An Institutional Survey of 143 Cases of Acquired Cerebral Palsy

Abstract

SUMMARY Out of 1,283 cases of cerebral palsy diagnosed at the Children's Division of the Institute of Physical Medicine and Rehabilitation, 143 (11 per cent) acquired their neurological disability after the neonatal period. In 46 per cent of these the cerebral palsy was acquired from infection, in 17 per cent from trauma and in 11 per cent from cerebrovascular lesions. Nearly three‐quarters of the total had the spastic type of neuromotor deficit. Nearly half had a quadriparesis. All the cerebrovascular lesion cases had a hemiparesis. In 41 per cent of the total the children could not walk; 35 per cent were deficient in one or more areas of the activities of daily living; 41 per cent were mentally retarded. About a third had sensory, perceptual and/or visual deficits, and over half had speech deficits. There are many opportunities for preventing acquired cerebral palsy. Prevention is more likely to be effective in infective, traumatic or postsurgical cases than in those secondary to cerebrovascular accident, tumor or seizures. The chances of prevention are highest in the area of central nervous system infection, through immunization techniques, early diagnosis and vigorous treatment, and greater respect for the potential damaging powers of all infections. The prevention of traumatic neurological defects depends on home and school educational programmes, vehicle safety engineering, and greater respect for and compliance with existing safety regulations. Réasuméa Enquéte effectueé dans une institution sur 143 cas de paralysie cérébrale acquise Parmi les 1.283 cas de paralysie cérébrale diagnostiqués dans la Division des Enfants du ‘Institute of Physical Medicine and Rehabilitation’, 143 (11 pour cent) ont acquis leur infirmité neurologique après la période néonatale. Dans 46 pour cent des cas la paralysie cérébrale provenait d'une infection, dans 17 pour cent d'un traumatisme et dans 11 pour cent d'un accident cérébrovasculaire. Presque trois quarts du total avait le type spastique de déficience neuromotrice. Presque la moitié avait une quadriparésie. Tous les cas dûs à des accidents avaient une hémiparésie. Dans 41 pour cent du total les enfants étaient incapables de marcher; 35 pour cent étaient déficients dans un ou plusieurs domaines de la vie de tous les jours; 41 pour cent étaient retardés mentalement. Un tiers environ avait un défaut sensoriel, perceptuel et/ou visuel, et plus de la moitié avait des difficultés de langage. Il existe de nombreuses opportunités pour prévenir la paralysie cérébrale acquise. La prévention semble devoir être plus efficace dans les cas d'infection, de traumatisme, et les cas post‐chirurgicaux que dans les cas dûs à un accident cérébrovasculaire, une tumeur ou des crises. Les chances de prévention sont les plus élevées dans le domaine des infections du système nerveux central grâce aux techniques d'immunisation, à un diagnostic précoce suivi d'un traitement vigoureux et un plus grand respect de la puissance destructive de toutes les infections. La prévention des déficiences neurolo...

An Epidemiological Study of Cerebral Palsy In Western Australia, 1956–1975. III: Postnatal Aetiology

“…Over 11 per cent of all cases of CP in Western Australia over a 20-year period apparently were due to postnatally acquired brain-damage. This compares almost exactly with a study from New York, although those authors included all children up to the age of 15 years (Swinyard et al 1963). Their lower limit in terms of timing of the brain damage was the end of the second postnatal week, and they included only children who appeared to be normal up to that time.…”

A Comparative Study of Postnatally‐acquired Cerebral Palsy in Cape Town

“…There is general agreement that this refers to a disorder of movement and posture due to a brain lesion arising after birth and not related to pregnancy or the birth process, but the exact age-limits are controversial. Some workers include only cases arising after the neonatal period, varying from seven days to four weeks (Swinyard et al 1963, Perlstein and Hood 1964, Hagberg et al 1975, Lademan 1978, while others have no lower limit (Arens et al 1978, Blair and Stanley 1982). Upper age-limits range from two years (Hagberg et al 1975, Cussen et al 1978 to an indefinite period in adolescence (Swinyard et al 1963, Perlstein andHood 1964, Holm 1982).…”

“…Some workers include only cases arising after the neonatal period, varying from seven days to four weeks (Swinyard et al 1963, Perlstein and Hood 1964, Hagberg et al 1975, Lademan 1978, while others have no lower limit (Arens et al 1978, Blair and Stanley 1982). Upper age-limits range from two years (Hagberg et al 1975, Cussen et al 1978 to an indefinite period in adolescence (Swinyard et al 1963, Perlstein andHood 1964, Holm 1982). In this study we recognise no lower age-limits and have included children who suffered brain insults in the neonatal period from extraneous causes such as neonatal meningitis or head trauma, providing the child was healthy at birth.…”

“…Despite this low prevalence rate, the rate of acquired cerebral palsy in the black group is still marginally higher than in the coloured group and markedly higher than in the white group. Table V shows the percentages of postnatally-acquired cerebral palsy given in three previous studies (Swinyard et al 1963, Perlstein and Hood 1964, Blair and Stanley 1982, together with an additional seven studies dealing with the epidemiology of cerebral palsy in general (d'Avignon 1963 and Lademan 1978 did not report incidence figures). Our earlier article (Arens et al 1978) dealt with cerebral palsy among white and coloured children from a wider geographical area than in the present study.…”

“…Spasticity predominates, varying from 68 per cent in the Lademan (1978) series to 90 per cent in the Western Australia study (Blair and Stanley 1982). All found hemiplegia to predominate, except Swinyard and colleagues (1963), who Swinyard et al (1963) found that 41 per cent of their children had an IQ <65. Blair and Stanley (1982) rated 75 per cent of their cases as having an IQ <70, but Lademan (1978) found only 27 per cent in his series to have an IQ <70.…”