Mood Disorders and Suicidality

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nIntroduction

nChildren face various forms of disorders that they get during or after birth, and some are being caused by infections that are passed through by their mothers during pregnancy (Barrett & Barber, 2013). One of this disorders is a cerebral disease that occurs in infants at birth, and the exact cause is not clear. Children with the disorder have difficulties with body movement and posture and needs help to do almost all their daily activities from their parents or guardian (Aisen et al., 2011). Those with severe forms of cerebral palsy are more likely to develop other complications such as seizures or intellectual disabilities. There is no remedy for CP although there is a variety of intervention approach that is taken to relieve symptoms and increase a childs ability to be independent. The paper by using cerebral palsy will illustrate the etiology, signs and symptoms, prevalence, prognosis and social dynamics of the disorder (BARRETT, 2011).

nCerebral palsy is known as a collection of perpetual disorders of the growth of movement and posture, leading to limitations in the manner in which a child plays or interacts (BARRETT & LICHTWARK, 2010). It is being credited to non-progressive turbulences that happen in the growing infant brain. The main characteristics being a problem with movement, there are other signs like difficulties with learning, thinking, feeling and way of communication. With children with cerebral palsy, 29 % have epilepsy, 57% have problems with communication, 42% have difficulties with their eyesight and 23-57% have disabilities in learning. Cerebral palsy characteristics are anomalous muscle tone, reflexes, or motor growth and coordination. Joints and bone malformations and contractures which means they are being fixed in a solid manner, muscles and joints are tight. The typical symptoms are spasms, spasticity, various involuntary movements in facial gestures, tottering gait, difficulties with balance, and soft tissues comprising of decreased muscle mass (BARRETT & LICHTWARK, 2010).

nFor children with cerebral palsy who can walk, they are scissor ambulating where their knees crisscross and toe walk that can cause a gait reminiscent of a marionette (BEAINO et al., 2010). The effects of cerebral palsy classify as a continuum of motor dysfunction. It may vary from minor clumsiness at the minor end of the spectrum to deficiencies so severe that hinders coordinated movement at the other end of the spectrum. Children born with complicated cerebral palsy most have a deformed posture; their bodies may be limp or rigid. Defects during birth such as small jawbone, spinal curvature or small head than normal may be present in cerebral palsy infants. The symptoms of CP in a child can emerge or modify as the baby grows older while in some the signs do not come up right away but they instead develop gradually. Typically, CP disorder becomes predominant when the child is six to nine months old where the movement and use of limbs, irregularity, or gross motor growth delay are evident (BEAINO et al., 2010).

nAn infant with cerebral palsy has speech and language difficulties. The occurrence of dysarthria is approximated to range from 30% to 88% (DARRAH et al., 2011). Disorders of speech are being linked with meager respiratory control, velopharyngeal malfunction and laryngeal, together with oral articulation dysfunctions that are being caused by limited movement in the oral-facial muscles. The dysarthria in cerebral palsy classifies into three main types: ataxic, spastic and dyskinetic. Language disorder is being linked with complications of hearing impairment, intellectual disability and learned vulnerability. Infants with CP are at risk of becoming passive communicators and erudite vulnerability, having limited communication with those around them (DARRAH et al., 2011).

nA child with cerebral palsy do not have regular bone shape and size; this is because they do not have normal musculature (Fleiss & Gressens, 2012). The shafts of the bones are thin and continue becoming weaker with each growth. In comparison to the slender shafts, the centers regularly emerge equally enlarged. Narrowed joint spaces may occur due to articular cartilage weakening. An extensive range of angular joint defects may be present and is dependent on the level of spasticity. Complete bone and skeletal growth can be stalled due to spasticity and gait abnormalities because vertebras require vertical gravitational loading powers so as to grow properly. Persons with CP seem to be smaller in height compared to the typical person because their bones are unable to develop to their fullest. Occasionally their bones grow to different lengths, and, therefore, the individual may have one leg longer than the other (Fleiss & Gressens, 2012).

nA child with cerebral palsy may experience pain that emanates from the inherent insufficiencies accompanied with this condition (de Brito Brandao, Mancini, Vaz, Pereira de Melo & Fonseca, 2010). The pain may sometimes come from the many measures and treatment that the children with this disease go through. Tight or shortened muscles, irregular posture, rigid joints and inappropriate orthosis is being associated with the pain. Cerebral palsy infants also have high chances of chronic sleep disorders that are being attributed to physical and surrounding factors. Difficulties in holding utensils, chewing and swallowing food may be evident in children due to the motor and sensory impairments, therefore eating becomes a problem. They may also experience mild or extreme sensitivity around their mouth cavity (de Brito Brandao, Mancini, Vaz, Pereira de Melo & Fonseca, 2010).

