve this goal.
What are specific treatment plans for cerebral palsy?
After the initial evaluation, specific treatment plans are outlined for each child:
Seizure medication
If the child has seizures, the treatment is based on the type and frequency of the seizures.
Complete seizure control can often be achieved using a single medication, but some children
with cerebral palsy have particularly difficult-to-control seizures. Medication can have side
effects affecting the brain, ranging from sedation to hyperactivity. They can also affect liver
function, white and red blood cells, and bone metabolism. Side effects are usually not harmful
and resolve when the offending medication is discontinued. The goal of the treating physician
should be for the child to become seizure free with few or no side effects. It must be noted that it
is of no benefit to the child to be seizure-free but significantly impaired by medication side
effects.
Medications for spasticity: The treatment of spasticity can involve multiple health
professionals. Treatments involve the use of medications and surgical procedures to decrease the
spasticity, facilitate movement, and prevent contractions. Among the most common medications
are dantrolene sodium (Dantrium) and diazepam (Valium). Diazepam is both a muscle relaxant
and a sedative. Baclofen (Lioresal) can be taken by mouth or infused continuously with an
implanted pump (intrathecal infusion) directly in the cerebrospinal fluid (the liquid that bathe the
spinal cord and the brain). This treatment might be specifically useful for patients with spasticity
in the lower legs. The most common complications with these medications are drowsiness,
sleepiness, and some degree of weakness. The sedative side effects of such medications often
limit their usefulness. In the case of the baclofen pump the most common complication seen in a
small number of patients is the infection of the catheter. Additionally, a muscle relaxing agent
called botulinum toxin can be injected into tight muscles to relax them. When used prudently,
this procedure may prevent surgical intervention.
Surgery
Surgery for spasticity: In the case of severe muscle spasticity, surgery may be a valuable
option. Tendon release procedures, usually performed by an orthopedic surgeon, allow improved
range of motion in some cases. Such procedures are usually performed on the muscles of the calf
or inner thigh. A less commonly used procedure, is the dorsal rhizotomy. During this operation,
the surgeon cuts some of the nerve roots that send sensory information from the muscles to the
spinal cord and brain. This procedure relieves some of the spasticity and thereby helps the child
walk with a more normal gait. Most neurosurgeons performing dorsal rhizotomies very carefully
select only those patients whom they feel may be helped by the surgery. From time to time, other
surgical interventions are required in children with cerebral palsy. In very rare cases of
choreoathetoid cerebral palsy, in which the writhing movements severely limit the ability of the
child to function, highly selective neurosurgical techniques can curtail these movements without
significantly harming other functions.
Other surgical procedures
Ophthalmologists (eye specialists) can help strabismus by operating on the muscles that control
the movement of the eye or to correct some other complications such as cataracts.
Neurosurgeons can treat intractable seizure control. Operations such as callosotomy,
hemispherectomy, and focal resections of areas of abnormal brain tissue responsible for the
seizures, might be indicated in some cases. An alternative procedure for the treatment of epilepsy
is the vagal nerve stimulation, an implantable device, that can be useful in selected patients with
difficult to control seizures.
Scoliosis, or curvature of the spine, is often the result of severe hypotonia. This condition can
create discomfort for the patient and difficulty for caregivers in performing the activities of daily
living. Furthermore, severe scoliosis may actually restrict a patient's ability to breathe. Several
surgical procedures are available in specialized centers for the correction of scoliosis.
Children who are unable to take adequate calories by mouth may require the placement of a
feeding gastrostomy tube (PEG tubes) directly into the stomach.
Therapy
The treatment of spasticity can involve multiple allied health care professionals. Physical and
occupational therapists play an important role.
Physical therapy: The extent of physical therapy depends on the degree of spasticity, hypotonia,
and motor impairment. The main therapeutic effect of physical therapy is maintaining range of
motion at the joints, thereby preventing contractures. Some scientists and therapists feel that
physical therapy actually helps maintain the connections in the brain, although this is
controversial. Other skills, such as improved gait, stance, and balance can be helped by physical
therapy. A strong, proactive physical therapy program greatly aids in the life of a child with
cerebral palsy.
Occupational therapy: Occupational therapy assists children with the skills needed for day-to-
day life in school and at home, including eating, writing, and work skills. In early infancy,
occupational therapists can provide assistance in feeding a child with a poor or uncoordinated
sucking response.
Speech therapy: Speech and language pathologists are involved with the development and
improvement of speech production. Using different techniques the speech pathologist helps to
improve the quality and the quantity of the speech production. The role of these specialists is not
limited to speech production alone, but they also teach the patients other communication
techniques (sign language, use of communication boards) to facilitate the communication
abilities.
Medical care
Medical care of children with cerebral palsy is often seriously hampered by the inability of the
child to communicate his or her needs and sensations. Relatively common childhood illnesses in
children with cerebral palsy, such as ear infections, urinary tract infections, and appendicitis,
which are easily treatable in most children, may prove to be life-threatening due to delayed
recognition on the part of caregivers and physicians. Each child with cerebral palsy should have
a primary care professional that is experienced with the special medical needs of affected
children.
