Arthritis: Secondary Condition in Cerebral Palsy

Arthritis often start early in adult with cerebral palsy in comparison to normal population. It may cause pain and stiffness in joints. But the, adult with cerebral palsy can be treated by pain management, preventative strategies, surgery, and other treatment for arthritis.

What is arthritis?

Arthritis means inflammation of joint. It present with swelling, difficulty in moving the joints, joint pain, and tenderness of one or more joints. It can affect our body joints like knees, hips, elbows, and knuckle.

 

Arthritis can occurs due to variety of reason and so it is named according to aetiology & presentation.  The most common type of arthritis is osteoarthritis, often affecting people with cerebral palsy. Mostly this is seen in older adults as it is caused by deterioration in the joint cartilage.

The cartilage gives cushioning with inside the joint, so while that wears down, the result is ache, swelling, and stiffness. 

 

Risk elements for arthritis in cerebral palsy include a family history of arthritis, being older, overweight, sever spasticity, limb deformity and injuring a joint.

 

The symptoms of arthritis are usually continual and progressive, and the remedy for this is to alleviate the ache and swelling and enhance motion within the joints.

 

How does cerebral palsy cause arthritis?

cerebral palsy adult can develop osteoarthritis. The risk factor include joint deformity, spasticity, dystonia abnormal gait pattern, over weight etc.  As a child with cerebral palsy age enters adulthood, chances of fatigue & joint pain increases..

 

Cerebral palsy has different phases of abnormalities in the neuromuscular system that cause unusual movements in joints, overuse or compression of joints, and excessive wear on joint cartilage. As a result, it leads to osteoarthritis.

 

Knee arthritis is most common in people with cerebral palsy. However, the joints not involved in walking can also get affected. Besides this, muscle imbalance across a joint is common in cerebral palsy. That may cause uncommon shoulder or elbow joint movements, which leads to premature wear on the cartilage. Spinal degenerative arthritis are common in dystonic cerebral palsy which can cause numbness in limb and sometime weakness that occurs due to compression over nerve.

Symptoms

However, people with cerebral palsy will not develop the symptoms of arthritis until they become adults. Parents as well individual with CP must know the signs of arthritis that make better results as early intervention.

 

The symptoms that include osteoarthritis are-

 

• Pain in joints while or after movement (commonly in hips, knees, hands)
• Stiffness in joints
• Tenderness of joints while touched
• Reduced flexibility that causes it hard to bend down or climb stairs
• Grating inside the joints while moving
• Hard lumps around the skin of joint

Treatment and Prevention of Arthritis

Prevention of joint arthritis is not completely possible but its intensity can be reduced by exercises, weight reduction, proper limb alignment and tone management. The treatment of arthritis depends on specific cause. The treatment is possible by the medications, physical therapies, or joint replacement surgery.

Some people with cerebral palsy develop arthritis which can be prevented by early diagnosis and treatment of cerebral palsy in childhood. That will make them enjoy their life with minimal pain.

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Effective Diet For Children With Cerebral Palsy

Cerebral palsy (CP) is a neuromuscular disorder that affects muscular coordination, movement and muscle tone. Amongst children, it can be difficult to deal if not handled correctly.

These children are frequently affected with malnutrition because of various reasons.  The reasons can be as follows..

• Undernourishment or over nutrition,  hormonal problems

• Frequent infections

• loss of appetite because of constipation or gastro esophageal reflex

• Dependency on others for feeding

• problems in feeding, eating, drinking etc.

• Weight of the child 

However, with the administration of the right feeding and diet techniques, mealtime experiences can be enjoyed despite cerebral palsy in children.

• Estimate energy needs according to: age, activity level, growth rate and muscle tone More spasticity CP require more energy expenditure, Ambulatory spastic CP have medium energy expenditure while Wheel chair bound/non ambulatory have lower energy expenditure. Reduced physical activity leads to weight gain and Wt gain itself detrimental to person’s physical activity and it becomes vicious cycle. 