nCerebral palsy is being caused by damage that occurs to the developing brain of an infant (Fleiss & Gressens, 2012). The impairment can happen during pregnancy, delivery or the early months after birth. Structural complications in the infant’s brain are being observed in 80% of recorded cases, often within the white matter. More cases are taken to have resulted from complications arising during pregnancy though sometimes there is no detectable cause. Typical reasons include problems in intrauterine growth, birth trauma during labor and delivery, hypoxia of the brain and problems with the birth or in childhood. Infants who develop cerebral palsy were mostly given birth while still premature. Prematurity is being linked to the issues of the time that the birth took place. Babies born as a result of multiple-birth are at a higher risk to have this disorder, and low birth weight compared to the single birth babies. Genetics features are also considered to have a vital role in the condition of prematurity and cerebral palsy in general (Fleiss & Gressens, 2012).

n There are other risk factors that give rise to a child being born with cerebral palsy (GORDON, 2011). There may be problems with the placenta, low birth weight, breathing of meconium into the lungs, caesarean section procedures, birth suffocation, seizures minutes after birth, low blood sugar and infections in the infant. Although the lack of oxygen may not play a significant role, few cases have been reported to have been caused by birth asphyxia. Cerebral palsy may also be inherent, and in many cases both parents must be carriers for the child to have the disorder. Other causes during early childhood include toxins, lead pollution, and severe jaundice, brain injury, instances that involve hypoxia to the brain, and meningitis or encephalitis. In infants, Asphyxia is caused by poisoning, near drowning and choking on particles of food or toys. Infections in the mother may multiply the risk of a child developing the disorder, the infections of the fetus membranes can as well upsurge the threat (GORDON, 2011).

nCerebral palsy is not a progressive ailment which means that the damage inflicted on the brain do not deteriorate further, although the signs can worsen over time (MAJNEMER, SHEVELL, LAW, POULIN & ROSENBAUM, 2010). A child with the disorder may recover gradually during childhood depending on the extensive care given. Nonetheless, orthopedic surgery may be needed if the bones and musculature are more established. A comprehensive intellectual capacity of a child with CP is mostly being noticed when the child begins school. Although the potential of learning is unrelated to IQ, children with the disorder may have learning problems. The life span of persons born with cerebral palsy is lower than that of the overall populace although it has become better with the introduction of modern medicine (MAJNEMER, SHEVELL, LAW, POULIN & ROSENBAUM, 2010).

nThe capability of a child living self-sufficiently with Cerebral palsy varies widely, partially relying on the gravity of impairment and partly on the ability to manage the logistics of life (Martin, Baker & Harvey, 2010). Some people with the disorder require help in all their undertakings while some need assistance with particular activities and others can survive on their own with no physical aid. However, irrespective of the level of impairment a persons capacity to live self-sufficiently is dependent on the individuals ability to manage physical dynamics of life by themselves. Individuals with the disorder can have children of their own because the reproductive system is not affected. For children with CP, parents are immensely required in the self-care undertakings like bathing, grooming, dressing, and that is mostly because upper limbs are the ones involved in self-care activities (Martin, Baker & Harvey, 2010).

nThe effects of the motor, sensory and cognitive malfunctions impact significantly on self-care occupations in youngsters with cerebral palsy and productivity occupations (Moster, 2010). Productivity can comprise of school performance, household errands and the contributions made to the society. The play is encompassed by productive work because it is the primary activity for children, and so if the kid does not play due to a disorder, then it becomes a problem to them. These complications can touch on a childs self-esteem, and in totality the motor and sensory difficulties experienced can affect the manner in which a child relates with the environs that include the people around. Some children with the disorder devote most of their time playing by themselves. Social, psychological and emotional problems may arise because of the child not being able to play due to a disability. As a result, it leads to an upsurge reliance on others, poor social skills, and low morale (Moster, 2010).

nChildren with cerebral palsy participate mostly in informal leisure activities that are done in the comforts of their homes and prepared by adults (Novak et al., 2013). Leisure occupations are activities mainly performed for pleasure, and they relieve stress. Usually, kids with disabilities perform recreational activities autonomously or with their parents rather than with friends. Therefore, children may experience restricted variety of social relations and activities, also to a more passive lifestyle compared to their peers. Despite leisure being vital to children with disorders, the social and physical barriers present can contribute to difficulties in leisure participation. When there are environmental restrictions like architectural designs that do not accommodate an elevator can hinder children with cerebral palsy from accessing higher floors in a building (Novak et al., 2013).