Because physicians have offered limited hope in curing cerebral palsy, many families have
turned to alternative methods in the treatment of their children. Such therapies may include diets,
herbal remedies, aromas, play with animals, and hyperbaric oxygen. The scientific evidence
supporting the use of diets is inadequate. Some of them such as hyperbaric oxygen therapy,
which is delivered in specialized centers, can be quite expensive and has not been scientifically
proven to help children with cerebral palsy. Other remedies must be investigated on a case-by-
case basis. Hopefully, the family of the affected child will be able to approach their physician
regarding these alternative treatments.
Cerebral Palsy (CP, Kelumpuhan Otak Besar) adalah suatu keadaan yang ditandai dengan
buruknya pengendalian otot, kekakuan, kelumpuhan dan gangguan fungsi saraf lainnya.
Cerebral Palsy dan Bells Palsy tidak sama penyakitnya walaupun sama gejalanya membuat
wajah kaku, Cerebral palsy lebih sering ditemukan pada anak kecil sedangkan Bells Palsy pada
orang dewasa.
CP terjadi pada 1-2 dari 1.000 bayi, tetapi 10 kali lebih sering ditemukan pada bayi prematur
dan.10-15% kasus terjadi akibat cedera lahir karena aliran darah ke otak sebelum/selama/ segera
setelah bayi lahir.
Bayi prematur sangat rentan terhadap CP, kemungkinan karena pembuluh darah ke otak belum
berkembang secara sempurna dan mudah mengalami perdarahan atau karena tidak dapat
mengalirkan oksigen dalam jumlah yang memadai ke otak.
Gejala biasanya timbul sebelum anak berumur 2 tahun dan pada kasus yang berat, bisa muncul
pada saat anak berumur 3 bulan.
PENYEBAB
1. CP bisa disebabkan oleh cedera otak yang terjadi pada saat:
- bayi masih berada dalam kandungan
- proses persalinan berlangsung
- bayi baru lahir
- anak berumur kurang dari 5 tahun.
2. Tetapi kebanyakkan penyebabnya tidak diketahui.
Cedera otak bisa disebabkan oleh:
a. Kadar bilirubin yang tinggi di dalam darah (sering ditemukan pada bayi baru lahir), bisa
menyebabkan kernikterus dan kerusakan otak
b. Penyakit berat pada tahun pertama kehidupan bayi (misalnya ensefalitis, meningitis, sepsis,
trauma dan dehidrasi berat)
c. Cedera kepala karena hematom subdural
d. Cedera pembuluh darah.
GEJALA
Gejalanya bervariasi, mulai dari kejanggalan yang tidak tampak nyata sampai kekakuan yang
berat, yang menyebabkan perubahan bentuk lengan dan tungkai sehingga anak harus memakai
kursi roda.
Gejala lain yang ditemukan pada CP:
- Kecerdasan di bawah normal
- Keterbelakangan mental
- Kejang/epilepsi (terutama pada tipe spastik)
- Gangguan menghisap atau makan
- Pernafasan yang tidak teratur
- Gangguan berbicara (disartria)
- Gangguan penglihatan
- Gangguan pendengaran
- Kontraktur persendian
- Gerakan menjadi terbatas.
-Gangguan perkembangan kemampuan motorik (misalnya menggapai sesuatu, duduk, berguling,
merangkak, berjalan)
DIAGNOSA
Tremor otot atau kekakuan tampak dengan jelas, dan anak cenderung melipat lengannya ke arah
samping, tungkainya bergerak seperti gunting atau gerakan abnormal lainnya.
PEMERIKSAAN PENUNJANG:
1. MRI kepala menunjukkan adanya kelainan struktur maupun kelainan bawaan
2.CT scan kepala menunjukkan adanya kelainan struktur maupun kelainan bawaan
3.Pemeriksaan pendengaran (untuk menentukan status fungsi pendengaran)
4. Pemeriksaan penglihatan (untuk menentukan status fungsi penglihatan)
5.EEG
6. Biopsi otot.

PENGOBATAN
CP tidak dapat disembuhkan dan merupakan kelainan yang berlangsung seumur hidup. Tetapi
banyak hal yang dapat dilakukan agar anak bisa hidup semandiri mungkin.
Pengobatan yang dilakukan biasanya tergantung kepada gejala
Jika tidak terdapat gangguan fisik dan kecerdasan yang berat, banyak anak dengan CP yang
tumbuh secara normal dan masuk ke sekolah biasa.Anak lainnya memerlukan terapi fisik yang
luas, pendidikan khusus dan selalu memerlukan bantuan dalam menjalani aktivitasnya sehari-
hari.
Pada beberapa kasus, untuk membebaskan kontraktur persendian yang semakin memburuk
akibat kekakuan otot, mungkin perlu dilakukan pembedahan.
Pembedahan juga perlu dilakukan untuk memasang selang makanan dan untuk mengendalikan
refluks gastroesofageal.