Dysarthria refers to speech problems. The child has difficulty producing sound and articulating words. Dysarthria occurs in 40% of patients. The causes are respiratory difficulties due to respiratory muscle involvement, phonation difficulties due to laryngeal involvement, and articulation difficulty due to oromotor dysfunction. Spasticity or athetosis of the muscles of the tongue, mouth and larynx cause dysarthria. It is important that every child is provided with an alternative means of communication as early as possible to avoid further disability.
The child has difficulty sucking, swallowing, and chewing. Drooling , dysarthria and inability to eat result in failure to thrive, delayed growth and nutrition, poor hygiene and impaired socialization.
Dentin : Primary or hyperbilirubinemia
Malocclusion : Spasticity
Tooth : Decay Feeding swallowing problems
Gingival : Hyperplasia Antiepileptic drug use
Gastrointestinal problems and nutrition
There is a general deficiency of growth and development. Children with dyskinesia and spastic quadriplegia fail to thrive. This is related to inadequate intake of food, recurrent vomiting with aspiration secondary to gastroesophageal reflux and pseudobulbar palsy. Difficulties in swallowing (dysphagia), hyperactive gag reflex, spasticity or loss of fine motor control impair feeding. Gastroesophageal reflux and impaired swallowing cause aspiration pneumonia. Many children with CP have high basal metabolic rates. Increase in basal metabolic rate coupled with feeding difficulties cause malnutrition. Malnutrition may be severe enough to affect brain growth and myelination in the first 3 years of life. There is immune system suppression and increased risk of infection.
Aspiration in small quantities leads to pneumonia in children who have difficulty swallowing. Premature babies have bronchopulmonary dysplasia. This leads to frequent upper respiratory tract infections. Respiratory muscle spasticity contributes to the pulmonary problems. These problems can be reduced by various chest physiotherapy.
Bladder and bowel Dysfunction
Loss of coordination of bowel and bladder sphincters results in constipation and/or incontinence. Enuresis, frequency, urgency, urinary tract infections and incontinence are common problems. The causes are poor cognition, decreased mobility, poor communication and neurogenic dysfunction. Urodynamic assessment has demonstrated bladder hyper-reflexia, detrusor sphincter dyssynergia, hypertonic bladders with incomplete leakage and periodic relaxation of the distal sphincter during filling.
Constipation is a common but overlooked phenomenon. It causes distress in the child, increases spasticity and results in poor appetite. It is a result of many factors, including poor diet and decreased mobility. Establishing a routine for bowel training and encouraging upright posture help reduce constipation.
Urinary problems may include enuresis, frequency, urgency, urinary tract infections, incontinence. Causes of urinary problems can be poor cognition, decreased mobility, decreased communication skills, Neurogenic dysfunction.
A diagnosis of CP is extremely stressful for the family and the child when he grows up. This causes various reactions ranging from denial to anger, guilt and depression. Coping with the emotional burden of disability is easier if the family has strong relationships, financial security, and supportive members of the community. The child and the family need to find ways to connect to each other. A healthy relationship between the mother and the child forms the basis of future happiness. Prevention or appropriate treatment of associated problems improves the quality of life of the child and the family.
Gajendra Jain is Sr. Software Engineer with Daffodil Software Ltd. Connect with Gajendra on Facebook here.