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Tuesday, March 5, 2019





Understanding Cerebral Palsy
Cerebral palsy is not a disease but it is a group of disabilities that affect children very early in life. It may be mild or severe in nature. Children with cerebral palsy have weak or stiff muscles resulting in uncoordinated muscle movements and difficulty in controlling the muscle movements.
Cerebral palsy can occur at any stage- in the fetus stage, during delivery or after birth of the child. During pregnancy, if infections like chicken pox or rubella affect the mother, then there is a chance that there can be brain damage to the developing fetus, resulting in cerebral palsy. If there is disruption of blood supply to the developing fetus, then a fetus stroke occurs resulting in cerebral palsy.
In case of a difficult delivery, there can be lack of oxygen to the baby’s brain resulting in its damage leading to cerebral palsy. Severe jaundice (yellow discoloration of skin due to bile pigment), meningitis (swelling of membranes around brain and spinal cord), and viral encephalitis (swelling of brain due to viral infection) can cause cerebral palsy in infants. The other causes of cerebral palsy in infants include malnutrition, lead poisoning, shaken baby syndrome (baby shaken as an infant), and trauma to head during a car accident.

Types of Cerebral palsy
There are three types of cerebral palsy.
In Spastic Cerebral Palsy, a single leg on one side or both legs and arms can be affected, and the child may have difficulty in movement as the muscles become stiff.
In Athetotic Cerebral Palsy, the entire body is affected and the body shows slow movements which are not controlled.
Ataxic Cerebral Palsy is the least common of the three types. In this type, there is no coordination and balance in the body.

A child with cerebral palsy may have stiff or floppy muscles with no muscle coordination (ataxia), and involuntary movements or tremors. The reflexes may be exaggerated, a condition called as spasticity, and there could be writhing movements that are slow (athetosis). The child may have delay in sitting up or crawling, and face difficulty in walking, eating or sucking, and speaking. The child may use only one side of body like reaching things with only one hand. The other problems associated with cerebral palsy included mental retardation, disability in learning, difficulty in hearing, vision problems, seizures, dental problems, and involuntary leakage of urine.

The doctor may conduct a series of tests to check for brain damage. To get 3D cross sectional image of the brain, a magnetic resonance imaging procedure is done in which radio waves and a magnetic field is used to produce required images of the brain. This is a painless procedure and takes about one hour to complete. The child is given a mild sedative for the procedure. Another procedure that is used is cranial ultrasound in which sound waves of high frequency are used to produce detailed images of the brain. In a procedure known as computerized tomography (CT scan), X rays are used to get cross sectional images of the child’s brain. It takes about 20 minutes for this procedure and the child is given a mild sedative so that he or she remains still during the procedure. If the child has seizures, then an EEG (electro encephalogram) is taken to check for the electrical activity of the child’s brain.
To rule out underlying problems that can cause cerebral palsy, lab tests like blood tests and assessment tests by specialists are done. The tests are done to find out if the child has any problems like blood clotting disorders, hearing impairment, vision problem, speech delays, mental retardation, and developmental delays.

There is no cure for cerebral palsy. However, the doctor may advise therapies that are beneficial for the child. Physical therapy involves muscle training and exercise to help the child develop balance, coordination, flexibility, and strength of muscles. The child also learns to sit on a wheel chair, use crutches, braces, and splints which will improve the child’s walking ability. In occupational therapy, the child is taught how to do normal activities at home and school like writing and improving on motor skills. In speech therapy, the child is taught how to speak in words or sign language and how to eat and swallow.
Muscle relaxants may be prescribed to reduce the stiffness of muscles. They include drugs like baclofen, dantrolene (dantrium), tizanidine (zanaflex), diazepam (diazepam, intensol, valium). In case of seizures, the doctor prescribes anticonvulsant. To reduce spasticity of muscle, Botox injections are directly given into the muscle or nerve.
Orthopedic surgery is recommended in children who have deformed bones and joints. The surgery helps in placing bones and joints in correct positions, and also to lengthen muscles and tendons that become too short due to contractures. Nerves that innervate the spastic muscles are surgically cut to relax the muscles and reduce pain.
Inspiring Jerry Traylor
‘Twelve individuals have landed on the moon and only one has jogged across America on crutches’. This one sentence says a lot about Jerry Traylor who is a well known motivational speaker with Cerebral palsy. When Jerry was just 6 years of age, he spent a year at the hospital getting 14 corrective surgeries done for his walking disability caused due to cerebral palsy. Jerry went on to participate in 35 marathons and climbing the top of 14,110 foot Pike’s Peak overcoming his disability. In Jerry’s own words he says, “Success is learning to control our limitations, rather than those limitations to gain control over us.”

