Cerebral palsy in Africa: Symptoms, Causes and Care

 

By Toba Ajayi. Freelance Health Writer ad DLHA volunteer, with medical review and editorial support from the DLHA Team

 

Caregiver and child with cerebral palsy. Image credit: CoRSU

 

 

Highlights

• Cerebral palsy is the most common cause of childhood disability globally.

• Most people in African communities lack awareness and resources for managing cerebral palsy effectively.

• Prevention is challenging, but certain measures during pregnancy can reduce the risk.

• Raising awareness, providing practical assistance, and promoting social engagement within African communities will help to support individuals with cerebral palsy.

 

 

Introduction

 

According to the Centers for Disease Control and Prevention (CDC), Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. 

 

It is the most common movement disability in childhood. CP greatly affects a person's behavior and brain functions, making it challenging to perform everyday tasks. 

 

Of every 1,000 births, 2 to 3 children are affected by cerebral palsy, making it the most prevalent cause of childhood disability worldwide, including in Africa. While efforts are being made to enlighten people about this condition and its management, most countries in sub-Saharan Africa still need more awareness and resources. 

 

This article will cover everything you need to know about cerebral palsy, including the causes, prevention, risk factors, and management from an African standpoint. You’ll also discover how you can help to empower individuals with cerebral palsy in your community.

 

 

What is cerebral palsy?

 

The word cerebral means “brain,” and palsy means “weakness” or “paralysis.”  Thus, CP is a brain disorder affecting a child’s ability to move, maintain balance, and coordinate. Sometimes, they also have an eye-muscle imbalance, in which the eyes cannot focus on the same object.

 

 

Symptoms of cerebral palsy

 

Usually, noticeable evidence appear in children within their first two years of development. Some infants are diagnosed with cerebral palsy immediately after birth, while others are diagnosed months later. It is a non-progressive disorder, i.e. it doesn’t get worse over time.

 

CP is generally classified based on its symptoms. Some of these include:

• Stiff muscles or exaggerated movement
• Weakness in arms or legs or both
• Delay in speech development
• Visual impairment
• Shaking or making uncontrollable movements (tremors and/or seizures)
• Excessive drooling (too much saliva)
• Having trouble sucking the thumb
• Inability to roll over.
• Mental impairment

 

 

Types of cerebral palsy

 

Cerebral palsy can be described/classified into different types. This description/ classification depends on the affected child’s movement pattern or the number of hands and legs affected.

 

By Number of Affected Limbs 

Depending on the part of the brain affected, some or both legs and hands might be involved. Here’s how CP is classified based on the affected limbs:

• Monoplegia: This type occurs only when one leg or arm is affected

• Diplegia: Mainly affects both legs and is common in premature babies

• Triplegia: When two legs and one hand finds it difficult to move freely

• Quadriplegia: Both arms and legs are affected, although the child could still move their hands and toes. This type of CP accounts for 6 out of 10 cases in southwest Nigeria.

• Hemiplegia: One arm and one leg are affected but on the same side of the body (i.e, either both the right arm and legs are affected or both the left arm and legs are affected)

• Double hemiplegia: Both arms and legs are affected, but one side of the body is more affected than the other

 

By Movement Disorder

 

Cerebral palsy can also be classified into three major types, depending on the type of movement disorder expressed.

• Spastic: This is the most common type of cerebral palsy, accounting for 80% of all CP cases. It usually causes stiffness in the joint, and the more you try to stretch or pull the joint, the more resistance you feel.

• Ataxic: This is caused by damage to a part of the brain called the cerebellum, which controls movement. It can result in poor coordination, shaking, difficulty determining depth, and speech difficulties.

• Dyskinetic: This causes rapid and unusual movement in the arms and legs that the affected child cannot control. It also affects their control of the facial muscles.

• Mixed: When more than one brain area is damaged, this can lead to multiple movement disorders. About 15% of all cases of CP are mixed, usually in the form of severe involuntary movements.

 

 

Causes

 

Cerebral palsy results from different types of insults or damage to the brain that can occur before, during, or shortly after childbirth. The damage to the brain affects the posture, movement, and coordination of muscles. It can be caused by several factors, such as:

 

• Poor development of the brain (Cerebral Dysgenesis)

 

The development of the brain begins after conception and does not fully develop until the mid-twenties. Cerebral Palsy due to poor brain development occurs when the brain is underdeveloped, undeveloped, or abnormally developed. It can happen at any point during brain development, but the first 20 weeks of fetal growth and development are crucial. 

 

Although CP caused by poor brain development cannot be inherited, research proves it can be linked to specific genetic factors.  

