Related effects

1) Acid Reflux (AR)

The frequency of acid reflux in children with Cerebral Palsy is reported to range from 26% - 75%, while in no disabled children and infants it is estimated around 7-8% (Cadman and colleagues 1978, Reyes and colleagues 1993, Katsiyiannaki 1994, Vandenplas 1991).

According to recent relevant reports, there is an increased impact of AR on the spastic types of CP, while the impact on the gender is almost the same (Ravelli και Milla 1998, Xinias 2001). The clinical impression and the complications of AR on children with CNS damage are particularly serious, and result in affecting the development of the basic malady. The main symptoms are periodical vomits, hematemesis, rumination, reductions, anxiety, refusal to eat and retrosternal pain (Reyes and colleagues 1993, Bohmer and colleagues 1996).

The most frequent complications of AR on children with CNS damage are: a) stenosis of the esophagus, b) bad nutrition d) the Barrett esophagus that is considered to be a pre-cancerous condition, e) iron deficiency anemia, f) blood during evacuations, g) bleeding from the upper digestive system and h) pneumonia due to aspiration.

2) Epilepsy

The frequency of epilepsy in children with cerebral palsy totals to 35-60% of the cases, while some estimate that this percentage is higher. Aicardi reports that epilepsy emerges in 34-60% of the hemiplegic, in 50-60% of the quadriplegic, in 16-27% of the diplegic and in 23-26% of children with extrapyramidal cerebral palsy. Seizures usually arise between the 3rd and the 6th year of life and are mostly generalized tonic-clonic, but sometimes also focal. Seizures arising in early infancy take the form of infant convulsions and are mainly down to perinatal causes. Epilepsy seizures arising in early childhood are often myoclonic and noted in children with spastic diplegia. In hemiplegia, the convulsions are in most cases focal, either without or with secondary generalization, usually start during the first years of life and – in a very small percentage – in school age. (Hagberg 1996, Panteliadis and Darras 1995, Reckert 1997). However, difficult types of epilepsy, such as the Lennox - Gastaut Syndrome, are not that rear.

Types of epilepsies
• pure generalized tonic-clonic, in case of spastic types, less in case of other types
• focal seizures in hemiplegics
• infant convulsions
• myoclonic seizures in early childhood or seizures of the Lennox-Gastaut type
• seizures of the temporal lobe

3) Intellectual Disability

It is found in 30-60% of children with cerebral palsy (Evans 1990) – Rumeau – Rouquette 1992). The degree of intellectual disability varies significantly and depends on the localization and extent of the brain damage, but also on genetic factors. This is why it is important that it is evaluated with accuracy, because it helps the goal setting as well as their achievement. Generally, patients with spastic types of cerebral palsy had more problems than those with athetosis. The type of cerebral palsy plays an important role, as the percentage of profound intellectual disability in quadriplegia totals to 65%, in hemiplegia to 39% and in diplegia to σε 33%. The evaluation of the intellectual ability of a child with cerebral palsy is extremely difficult due to the kinetic malfunction, but also to additional disorders, and requires an experienced clinical psychologist who will be able to use various tests in order to accurately evaluate it.

4) Visual impairments

They are frequent in cerebral palsy; arise in percentages ranging from 30-75% and are associated with etiopathogenetic factors that lead to cerebral palsy, such as congenital infection, prematurity etc. (Schenk – Rootlieb, 1992). Periventricular leukomalacia is the main cause of visual impairments in premature infants (Jacobson και Duffon, 2000). These could be:

a) Refraction abnormalities,
b) Strabismus (crossed eyes) particularly convergent due to the paresis of the abducent (VI cranial syzygy), which is a typical disorder in spastic diplegia and emerges in a percentage of 43%, according to an Ingram study,
c) Nystagmus, often found in cerebral palsy, particularly in its atactic type

5) Hearing impairments

Around 5% of children with cerebral palsy develop hearing problems, a percentage that is clearly higher than the one of the general population. The spastic types present with a lower percentage compared to other types of cerebral palsy (7%), while in the case of choreoathetosis the hearing impairment totals to 20 -25% of the cases. Children with cerebral palsy often develop poor hearing of the conductance type, while the sensorineural hearing loss is also frequent and associated with each etiopathogenetic mechanism of cerebral palsy.

6) Speech and language disorders

They often arise in cerebral palsy and, according to various studies, the percentages range from 40% to 70%, while they are more frequent in the cases of choreoathetosis (80-90%) and less frequent in the spastic types. The problems are segregated to those associated with the malfunction of the kinetic control and are called "kinetic speech and language disorders" and to the so-called dysphasic syndromes.

The kinetic disorders of speech-language are characterized by the person's inability to regulate his/her movements needed for the speech production and they include dysarthria and inactivity of speech. Dysarthria derives from a disorder in the function of the kinetic part of the speech. The inactivity of speech derives from the person's inability to voluntarily perform movements needed for speech articulation, and while the participating muscles function normally, namely they don't demonstrate paralysis, they are weak or badly synchronized.

7) Learning difficulties

Learning difficulties (L.D. = Learning Difficulties) emerge when there are disorders of visual perception, processing, sequencing and speech. The co-existence of sensory disorders (visual, hearing) and behavioral disorders intensify the problem and might be perceived in pre-school age or later, in the beginning of school age. Children with cerebral palsy that present with satisfactory mental development and sufficient speech development, which allow them to go to a regular school, develop learning difficulties such as dyslexia, dysgraphia, dyscalculia etc. (Kurtz and Scull1993). It is necessary for children with cerebral palsy to be evaluated with the appropriate psychometric tests in order for both the strengths and the weaknesses to be detected.

8) Psychological or psychiatric disorders

Children with cerebral palsy and their families might often develop psychological problems. Problems faced by parents that unfavorably impact on their adjustment to the child's condition are guilt, denial of the disability, depression, etc. In order for the existence and the extent of these difficulties to be ascertained, it is primarily necessary to explore whether the parents understand the degree and the severity of the disability or if they are in a denial of the problem.

9) Sensory disorders [more frequent in the hemiplegic type of cerebral palsy (68%)].

10) Feeding – nutrition disorders

11) Constipation

12) Salivation