Growth is very rapid during adolescence and teenage, and sufficient amount of calcium is needed during this period. But many do not get the recommended amount of calcium, which differs according to the age of the person. Calcium is found in abundance in many food sources. It is better to obtain calcium form food sources rather than taking calcium tablets. Foods that are rich in calcium are listed down
Nonfat and low-fat dairy products like cheese, yogurt, and milk
Dried beans
Pink salmon
Brewer’s yeast
Brazil nut
Dried fig
Dark leafy greens
Canned salmons
Fortified calcium foods include Orange juice, soy milk, rice milk, breads, and dry breakfast cereals
Dietary requirement of calcium
Our body does not have the capability to produce calcium, therefore it requires sufficient amount of calcium from dietary sources to form healthy bones and teeth. It is important to make sure that the required amount of calcium is provided to the body. If a person is below 50 years of age, he needs about 1000 milligram (mg) of calcium per day, and if the person is above 50 years then 1200 mg of calcium is required per day. Teen age guys and girls require about 1300 mg per day. High amount of calcium is required in old age, during pregnancy, and in teenage. Rather than taking the required amount of calcium all at once, it is better if the person takes twice or thrice throughout the day. Along with calcium the person should also make sure that the body is provided with enough vitamin-D for effective calcium absorption.

Calcium deficiency
The normal level of calcium in blood is 8.5 to 10.2 mg/dL.  If serum blood calcium level falls below this level then the person is said to be calcium deficient person, the condition is called as hypocalcaemia. If the body does not get enough calcium it starts taking the calcium from bone for other vital functions of the body. As time goes by, the bones may be eroded to the maximum and result in reduced bone mass/weak bones. Calcium deficiency may result in many health complications like
Osteoporosis, weakening of bone due to calcium depletion, especially in old and post-menopausal women
Frequent fracture
Deformed spine with hump
Loss of height
Rickets (soft weak bones) in children, rickets is actually caused by vitamin-D deficiency, which is required for absorption of calcium
Hypoparathyroidism: Decreased parathyroid hormone that is essential for regulating calcium levels in the body
High blood pressure: People deficient in calcium show signs of hypertension. Few studies show that calcium reduces blood pressure. But it is not clear whether calcium is actually beneficial or the low-fat dairy product is responsible
Nerves and bone disorder
Premenstrual syndrome: Calcium helps to reduce premenstrual syndrome symptoms and menstrual pain
Tingling of fingers
Muscle cramps
Convulsions (involuntary contraction of muscles)
Poor appetite
Mental confusion
Abnormal heartbeat

Calcium supplements
People who suffer from calcium deficiency require calcium supplements. Calcium supplements are usually recommended to menopausal women. They should take calcium supplement along with magnesium as they work together. Calcium and magnesium is usually prescribed in a ratio of 2:1, for instance if the woman is taking 1000mg of calcium then 500mg of magnesium is prescribed. Calcium supplements usually come in two forms- Calcium carbonate and Calcium citrate. Over-the-counter antacid contain calcium carbonate and can give the required amount of calcium. Remember to always take calcium carbonate with meals and calcium citrate on empty stomach to avoid side-effects. Other thyroid or iron supplements should be taken separate from calcium supplements. Other calcium supplements used are calcium phosphate, calcium gluconate, calcium glubionate, and calcium lactate.

Too much of calcium
Calcium level higher than 10.5 milligram per deciliter of blood is termed as hypercalcemia. Normally, the amount of calcium taken by bones is equal to the amount of calcium let out of bones. This helps to maintain blood calcium level. If a person has hyperparathyroidism, then the amount of calcium coming out from the bone is higher than the amount of calcium taken back by the bone. This increases calcium level in blood stream. Too much of calcium in blood causes pain in bones, fracture, loss of height, curving of spine, high blood pressure, kidney stones, increased thirsty, frequent urination, constipation, nausea, lethargy, fatigue, abdominal pain, decreased appetite, confusion, memory problem, dementia, and depression.

Calcium- No bones about it…
As calcium is a very vital element that has many important functions in our body it is essential to keep a track on the amount of calcium intake. Try to maintain the intake within a safe range. The person can consult a dietician to know the right amount of calcium per day depending on age and other health conditions. Do not take calcium fortified drinks or over-the counter calcium medicines. Calcium supplements should be taken after consulting a nephrologist (kidney specialist).


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