Cerebral palsy: myths versus facts

SINGAPORE - Cerebral palsy is a poorly understood condition among the public and parents alike.

"Many parents are devastated by the diagnosis and many hope that their child will grow out of it or will stop being lazy and start using their muscles better," said Ms Sarah Wong, the chief paediatric physiotherapist at Kids Focus Physiotherapy, a private physiotherapy centre.

She dispels some common misconceptions parents have about the condition.

MYTH: My child does not have cerebral palsy. He is just lazy and does not want to move around to get his toys.

FACT: One of the earliest signs of mild to moderate cerebral palsy is gross motor development delay.

Children with gross motor delays achieve critical physical movement milestones, such as rolling over, sitting up and crawling, later than their peers, or they do not achieve these milestones at all.

Children are innately curious and will want to explore the world around them.

Your child's lack of movement is a cause for concern, especially if he was also born premature and has other symptoms of cerebral palsy such as muscle stiffness.

About one in two cerebral palsy babies are born premature.

MYTH: My child walks on tiptoes because "tiptoe" walking runs in the family. My older child also walked on tiptoes but is now walking fine.

FACT: As part of normal development, children will learn to walk on tiptoes for brief periods. A child could take 10 to 20 steps in a row, all on tiptoes, up to five times per day. But when asked to walk on flat feet, he should be able to do so right away.

However, parents should see a doctor if their child tiptoes persistently and is not able to keep his feet flat even when standing.

This is especially so if the persistent tiptoe walking occurs in the presence of other symptoms which are strongly suggestive of cerebral palsy.

These include spastic (tight and stiff) muscles, hyperreflexia (overresponsive reflexes which can lead to twitching and other symptoms), poor balance and gross motor delays.

MYTH: I know my child has cerebral palsy and is delayed in motor development. But I can carry him now and he will outgrow it eventually.

FACT: Cerebral palsy is a non-progressive lesion - an abnormality in the brain structure or function - in a developing brain.

The brain lesion will not worsen, but neither will it get better. Children with cerebral palsy grow up to be adults with cerebral palsy.

In fact, the signs and symptoms of cerebral palsy, such as spastic muscles, poor balance and gross motor delays, will get worse without treatment. It is physically strenuous to look after an adult with cerebral palsy who is highly dependent on others for his movements.

MYTH: My child has cerebral palsy and has learnt to walk independently with therapy. He no longer needs any therapy.

FACT: As children grow, their bones become longer. Their muscles must also grow in tandem, otherwise they become tight.

Extreme muscle tightness leads to shortening of muscles, or contractures.

Spastic muscles do not lengthen very well.

Hence, many children with spastic cerebral palsy find that as they grow older and their bones lengthen, their muscles become even tighter and they walk less steadily.

To preserve the quality of their walking and prevent future deformities, it is best that they continue to go for therapy.

MYTH: My child has cerebral palsy. Does that mean that he is mentally retarded and will never go to a mainstream school?

FACT: Cerebral palsy affects many areas of a child's development, including mental ability.

Due to advances in neonatal and medical care in developed countries, damage to the immature brain in cerebral palsy nowadays tends to be limited to the part of the brain that controls physical movements and not mental functioning.

Hence, many children with cerebral palsy tend to have only physical disabilities such as walking with poor balance and control. They can continue to attend mainstream schools.

MYTH: Children with cerebral palsy will not grow up to become independent adults.

FACT: Some children with cerebral palsy, usually spastic quadriplegia and spastic dystonia, will not be able to achieve self-care as adults due to their disabilities. But others, usually with spastic diplegia and hemiplegia, can become adults with jobs and families of their own. One famous example is paralympian Laurentia Tan, 33, who is also deaf. The Singaporean, who is based in London, is a competitive equestrian rider.

All children with cerebral palsy should be encouraged to work towards self-care and making themselves more mobile to reduce the burden of care on their families.


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