Times of India
04 October 2010
By Umesh Isalkar
Pune, India

Assistive Devices And Timely Help Can Make A Lot Of Difference
The incidence of cerebral palsy in the country is three per thousand live births. The rate has remained the same for more than two decades as more and more low birth weight babies are surviving with the help of advanced technology, say experts.

"Previously, the damage would have been in ‘higher birth weight’ babies. However, babies with low birth weight, like 800 to 900 gram, who would have otherwise died, do survive now with the help of advanced technology. They are the ones who are more susceptible now," says paediatrician Anand Pandit, director, department of paediatrics, KEM hospital, Pune.

Cerebral palsy (CP), which mainly occurs due to interference in brain development, causes difficulty in movement, speech and, sometimes, learning of the children. This occurs either in the womb, or during birth, or even after two years of birth during which rapid development of the brain takes place. The disability can also affect one’s skills such as writing or typing, as well as balancing the body while walking or standing. Some cannot even hold objects, eat or drink without help and may have fits.

A recent study has found that in 10 to 20 per cent patients, CP is acquired after birth, mainly because of brain lesions caused by bacterial meningitis, viral encephalitis, accident or physical assault. Spastic CP is the most common type, occurring in 70 to 80 per cent of all cases. In some cases it affects one side of the body, in few spastic cases, all four limbs are affected equally, said paediatrician Sharad Agarkhedkar, president of the city chapter of the Indian Medical Association. There are an estimated 25 lakh people in India with CP.

"CP is a disease of movement and posture. It is a dynamic expression of a static disorder. In CP, the brain develops differently in different children. The damaged brain will have different expression in different children. But the bottomline is that the disorder pertaining to movements and posture remains same – but either severe, moderate or and mild," Pandit said.

Pandit started a rehab centre for children with CP at KEM in 1979. "The aim was to minimise the expression of the damage and enable the child to perform routine activities and be self-reliant. As many as 500 children with CP are enrolled with the rehab centre. The results have been very fulfilling," he said.

Agarkhedkar said, "Low birth weight and premature babies are saved with the help of latest technology. However, the important point is whether there is ‘intact’ survival, ie., whether the babies are saved without any handicaps. In 1980s almost 50 per cent of babies had some handicap that included CP, deafness and visual problems. With the advances in medical science, the incidence of handicap has gone down to almost 20 per cent."

"Early intervention in the form of therapy, exercises and sensory integration can help in bridging the gap in childhood growth milestones achieved and which are not yet achieved," said Agarkhedkar.

"There are both social and medical myths prevalent in the country regarding CP. We need to educate people. The greatest myth is that it is a disease and it is not curable and is caused by medical negligence. With appropriate and timely help and assistive devices, many can lead a near normal life. We need to make people realise that disability needs to be tackled with a care model of health and not a cure model. Energetic public health education is the only way out," said G Shashikala, general secretary, Indian Academy of Cerebral Palsy, a body formed by doctors and rehab professionals across the country.

What is Cerebral Palsy?
Cerebral palsy is caused by damage to the motor control centres of the developing brain and can occur during pregnancy, childbirth or after birth up to about three years of age. The symptoms are spasticities, spasms, other involuntary movements (eg., facial gestures), unsteady gait, problems with balance, and/or soft tissue findings consisting largely of decreased muscle mass.

Cerebral palsy is not a disease but a broad range of disorders that disrupts a child’s ability to move, sit, stand, walk, talk and use its hands. There is no cure for cerebral palsy, as the damage to the brain cannot be reversed. However, it can be managed.

What is scoliosis?
Scoliosis causes abnormal curvature of the spine. Patients with cerebral palsy have a high incidence of scoliosis which often becomes severe. This can lead to sitting balance problems for patients who are wheelchair-dependent, and ultimately to respiratory and cardiac problems. Some patients can be treated with bracing, while many may need surgery.