Mixed Cerebral Palsy - Los Angeles Medical Malpractice Lawyer
Cerebral palsy is a brain injury that happens to the motor areas of the brain or the cerebellum and basal ganglia. In its pure form, most cases are spastic, ataxic or athetoid. About ten person of kids with cerebral palsy can’t be pigeonholed into one category alone and have features of the different types of cerebral palsy. The result can be devastating because the child can have the worst features of each type of cerebral palsy and can be difficult to diagnose.
The most common type of mixed cerebral palsy is part spastic cerebral palsy, which tight muscle tone, and involuntary movements, typical of athetoid cerebral palsy. This is due to an injury in the pyramidal part of the motor system and the extra pyramidal portion of the motor system. Usually, it is the spasticity that is noticed first, with abnormal movements showing up when the child is between 9 months and 3 years old. This means that the diagnosis of mixed cerebral palsy is often done later in life than, for example, spastic types of the disease.
Other combinations of mixed CP can be identified but they aren’t as common as spastic and athetoid disease. The combination that is the rarest is athetoid and ataxic cerebral palsy mixed together but it is still a possible combination. You can also technically have athetoid, spastic and ataxic features all in the same child. Balance is affected, there are abnormal movements and there is an increase in muscle tone.
Athetoid / Spastic
With a mixture of athetoid and spastic cerebral palsy, the child has tight muscle groups in any or all extremities, which decrease movement, and jerky, stiff movements that make it difficult to grasp objects or even let go of objects because the tone is so high. Those kids with athetoid movements have additional damage to the cerebellum or to the basal ganglia of the brain. The purposeless movements that develop out of these areas of damage include movements of the arms, trunk, face and mouth.
Kids with involuntary movements often have twitches that are caused by electrical activity traveling to the muscle. The twitching interferes with purposeful movement so the child can’t function well and can’t do much in the way of spontaneous small motor skills.
Involuntary movements in mixed cerebral palsy commonly impair speech, reaching for things, grabbing things, feeding and swallowing, and other coordinated movements. They may have sever tongue thrusting which impairs being able to suckle or eat regular food. Swallowing problems can lead to the child receiving a gastrostomy tube that can feed the child through a hole placed in the stomach wall. These kids also have problems with sitting and walking because abnormal movements affect posture. This can also impair the ability to sit up and eat food.
Because mixed CP has a wide variety of different possible movement problems, it can be very difficult to treat. When a child has increased muscle tone and increased involuntary movements, they have more difficulty than kids who only have athetoid movements because the movements tend to be more severe and forceful than with kids who have low tone athetoid movements. The can kick out and punch, and can hurt their caregiver as a result. The kids can grasp things with some minor abilities to control the movements but often, they cannot let go of what they’ve grasped. The stiff and jerky movements make the disorder frightening for some parents and siblings.
As the child grows, the spasticity becomes less and the athetoid movements become more prominent. This makes it hard for doctors to be able to make the diagnosis of mixed disease because it just doesn’t show up as such until the child is older. The rarest type of mixed cerebral palsy is a combination of spastic, athetoid and ataxic cerebral palsy, and this is, of course the hardest to identify and diagnose.
Interestingly, kids with mixed cerebral palsy have normal muscle tone and no abnormal movements when they are sleeping. Some types of mixed cerebral palsy have low muscle tone the whole time. This is when spastic cerebral palsy is not affecting the picture of cerebral palsy.
When faced with a possible child who has cerebral palsy, the pediatric neurologist will examine the child and will look for evidence of increased or decreased muscle tone, movements that are not purposeful, drooling, speech, or swallowing difficulties. Balance is assessed to check for ataxic symptoms. As not all of the symptoms occur at the same time, often several different evaluations need to be done. By the time the child reaches 3 years old, all symptoms should be present so if it is a case of mixed cerebral palsy, it should be diagnosed by that time.
As soon as cerebral palsy is suspected, the neurologist may order a CT scan or MRI of the brain to look for areas of damage to the motor or extrapyramidal aspects of the brain. This may not say what type of mixed cerebral palsy the child has but will show that, in fact, motor areas of the brain are damaged. The true diagnosis of mixed cerebral palsy comes not in the scan but in the physical features the child displays, and this can change over time.
Physical therapy should be started immediately to teach the child the best way to develop his or her muscle skills in spite of a serious disability. Braces can be prescribed to keep the foot in the proper position and truncal braces can be used to keep the abnormal movements of the trunk and scoliosis to a minimum.
Occupational therapy is prescribed for these kids to help them deal with activities of daily living, like dressing oneself, feeding oneself and using various utensils. This can be painstaking work because the child may have abnormal movements besides increased (or decreased) muscle tone. With help, some children can learn some independent skills, including feeding and dressing themselves. Others can learn to do these things with assistance. Both physical and occupational therapy can go on for many years to keep the child attaining as many goals as possible.