Massage & Bodywork

November/December 2012

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First documented in the 1860s by British surgeon William Little, "Little's disease" was later identified to be spastic diplegia, one of several forms of CP. It was once thought to be due to accidents during childbirth, but fewer than 10 percent of all CP cases are related to birth trauma. More often, CP is due to abnormal development of the cerebrum, complications of maternal infection, Rh incompatibility, toxic exposure, or bleeding in the brain due to vascular malformation or maternal hypertension. Postnatal causes include head injury, jaundice, and seizures. CP happens most often among infants with very low birth weight (under 5.5 pounds) and prematurity (less than 37 weeks of gestation). FORMS OF CP The terms used to describe types of CP indicate motor symptoms and what part of the body has been affected. Here is a short list of CP descriptors: • Ataxic: Problems with balance and coordination. • Athetoid: Involuntary writhing movements of the face, trunk, arms, and legs. • Di: The upper or lower body is affected; the lower body tends to be affected more often than the upper body. • Hemi: The left or right side is affected. • Paresis: Weakness. • Plegia: Paralysis. • Spastic: Pathologically tight muscles; flexors win over extensors. • Tetra: All four limbs are affected. So in the spastic diplegia recognized by Little, the patient experienced spastic paralysis of either the upper or lower body. Erica's case involves problems with her legs, and she has a tendency toward making constant fists with her hands, even when she is relaxed. "I think that's why I'm such a strong massage therapist," she says. "Giving counter- pressure feels kind of soothing to me. I am a 4' 11" skinny woman, but people say I feel like a big, burly man. I have the strongest hands." Many people with CP face challenges beyond problems with motor control. About two-thirds of CP patients have some cognitive disability. Half of them experience seizures. Delayed growth is common, along with spinal deformities, including hyperkyphosis, hyperlordosis, and scoliosis. Motor control problems with the musculature of the face can lead to communication challenges, drooling, and serious skin problems. Incontinence related to poor muscle control is another common challenge. People with CP who can walk often experience stiffness in their legs, leading to a characteristic and inefficient "scissor gait." Many of these problems can become worse over time, so although the CP itself does not progress, its consequences may. And because some of these complications may be unsightly, people with CP are often socially isolated, a phenomenon that appears to make many symptoms worse. CP IN ADULTS Until the mid-20th century, most people with CP didn't make it out of their teens. Nowadays, 65–90 percent of CP patients live to adulthood, although they tend to be vulnerable to premature aging; some organ systems, especially the cardiovascular and respiratory systems, often don't operate at full capacity, and muscular activity appears to take a greater toll on people with CP than it does on the general population. While the improved life span for people with CP is great news, it comes with a lot of unanswered questions. CP has always been considered a child's condition, and all of its treatment options and strategies have been designed for children. The physical therapy, occupational therapy, surgical options, and drug treatments for CP were developed to help children achieve the maximum level of independence possible. But these strategies have not taken into account the needs of a person with CP who is in his 30s, 40s, or 50s. Polls and surveys of adults with CP who do not have cognitive disabilities reveal some disturbing information. Patients making the transition from childhood to adulthood often find that their access to health services dries up, just as their need for therapies to deal with long-term problems is becoming known. Not all people with CP lose the ability to walk. If they See what benefits await you. 43

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