Depending on the variation of cerebral palsy a person suffers from, insurers can range from offering cover at standard rates to declining the application altogether, writes Lea Taylor
Cerebral palsy is not a disease or illness, it is a permanent motor condition affecting the cerebrum (area of the brain) that affects a baby's posture, movements and co-ordination, with signs normally developing before the age of three.
This condition is either congenital (present at birth) or can be acquired after birth. The usual cause is non-progressive damage to the brain, either suffered during the gestation period or occuring during a difficult birth. It can also happen as a result of a poorly developed brain. Symptoms may vary from an almost unnoticeable spasticity in one limb to severe spasticity and mental impairment.
Causes
Damage to the brain can be caused by various reasons:
n One in 10 babies are affected by lack of oxygen during birth.
n One in 50 babies are affected by a defective gene transmitted by the parents.
n Certain infections during pregnancy, for example, rubella, toxoplasmosis and severe jaundice can affect the nervous system of the foetus.
n Drug or alcohol abuse during pregnancy.
n Recurrent kidney or urinary tract infections during pregnancy can result in cerebral palsy.
Infections in young children, such as meningitis and encephalitis, can also cause swelling of the brain resulting in the death of brain tissue.
Around one in 500 children have some degree of cerebral palsy.
Types
There are three main types, with spastic cerebral palsy being the most common and affecting approximately 70% of sufferers. Symptoms are characterised by permanently stiff or contracted muscles, resulting in jerky movements. It can affect either one or all four limbs:
Classifications of spastic cerebral palsy are split as follows:
n Monoplegia - intellectual function frequently normal and one limb affected.
n Hemiplegia - intellectual function frequently normal with one side of the body affected.
n Diplegia - intellectual function frequently normal with both legs affected.
n Quadriplegia - most severe form, involving all four limbs coupled with severe mental impairment and often epilepsy.
The two least common types are ataxic and athetoid cerebral palsy. The symptoms of ataxic cerebral palsy mainly feature poor co-ordination affecting the senses and balance resulting in difficulty with walking and posture. A tremor may also be a feature. This type affects approximately 5% to 10% of patients. The symptoms of athetoid cerebral palsy include involuntary muscle stiffness and can often affect speech or hearing. Approximately 10% to 20% of patients are affected by this type of cerebral palsy.
Cerebral palsy can also have associated conditions, including epilepsy, visual or hearing problems and speech disorders. Around 60% of cases are affected with epilepsy. Both visual and hearing problems affect approximately 20% of cases.
There is a high prevalence in speech disorders due to the poor co-ordination of the tongue, palate and lip muscles. This can also cause problems with eating and drooling. Malnutrition can be a concern for severe cases with eating difficulties. Around 30% of patients suffer from drooling, which can cause social stigma. There are treatments available to help reduce drooling; surgery, medication and bio-feedback - a method where the patient learns their own swallowing reflexes to combat drooling symptoms.
In addition, there can also be a degree of incontinence.
Sufferers that are unable to walk or weight bear on lower limbs are at an increased risk of thinning or brittle bones, which can increase chances of broken bones.
Approximately 60% of children with cerebral palsy have an IQ of less than 70, however, children with severe cerebral palsy can have normal intelligence levels. It is important to note, however, that not all cerebral palsy sufferers have learning difficulties.
Diagnosis
Diagnosis can be difficult to establish, especially within the first 12 months of life, due to the rapid changes in the brain. It is common practice to wait until babies are around 12 months old before a definite diagnosis is confirmed. Only then can an assessment of the severity begin.
A physical examination is normally the source of initial diagnosis followed by a magnetic resonance imaging or computerised tomography scan. These scans will show up any abnormalities in the cerebrum. Other tests may also be carried out to rule out other conditions with similar symptoms. Blood tests can help identify conditions such as brain tumours or muscular dystrophy. To help identify or rule out epilepsy, an electroencephalogram scan is very effective. This measures the electrical activity in the brain.
Treatment
Cerebral palsy is not a curable condition, as damaged brain tissue cannot be repaired. However, various treatments are available to help alleviate symptoms and to prevent deformities developing further.
Treatments for this condition can vary depending on the type, severity of the condition and each individual's needs.
Physical, behavioural and drug therapy can be used. Surgery can be recommended for more extreme cases.
Physiotherapy and walking aids can help with posture and movements, medication such as muscle relaxant drugs and injections can also be used to reduce the hyperactivity of the muscles. Therapists can also be used to improve communication and behaviour skills.
Patients with extreme muscle contractions that do not respond to other methods of treatment can undergo surgery. The surgical procedure involves the lengthening of the affected muscles or tendons to improve movements. In some cases, groups of muscles or tendons may have to be adjusted to enable the patient any chance of movement such as walking.
Lea Taylor is life and disability underwriter at Aegon Scottish Equitable