nThe prevalence of cerebral palsy in children occurs at approximately 2.1 per 1000 live births (Shatrov et al., 2010). In kids born at term, rates are at 1 per 1000 births, and the rates seem to be the same in both the developed and developing world. The rate of cerebral palsy is higher among males than in females, for instance in Europe the rate is 1.3 times more often in the male gender. Some form of motor impairment is evident in 100% of cerebral palsy incidents, approximately 72 to 91% of those with the disorder have the spastic syndrome. Cognitive impairments are estimated to be 23 to 44% of children with CP; the impairments include mental retardation and behaviors like hyperactivity and is dependent on the type of CP disorder particularly when epilepsy is present (Shatrov et al., 2010).

nSensory impairment prevalence in children with cerebral palsy is prevalent among those with hemiplegia (Shevell, Majnemer, Poulin & Law, 2008). Four out of five hemiplegic infants have substantial bilateral sensory deficits. Speech impairments is common and greatly linked to the kind and seriousness of motor damage: dyskinetic is 95%, tetraplegic 85%, and diplegic is smallest at 20%. Ophthalmic malfunctions are predominant at 62% of kids with CP, while the most common impairment is dysarthria, although aphasia also happens while 72% of infants with CP have low visual acuity. The bulk of CP kids has gastrointestinal and feeding difficulties. Therefore, the majority of CP children have issues with their weight it can be under or overweight and nearly a quarter of them have stunted growth. Up to 80% of children with CP have a speech impairment. Approximately 72% of persons with spastic cerebral palsy have anomalous brain CT findings (Shevell, Majnemer, Poulin & Law, 2008).

nChildren with the cerebral palsy disorder require numerous health, rehabilitative and communal services (SIGURDARDOTTIR & VIK, 2010). The aim is to detect risk and protective factors that predict the resources and intervention needed to financial and family support. Moreover, discuss consequences for coordinating medical and societal services in CP kids and their family. Limited child gross motor function is a risk factor while opinion on family-centered services is a protective factor in having the needs taken into consideration. Parents of CP children whose mobility is good express tight family relationships, and apparent need-oriented and family-centered services states less financial and community support. On the other hand, parents of CP children with limited mobility are more likely to express family needs on medical expenses and searching for resources that can meet their requirements (SIGURDARDOTTIR & VIK, 2010).

nThere are various protective factors that should be in place before pregnancy, during pregnancy and after the child is born to lower the risks of cerebral palsy (Sigurdardottir et al., 2008). Any infections should be determined and immediately treated before the pregnancy. Immunization of certain ailments like rubella and chickenpox should be administered to potential mothers because they can cause harm to the growing fetus. When modern ways of getting pregnant are being used, ways to minimize multiple pregnancies should be put in place like transferring an embryo one at a time. During pregnancy, mothers should get regular and early prenatal care and contact health caregiver for checkups so as to detect infections early. Women must be familiar with their blood type so as to prevent incompatibility that causes Jaundice and kernicterus. After the child is born vaccination against diseases that bring encephalitis and meningitis, including HiB vaccine, and pneumococcal vaccine should be introduced (Sigurdardottir et al., 2008).

nThere is various intervention approach that can be in place with cerebral palsy children including therapy (Snider, Majnemer & Darsaklis, 2010). Physiotherapy programs can be in place because they are put to use with an aim of motivating the patient to generate strength base for enhanced posture and volitional movement, mixed with stretching exercises to limit contractures. Continued physiotherapy is important in sustaining muscle tone, bone structure, and averting joints dislocation. Speech therapy can also be introduced to aid in controlling mouth and jaw muscles, thus improve communication. With the child being unable to move his or her face, mouth and head it can be very difficult for them to breathe, converse eloquently, chew or swallow food. The introduction of speech therapy is best before the kid joins the school and then rolled out all through the school years (Snider, Majnemer & Darsaklis, 2010).

nMassage therapy can as well be used on CP children because it relieves tense muscles (SIGURDARDOTTIR et al., 2010). The muscles are being strengthened in the process, and the joints flexibility is maintained to avoid stiffness. Biofeedback therapy can be introduced so as to train CP patient on how to control their affected muscles and improve gait. Another treatment called occupational therapy can be put to help children with CP capitalize on their day to day activities, adjust to their limitations and, therefore, live autonomously. Occupational therapy is vital because families can indulge with an objective of meeting the concerns and priorities of their children. With hemiplegic patient, a certain technique known as constraint-induced movement therapy (CIMT) can be applied. The unaffected limbs are constrained to compel the patient to adapt using the affected limbs; this will prevent increased complications with motor control, muscle tone and range of motion (SIGURDARDOTTIR et al., 2010).