 

• Hypoxic-ischemic encephalopathy (HIE) 

 

This is damage to the brain caused by a lack of oxygen for a prolonged period. The brain cannot do without adequate oxygen, even in a fetus. So, when a developing child goes for an extended period without oxygen (usually under 4 minutes), the brain cells may die, causing irreparable damage to the brain.

 

Some factors that can cause HIE are low blood pressure in the mother during pregnancy, poor circulation in the fetus, heart and lung issues, placenta abruption (separation of the placenta), and knotting of the umbilical cord. Negligence during delivery can also cause the baby to go for a long period without oxygen, resulting in cerebral palsy or death.

 

• Brain Bleed

 

Brain bleed is a critical event and can cause severe permanent damage to a baby’s brain due to poor oxygen supply to the brain cells.

 

Excessive bleeding can also lead to blood collection in the brain, causing inflammation. This swelling can cause severe brain pressure if it is not relieved, thus, causing cerebral palsy.

 

• Others like Infection, Kernicterus and Low birth weight

 

Malaria infection of the brain (Cerebral malaria), Kernicterus (the accumulation of yellow pigments in some brain areas due to excessive breakdown of red blood cells), and low birth weights have also been identified as high risk factors for cerebral palsy in African children.

 

 

Treatment

 

Currently, there’s no cure for CP, just like many other brain and nerve disorders. So, most affected children require lifelong care. Specialist doctors and other health professionals such as neurologists, pediatricians, physical and behavioral therapists are in the best position to provide treatment. 

 

While there is no known cure for cerebral palsy, specific treatment options exist that can help reduce its effect. Depending on the type of CP and the degree of damage done, your care provider may advise medications, physical therapy, or surgery.
 

Medications

 

Certain medications have been proven to relax the muscles and reduce stiffness in the arm or leg of CP patients. Thus, your care provider may recommend them to treat some symptoms. 

 

Anti-seizure medications can help reduce seizures in affected children. These medications have side effects such as feeling sleepy, skin rash, irritability, and stomach upset.

 

Other Therapies

 

Several therapies are used in treating CP symptoms and have proven effective. Some of these are physical therapy, occupational therapy, and speech therapy.

• Physiotherapy: This therapy is done to improve the moment in affected children gradually, and it involves the use of braces, orthotics, and walking aids. Affected children can begin physical therapy as early as 18 months old. 

• Occupational therapy: This therapy is more personalized and designed to help children with CP perform everyday tasks such as brushing their teeth, writing, reading, and using the toilet. An occupational therapist can advise parents and caregivers on accommodations, relationships, and employment.

• Speech Therapy: About 45% of children with cerebral pasly experience speaking difficulties, depending on the part of the brain affected. Speech therapy can help improve communication skills while addressing any chewing or swallowing issues. A speech-language pathologist specializes in this kind of treatment. 

 

Surgery

 

Usually, the last resort, surgery can be done to help reduce muscle stiffness and correct bone abnormality. Two major types of surgery can be done, which are:

• Orthopedic (Bone) surgery to correct the position of the bone, or to straighten the curved backbones of an affected CP child. Surgery can also be done to release or remove certain tight muscles or tissues. 

• Nerve surgery (Rhizotomy) to kill or destroy a part of the nerves that control the affected muscle. This form surgery is particularly effective for treating spasticity (i.e the stiffness of a muscle).
   

 

Prevention

 

Currently, there is no specific way of preventing cerebral palsy. Research is ongoing to determine more effective ways to prevent the incidence of cerebral palsy. However, you can take measures before, during, and after pregnancy to reduce the risk factors for your unborn child.

 

Before Pregnancy 

Certain lifestyle choices before pregnancy can help reduce your child's risk of cerebral palsy. Here are some of the boxes to check if you might be having a baby soon: 

• Eat and Stay healthy 
• Treat any underlying infections
• Get vaccinated against infections like rubella

During Pregnancy

You need to pay extra attention to your body and well-being during pregnancy. Always be ready to make safe lifestyle choices for you and your baby. Some of the things you can do to reduce the risk factors of cerebral palsy include:

• Take your prenatal care seriously
• Avoid alcohol, tobacco, or any other hard drug
• Avoid contact with people who have infectious diseases
• Eat healthy foods and regularly take vitamins as directed by your physician
• Discuss with your doctor about your delivery and how delivery-related risk factors can be prevented

 

After Delivery

Your baby’s brain is still developing even after birth. So, you want to ensure you provide the utmost care during this period, especially when they’re under 5 years old. Here’s what you can do to care for them during this vulnerable period:

• Vaccinate your child against hepatitis (jaundice-inducing infection), meningitis, viral encephalitis, and other infections.
• Protect their heads while playing and make your home child safe 
• Give your child healthy and nutritious food that aids development

 

 

Support for cerebral palsy children from an African standpoint

 

Sub-Saharan African countries present unique challenges and opportunities to directly impact the lives of individuals with cerebral palsy within specific communities. You can provide meaningful support and help create a more inclusive environment by following these practical strategies:

 

• Join or form support groups

By engaging in the activities of support groups for children with cerebral palsy in Africa, you have the incredible opportunity to make a significant impact. These groups are a haven for sharing unique experiences, insights, and valuable resources, creating a closely-knit community to help improve the lives of people living with CP. 

