Disabilities Research Paper

Cerebral Palsy

Teri Tomkins

Dental Hygiene IV
December 2020

The definition of cerebral palsy has been a subject of debate for some time. As of 2007, it was

defined as “a group of permanent disorders of the development of movement and posture, causing

activity limitation, that are attributed to non-progressive disturbances that occurred in the developing

fetal or infant brain.”[ CITATION Vel19 \l 1033 ]. It can also be defined as a group of permanent

disorders of the development of movement and posture, causing activity limitations that are attributed

to non-progressive disturbances that occurred in the developing fetus or infant brain. [ CITATION

Sad20 \l 1033 ] The current definition states that CP is a group of permanent, but not unchanging,

disorders of movement and/or posture and of motor function, which are due to a non-progressive

interference, lesion, or abnormality of the developing /immature brain.

Cerebral Palsy was first discovered in 1861 by William Little who was an orthopaedic surgeon.

He described the cause to be from birth asphyxia from the umbilical cord being wrapped around the

infant’s neck which ultimately caused neurological disturbance in the infant. CP is considered an

acquired disability that usually happens at birth and can happen to any child, male or females.
 Risk factors may include mother’s systemic diseases, drugs and stimulants used, poisons,

immune system disorders preceding pregnancy, and impaired fertility. These factors are pre-conception.

During the perinatal and neonatal/infant period, risks can include respiratory distress syndrome,

respiratory therapy/support, neonatal convulsions, complicated delivery methods such as premature

birth, vacuum assisted delivery, prolonged labor, asphyxia, and labor induction. The one major CP risk

factor is prematurity. Premature infants are at risk for neurological disorders. [ CITATION Sad20 \l

1033 ].

CP has many physical effects on the body. Spastic cerebral palsy effects 70-80% of all children

with CP. Because the muscles are tight and stiff, the limbs are weak making it hard to control movement.

Difficulty walking has been reported as well. This is because of tight hip and leg muscles. Legs can

sometimes pull together, cross at the knees and sometimes turn inward. There is a disorder called

Athetoid cerebral palsy and this is when the muscles change rapidly from being hypertonic or increased

tone to hypotonic or becoming floppy and loose. Maintaining balance and coordination can also be

difficult. Physically, CP can affect the body in many ways. Mainly problems with posture, balance or fine

motor skills including writing, getting dressed and other activities when use of hands or extremities will

be needed. [ CITATION Man19 \l 1033 ]

Intellectual concerns include delayed development which can lead to learning disabilities.

Reports show that some individuals may have moderate to severe mental retardation. Other concerns

for the body with people that have CP include vision problems, urinary incontinence, hearing problems,

sleeping problems and a big one is orthopaedic problems which consist of increased risk for

osteoporosis, and low bone density. [ CITATION Man19 \l 1033 ].

There are several levels of the severity of symptoms associated with CP. Level I is when the

person can walk without restrictions. Level II is when the person walks without devices but have

limitations. Level III is walking with mobility devices and with limitations. Level IV is self-mobility with
limitations. Children are often transported with the use of power chairs. Level V is self-mobility is

severely limited even with the use of supporting technology.

CP individuals are more likely to have functional difficulties with their central nervous system.

This can start early in life and affect feeding, and sleep patterns. CP generally effects people in a physical

way but can lead to delayed learning as well. This can include attention span, decision making, memory,

language skills, speech proficiency and problem solving. Some factors that can cause cognitive

impairments include brain hemorrhage, lack of oxygen during labor, preterm complications, and genetic

abnormalities.

Cerebral Palsy is one of the most serious disease that affects the central nervous system and

there is no cure. There are a few non-drug related therapies that can provide some help which include

motor therapy, homework therapy, physical factor therapy and sensory integration therapy. Since

motor control involves the ability to walk, stand, and posture, motor therapy works to help promote

these normal developments. Core training is important because it greatly supports the spine and pelvic

muscles. By intervening early on and preventing incorrect posture, this can promote correct function of

the spine and core muscles. Homework therapy basically takes any motor skill therapies and applies it to

at home learning that involves family life and social life. It can also greatly improve the ability to

communicate and reduce any stress and encourage emotional adjustment. Homework therapy also uses

computer simulated games that encourage the interest in therapy approaches.

Drug therapies are also used that can have a therapeutic effect on the body. Preventive drugs,

drugs to reduce muscle tension, and neurotrophic drugs are used. A common preventive drug used is

prenatal magnesium sulfate. This can prevent CP in premature infants. Neurotrophic drugs used include

Ganglioside, and Mecobalamin. These work to nourish brain and cell nerves which promotes synaptic

connections. Side effects of Mecobalamin include loss of appetite, nausea, vomiting, diarrhea. Muscle

relaxant drugs may be used such as Baclofen and Botulinum toxin A. Baclofen works by essentially
reducing the perception of pain and is effective for children with dysfunction caused by abnormal

muscle tone. Botulinum toxin A(BTX-a) is sued to reduce spasms and decrease muscle tension and can

adjust the effect of abnormal posture, this improving the movement function. [ CITATION Wan18 \l 1033

CP is a lifelong disease that can only be controlled with therapy interventions to help with any

symptoms. With these interventions, children can come to adapt and learn to live with the disease with

the help of a great support system and a great team of doctors and medical staff.