n The use of clinical intervention approach on cerebral palsy children. For spastic or dystonic muscles, an injection known as Botulinum toxin can be administered to minimize hypertonus of muscles which is agonizing (Snider, Majnemer & Darsaklis, 2011). Moreover, by toning down the muscles it enables bracing and use of orthotics. Different forms of surgeries can take place on the patient. A surgical approach can work on the knees, hips and ankles to loosen stiff muscles and relieve static joints. Baclofen pump can be inserted into the left abdomen and connected to the spinal cord. The aim is to convey bits of Baclofen which reduces the incessant muscle flexion because it is a muscle relaxant and is commonly administered by mouth to patients to counter spasticity effects (Snider, Majnemer & Darsaklis, 2011).

n Alignment of abnormal twists of the limbs bones can happen through derotation osteotomy (Sokolowska et al., 2011). The bone is cut and then fixed correctly to improve the posture of the affected child. Rhizotomy can be used where the affected nerves on the limbs are cut to minimize spasms and enable more flexibility and enhance control over the affected joints and limbs. Various surgical techniques also exist like for the children with severe feeding difficulties a procedure known as gastrostomy can be introduced. With this process, a hole is made through the abdomen skin and into the stomach to facilitate the child to feed via a feeding tube. The system is widely in use, but there is scant proof of its efficiency and safety on the patient (Sokolowska et al., 2011).

nBeside gastrostomy, other modern technology like manual feeding aids can be of use (Towsley, Shevell & Dagenais, 2011). A gadget made by using viscous fluid damping that streamlines vital tremors linked with the cerebral palsy disorder. However, there are various electronic feeding assistances for those who can chew and swallow food but incapable of feeding themselves. For purposes of drinking, there are gadgets designed with non-return valves to facilitate children who are unable to drink directly from a cup to get nutrition and hydration. If both legs of a CP kid are affected then, movement can be facilitated by way of scooter board that is used by the child to self-propel while lying down. An electronic wheelchair is also effective in enabling mobility without any external help from either the parent or guardian. For CP patients with hearing and sight impairment Ophthalmologists, Doctors and Audiologists can recommend corrective eyewear, hearing aids and contact lenses. Physiotherapists can prescribe specialized sleep methods to assist kids with postural problems feel comfortable in bed (Towsley, Shevell & Dagenais, 2011).

n Drafting of Individualized Education Program for these children with cerebral palsy should start in earnest (Van Haastert et al., 2010). Therefore, goals set should consider their status. The child will gradually walk throughout the school playing ground with or without any assistance from the device, with minimal falls. Will ensure that he or she plays and sit properly in the right posture and maintain balance for at least 15 minutes. The child should be able to have increased speech intelligibility by maximizing on sounds pronunciation accuracy. Positive attitude and learning capabilities should improve within a year through accommodative training and tap on childs strengths. The kid should demonstrate self-sufficiency, self-direction and be able to interact with friends in school (Van Haastert et al., 2010).

nThe child is having difficulties in feeding because he is unable to hold a cup will be trained step by step on a daily basis until he regains his grip (van Haastert et al., 2011).The kid will exercise by holding light loads so as to build strength in his fingers and over time he will now hold the cup. Hemiplegic children uses the unaffected leg to walk with should be able to walk with both limbs. Through constraining the unaffected leg and making them walk with the other affected leg, he will gradually regain balance and power to use both of them. For a child who is unable to pull his or her pants up or down when using a toilet, required facilities like safety railing will be in place. Coaching the kid on removing his pants, turning and sitting on the lavatory safely (van Haastert et al., 2011).

nIn conclusion, primary care of the child with cerebral palsy can be a little bit challenging and therefore it requires full commitment from both the parents and staff members in school (ZADNIKAR & KASTRIN, 2011). Diagnosis starts with the observation of slow motor growth, anomalous muscle tone and unusual posture in children. CP is not a progressive disorder therefore it does not worsen, but the symptoms can aggravate and become severe over time. A pregnant woman is clinging to the fact that no known cause of this disorder are advised to have regular checkups to clear any infections there may be. Cerebral palsy is partially preventable through vaccination and avoiding head injuries in children. There is no cure for CP but through medications, therapy and surgery the problem can be alleviated. The requisite health care should be reinforced so as to extend the lifespan of the child with this disorder (ZADNIKAR & KASTRIN, 2011).

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nReferences

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nZADNIKAR, M., & KASTRIN, A. (2011). Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis. Developmental Medicine & Child Neurology, 53(8), 684-691. doi:10.1111/j.1469-8749.2011.03951.x