• The solution is good balanced diet having all the kind of nutrients including vegetables and fruits. 

• These children are more vulnerable to vitamin D deficiency because they are confined indoors. To prevent this regular exposure to sunlight is necessary. 

• Assessment and treatment of any hormone related problem should be done promptly.

• Standing, walking, outdoor activity, regular physical therapy must be done. The key is to be mobile as much as possible. 

Type of nutritional problems for CP children     

Reasons of Nutrition related problems in cerebral palsy in children

1) Feeding, Eating, Drinking and Swallowing Difficulties (FEDS),

2) Oro-motor Difficulties

3) Sensory  Difficultés 

4) Self-Feeding 

5) Gastro-esophageal Reflux

6) Constipation 

7) Tooth Decay

FEDS (Feeding eating, drinking and swallowing) for this it is necessary to maintain posture of child and the body must be in one direction. You can use CP chair or corner chair if needed. The feeder must sit facing towards the child and try to develop coordination by supporting jaw and upper lip closure. The child must first learn to have liquids properly then semisolids and then solids. You must always give small bites and give second bite only after mouth is cleared of the first. Let the child take her own time.  Encourage child to eat himself, use various assistive devices for this. 

GOR: This can be potentially hazardous. If the child regurgitates the food and aspirates it into the lungs it can even be fatal. To prevent this always feed the child in propped up position and always give small but frequent meals.  Avoid giving acidic food and prevent or treat constipation. 

Digestive problems such as constipation and gastro esophageal reflux often make eating uncomfortable. These children are frequently constipated because of less mobility and faulty diet. Give them plenty of fibrous diet like green vegetables, fruits, whole grains etc.   These children are also very much vulnerable for tooth decay which further hampers their nutrition. To prevent this regular cleaning with soft toothbrush is necessary especially at night before sleeping.

Important Facts About Cerebral Palsy

A common childhood disease, Cerebral Palsy (CP) describes individuals with abnormalities in body posture, balance, speech, and movement, all of which are due to problems in the neurological process. This condition is not caused due to hereditary factors but from brain damage. Individuals affected by CP have the same kind of desires and goals as us, so we must not discriminate against them anywhere.

Symptoms of Cerebral Palsy

Have you noticed people around carefully as of late? People affected by CP may be exhibiting some of more of these symptoms. However, these are not the only Cerebral Palsy symptoms and these may vary from case to case.

•    Problem in coordination

•    Decreased or increased muscle tone

•    Tremors

•    Delays in attaining milestones

•    Difficulties in eating

Globally 17 million people are affected by CP. 15-20% of all physically disabled children face Cerebral Palsy, while 3/1000 of live births get this abnormality in India. It is certainly the most common motor disability for childhood across the world. Due to the developing nature of rural and semi-urban areas as well as less technology being used in these areas, cases of CP are high in India.

What can Cerebral Palsy affect?   

The abnormality may affect any of the following limbs:

•    Lower limb (Paraplegia)

•    Affects one side of body (Hemiplegia)

•    Affecting all four limbs but lower limb more severe than upper limb (Diplegia)

•    Affecting all four limbs (Quadriplegia). Sometimes face may be contorted as well

Prevention: cerebral palsy can’t be prevented fully but its incidence can be decrease by strict follow-up and good care given to mother and new born. Regular antenatal checkup under experienced gynecologist, regular ultrasound of foetus, regular intake of folic acid, iron, treatment of hypothyroidism, treatment of TORCH infection, delivery in hospital with good care to new born under pediatrician can decrease the incidence.  However, once CP has kicked in, there is no sure-shot cure as of now.

Medications, surgery and speech therapy, along with physiotherapy, have helped many people in leading a contented life. Exercises and muscle training help the body gradually regain control. Your regular doctor, upon confirmation of CP, is likely to recommend you to a specialist who can train children on the brain and various nervous conditions.  A series of tests will also be run by your neurologist and will also look to eliminate all other causes.