Many oral implications have been reported with cerebral palsy. Because there are different

stages of the severity of cerebral palsy, this can vary in the ability for one to care for their mouth. Due to

uncontrolled movements or tightening of the muscles of the extremities, it may be difficult for patients

to grasp a toothbrush or to get one up to their mouth. Some severities of cerebral palsy also make it

hard for patients to chew and swallow. Also due to the impaired motor functions, this can affect the oral

cavity by causing temporomandibular joint pain, vomiting, drooling, and speaking difficulties. Dental

caries is a disease that has many factors including biological, environmental, and social factors. The

incidence of caries among children and adolescents who have CP is high. This in mainly in part due to

poor oral hygiene and poor diet. In patient’s that have severe cases of CP, bruxism has been reported

which is the grinding of teeth. This can lead to severe attrition or wearing away of the biting surface of

tooth. Persons with CP can also exhibit signs of dental trauma which include the chipping and fracture of

dental. Also due to the inability to control muscles, trauma to the lips have been reported. Because

gastroesophageal reflux disease can be an issue, it is common to see erosion in the enamel as well.

[ CITATION Seh14 \l 1033 ] If bacteria cannot be controlled, this can lead to dental caries and can

ultimately lead to periodontal disease and even tooth loss.

There are many health challenges when dealing with a patient with CP. Depending on the

severity of CP that the person has, they will often have a caregiver with them. This can be a family
member or someone who works at a health care facility that helps bring patients to and from personal

appointments. Caregivers not only assist with transferring a patient, but they are also there to gain

knowledge firsthand on how to assist with oral hygiene. It will first be very important to obtain a

thorough health history including medications. If the patient is in a wheelchair, maintaining a clear path

to and from the operatory will be best. You may have to treat the patient while still seated in the

wheelchair. If you need to transfer your patient, ask if they will need any pillows or padding. Most times

if there is a caregiver with them, they will help transfer the patient. Uncontrolled body movements are

common with CP patients so keeping them calm can help relax them and make the movements less

frequent or intense. Allow the patient to settle in the chair to a position they can comfortably maintain

throughout the appointment. Make sure to observe the patient’s movements so that you can anticipate

the direction or intensity. Do not try to help or stop the movements. This again can make the

movements more intense. It will be important to be empathetic with the patient’s concerns or

frustrations. Try minimizing any distractions in the treatment room including light, sounds or other

stimuli. Always tell the patient what you are going to do if it involves a new form of stimulation. This can

be as simple as moving the dental chair, turning the light on, or even beginning to use the handpiece for

polishing. [ CITATION Nat09 \l 1033 ]

Periodontal disease can be common among people with CP. This is in part due to poor oral

hygiene and sometimes caused by gingival hyperplasia from some medications. Dedicating some time to

discuss the prevalence of dental disease with the patient and care giver will help encourage and

hopefully help reduce the incidence of dental caries. First ask the patient and care giver what habits and

routine they are currently using and have them demonstrate the technique. Involve the patient and

caregiver with hands on demonstrations. In severe cases when a patient can not hold a toothbrush, it

will be important for the caregiver to understand proper brushing technique. A power toothbrush might
help simplify brushing. Help the caregiver to find standing positions and sitting positions that can help

them gain access to properly brush. [ CITATION Nat09 \l 1033 ]

Educating CP patients and the caregivers about the prevalence of dental caries will also be

important. They will need to understand about medications that may reduce saliva flow and

medications that may contain sugar. Make suggestions to drink water often and offer alternatives to

cariogenic foods and dental hygienists can offer preventive measures such as fluoride and sealants.

[ CITATION Nat09 \l 1033 ]

Dental hygienists can make a difference as well as the caregivers. Showing determination, trust

and understanding will be important in all aspects. Being able to communicate and work to together

with the patient and caregivers, nurses, doctors, etc can make a huge impact on the quality of life for a

patient with CP.

References
Mandal, A. (2019, February 26). Cerebral Palsy Symptoms. Retrieved from News-Medical.net:
https://www.news-medical.net/health/Cerebral-Palsy-Symptoms.aspx

Research, N. I. (2009, July). Practical Oral Care for People With Cerebral Palsy. Retrieved from Practical
Oral Care for People With Developmental Disabilities :
https://www.nidcr.nih.gov/sites/default/files/2017-09/practical-oral-care-cerebral-palsy.pdf

Sadowska, M., Saracka-Hujar, B., & Kopyta, I. (2020). Cerebral Palsy: Current Opinions on Definition,
Epidemiology, Risk Factors, Classifications and Treatment Options. Dovepress, 1505-1518.

Sehrawat, N., Marwaha, M., Bansal, K., & Chopra, R. (2014). Cerebral Palsy: A Dental Update.
International Journal of Clinical Pediatric Dentistry, 109-118.

Velde, A. t., Morgan, C., Novak, I., Tantsis, E., & Badawi, N. (2019). Early Diagnosis and Classification of
Cerebral Palsy: An Historical Perspective and Barriers to an Early Diagnosis. Journal of Clinical
Medicine.
Wang, H.-J., & Yan, Q. (2018). A review of the treatment of cerebral palsy in children. TMR Journals, 151-
158.