 

You can help improve access to therapies, education, and emotional support by joining or setting up a local support group. Promoting awareness and reducing stigma will empower families and caregivers to advocate for these children's well-being within different communities of sub-Saharan Africa.

 

• Foster Inclusion through Education 

You can engage with local schools and institutions to promote inclusive practices for people with cerebral palsy. Advocate for accessible infrastructure to ensure an inclusive learning environment. As a volunteer, you can also encourage establishing special education programs or resource rooms where students with cerebral palsy can receive tailored support.

 

• Volunteer and Offer Assistance

Volunteer your time and skills to support individuals with cerebral palsy. You can contact local organizations or community centers that work with individuals with disabilities and offer your assistance. This service could involve helping with therapy sessions, organizing recreational activities, or providing transportation to medical appointments.

 

• Raise Awareness

One of the significant problems in managing a child with cerebral palsy in most sub-Saharan African countries is the lack of awareness about this condition. As someone with a child with CP or interested in helping, you can help raise awareness about the condition within your neighborhood. 

 

One way to help raise awareness is to support the effort made by some organizations. You can also help organize community workshops to educate others about the condition, its challenges, and the abilities of individuals with cerebral palsy to lead independent and healthy lives.

 

• Facilitate Access to Healthcare 

Access to healthcare services can be challenging for people with cerebral palsy, especially in rural areas. Still, you can help individuals with cerebral palsy navigate healthcare systems by providing information about local clinics, hospitals, and specialists who can offer appropriate care. 

 

• Encourage Social Engagement 

Support social inclusion by organizing and participating in events and activities to encourage interaction among individuals with cerebral palsy and the broader community. These arrangements could be sports events, art workshops, or cultural celebrations that create opportunities for social connections and friendships. 

 

Remember, even small acts of kindness and support can significantly impact the lives of individuals with cerebral palsy and their family members. You can create a more supportive and inclusive environment by raising awareness, providing practical assistance, and promoting social engagement within your neighborhood. 

 

 

Outlook

 

Having a child with cerebral palsy comes with its many challenges, but people with cerebral palsy can live fulfilling lives with determination, support, and access to the right resources. Several medical advancements and assistive technologies make it easier for them to move, communicate and sometimes, live independently.

 

By staying positive and persevering, parents and caregivers can support individuals with cerebral palsy to overcome obstacles, reach their goals, and make meaningful contributions to their respective communities.

 

 

Conclusion

 

Cerebral palsy affects 2 to 3 out of every 1,000 children, making it the most common cause of childhood disability worldwide. It is a non-progressive brain disorder that affects movement and coordination. There is no known cure, so treatment is targeted at reducing its symptoms. Prevention is challenging, but specific measures before and during pregnancy can help reduce the risk.

 

Efforts to raise awareness and provide resources are crucial, especially in sub-Saharan Africa, where knowledge about the condition is limited. By forming or joining support groups, promoting inclusion, volunteering, raising awareness, facilitating healthcare access, and encouraging social engagement, you can help to improve the lives of individuals with cerebral palsy significantly.

 

 

References:
 

1. Burton A., (2015). Fighting Cerebral Palsy in Africa. The Lancet Neurology. 14(8), 876-877. DOI:https://doi.org/10.1016/S1474-4422(15)00189-

2. Donald KA., Samia P., Kakooza-Mwesige A., Bearden D., (2014). Pediatric cerebral palsy in Africa: a systematic review. Seminars in Pediatric Neurology. Mar;21(1):30-5. doi: 10.1016/j.spen.2014.01.001. Epub 2014 Jan 8.

3. Donald KA, Kakooza AM, Wammanda RD, et al., (2015). Pediatric cerebral palsy in Africa: where are we? Journal of Child Neurology. 30(8):963-71. doi: 10.1177/0883073814549245. 

4. Durkin MS., Benedict RE., Christensen D., et al., (2016). Prevalence of cerebral palsy among 8-year-old children in 2010 and preliminary evidence of trends in its relationship to low birthweight. Pediatric and Perinatal Epidemiology. 30(5):496-510. doi: 10.1111/ppe.12299.

5. Amor DJ, Craig JE., Delatycki MB. Reddihough D., (2001). Genetic factors in athetoid cerebral palsy. Journal of Child Neurology. 16(11):793-7. doi: 10.1177/08830738010160110301. 

 

 

Published: August 28, 2023

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