Cerebral palsy, the most common childhood physical disability, is caused by damage to the brain before birth or in infancy. 脑瘫患者可能有影响姿势的神经和肌肉骨骼问题, sensory perceptions, communication, movement and other functions.

Cerebral Palsy: What You Need to Know

• 在出生前、出生中或出生后脑部受伤都可能导致脑瘫.
• 脑瘫的症状通常首先在婴幼儿中被发现.
• Almost half the children affected by cerebral palsy develop hypertonia (excessive muscle tension) or spasticity (excessive muscle tension with increased tendon reflexes).
• There is currently no cure for cerebral palsy, but treatment can address associated neurologic, orthopaedic and medical conditions.

What is cerebral palsy?

脑瘫(CP)是一种影响运动和肌肉张力的疾病. The exact cause, in many cases, is unknown, 但当大脑中控制运动功能的区域发育异常或受损时，这种疾病就会发生. CP develops in approximately three out of every 1,000 live births.

What causes cerebral palsy?

有几种类型的损伤会损害大脑中控制运动功能的部分，包括:

• Preterm birth: the most common cause in the United States
• Head injuries including shaken baby syndrome
• Infections of the brain or spinal cord
• 缺氧:大脑的氧气供应受阻，如在濒死经历中
• Events that block blood flow to the brain, such as stroke
• Malnutrition
• Heavy metal ingestion

What are the symptoms of cerebral palsy?

Children with CP usually show signs of motor delay before age two. CP is often not formally diagnosed until age 2 or 3. 患有脑瘫的婴儿通常发育缓慢, such as learning to roll over, sit, crawl or walk. 他们也可能有某些反射，通常在婴儿期早期就消失了. 

The symptoms of CP may resemble other conditions. 虽然每个孩子都表现出独特的缺陷模式，但也有一些共同的迹象. 

你可能会注意到你的孩子在躯干或四肢上表现出夸张的反应或松弛. Another sign is spasticity这可能表现为躯干、手臂或腿部颤抖或僵硬，或握紧拳头. 不受控制的运动和不正常的步态也可能是画面的一部分. 

患有CP的儿童可能还有其他问题，包括:

• Seizures
• Vision, hearing and/or speech problems
• Learning disorders and behavior problems
• Intellectual or developmental disabilities
• Respiratory problems
• Gastrointestinal and nutrition issues
• Bowel and bladder problems
• Bone abnormalities, including scoliosis (a sideways curvature and rotation of the back bones) and hip dysplasia (dislocation)

What are the different types of cerebral palsy?

脑瘫是根据受影响的身体部位来分类的. The spasticity of CP can present itself in three ways:

• Spastic diplegia involves the legs more than the arms. 这种类型更容易影响早产儿，32周前出生的婴儿.
• Spastic quadriplegia involves all four limbs more or less equally. Full-term or preterm babies with CP may have this type.
• Spastic hemiplegia involves one side of the body, 也可能发生在有过一次或多次脑室出血的儿童身上.

Cerebral Palsy Treatment

There is no cure for CP, 但有许多治疗方案可以帮助解决与这种情况相关的问题.

Baclofen巴氯芬是一种肌肉松弛剂，可以口服，也可以通过手术放置在腹部的巴氯芬泵直接注入脊柱的脑脊液.

Therapeutic electrical stimulation (TES) tes是一种电刺激，可以增加血液流向虚弱的肌肉.

Selective Dorsal Rhizotomy (SDR) 选择性背神经根切断术是一种外科手术，切除一些来自肌肉并进入脊髓的腰椎和骶神经纤维. 手术后配合高强度的物理治疗可减少痉挛.

Orthopaedic Issues Associated with Cerebral Palsy

Hip Dysplasia

Hip dysplasia 患有先天性神经肌肉疾病(如CP)的儿童是否存在单侧或双侧髋关节畸形. 肌肉张力的增加或减少可导致股骨头向髋关节外移位, requiring additional treatment, such as proximal femoral osteotomy or acetabular osteotomy.

Neuromuscular Scoliosis

Neuromuscular scoliosis 脊柱疾病是否与潜在的神经肌肉疾病有关, such as cerebral palsy, muscular dystrophy or spinal cord injury. The underlying condition typically causes changes in the muscles, leaving them unable to support the spine adequately. This leads to a curvature of the spine. The typical presentation is an abnormal S- or C-shaped curvature. 脊柱也可以旋转，形成多维曲线. The curvature can be progressive, especially with growth spurts. Treatment may include bracing or spinal fusion surgery.

Talipes Equinovarus Foot (Clubfoot)

Clubfoot is commonly seen in children with CP. 由于肌肉不平衡，畸形会使负重活动具有挑战性. 你的医生可能会建议的外科手术包括胫骨前腱分离转移或跟骨截骨

Neuromuscular Flatfoot

这是由于潜在的神经肌肉疾病引起的足部畸形. 脚部肌肉的异常导致足扁平足很少或没有足弓. 这种情况常见于张力低下或肌张力低的儿童. 牙套或矫形器可以提供足弓支撑并减轻疼痛, or surgery may be recommended to address the problem.

Toe Walking

Toe walking 儿童是否有一种潜在的神经肌肉疾病导致儿童脚踝的高张力或肌肉紧绷, and can cause them to walk on the toes or balls of the feet. Physical therapy can be beneficial, 一系列的石膏也可以逐渐调整脚和脚踝的位置. 如果这些方法无效，医生可能会建议手术延长跟腱或腓肠肌.

Limb Length Inequality

Limb length inequality 儿童下肢(腿)长度的差异. 这种长度的差异可以在偏瘫CP患儿中发现. For slight discrepancies of leg length, a shoe lift may be helpful. For more pronounced differences, 手术治疗可能会建议缩短较长的腿，并在您的孩子成长过程中提供更平衡的腿长.

Torsional Disorders

有些患有CP的儿童下肢骨骼会向内或向外扭曲, including internal tibial torsion. When this is excessive, it can interfere with their gait pattern. 一种叫做旋转截骨术的外科手术可以矫正畸形.

Muscle Contracture

患有神经肌肉疾病的儿童可以表现出肌肉张力增加，从而导致肌肉挛缩, preventing it from stretching well. 腘绳肌、内收肌、髋屈肌和腓肠肌都可能受到挛缩的影响. Physical therapy, bracing, 肉毒杆菌注射或肌腱延长手术可能是必要的.