ASSOCIATIVE CONDITIONS AND CO-MITIGATING FACTORS

NEUROLOGIC

Cerebral palsy is caused by brain injury or brain malformation that occurs while the brain is still developing — during the fetal stage, at birth, or after birth — in areas of the brain that affect motor control. The damage does not progress, which differentiates cerebral palsy from similar disorders. However, accompanying health conditions, such as epilepsy, intellectual impairment, hearing and visual impairment or loss, and learning disabilities, can change over time.

The brain damage that causes cerebral palsy is a result of either:

  • Prenatal disturbance of brain cell migration - Genetic and environmental factors disturb brain cell migration as cells move to their appropriate location during brain development.
  • Prenatal poor myelination (insulation) of developing nerve cell fibers – Brain function is impeded when poor myelin provides an inadequate protective covering over nerve cells that aid in transmission.
  • Perinatal brain cell death – Events in the birthing process that rupture blood vessels or starve oxygen to the brain.
  • Postnatal non-functional or inappropriate connections (synapses) between brain cells – Trauma, infections, and asphyxia that damage connections developed in the brain.

The brain injury or brain malformation in cerebral palsy is the result of one of four types of brain damage that cause motor impairment. The four types are:

  • Periventricular Leukomalacia (PVL) – damage to the white matter tissue in the brain
  • Intracranial Hemorrhage (IVH) – brain hemorrhage
  • Cerebral Dysgenesis – brain malformation or abnormal brain development
  • Hypoxic-Ischemic Encephalopath (HIE) or Intrapartum Asphyxia – lack of oxygen to the brain, also known as asphyxia

Neurologists and neuroradiologists are essential in diagnosing the brain injury or brain abnormality that caused cerebral palsy. They also attempt to discern the cause of the brain damage, but cause may not be determined in all cases. Neurologists specialize in diagnosing and treating disorders of the central nervous system, such as brain, muscles, and nerves, while neuroradiologists specialize in clinical imaging, therapy, and the science of the central and peripheral nervous system.

These specialists prefer to perform MRIs or CT scans to aid in diagnosis. In severe cases, cranial ultrasounds may be ordered at specific times after birth. No definitive test can predict or determine cerebral palsy. In most cases, it is not formally diagnosed until the brain is more fully developed and the child’s growth and development can be observed over time.

Seizures, autism, apraxia, and intellectual impairment are some of the most common neurological disorders that may also accompany cerebral palsy.

Seizures are Commonly Associated with Cerebral Palsy

It is estimated that as many as half of those with cerebral palsy are also affected by seizures. Several types of seizures exist:

  • Tonic-clonic seizures - A tonic-clonic, formerly known as grand mal, seizure is the most common type of seizure for those with cerebral palsy. In a tonic-clonic state, the person may cry out, stiffen, fall to the ground, shake or jerk, and bite the tongue. The electrical activity is registered as full-brain.
  • Focal seizures - In focal (partial) seizures, activity registers in a portion of the brain and can be called “simple” when not impacting awareness or memory; or, “complex” when momentarily affecting awareness or memory. Focal seizures generally do not cause loss of consciousness.
  • Petit mal seizures - In petit mal seizures, a short-term loss of consciousness occurs, but lasts only a few seconds with rapid recovery. During this time, the person’s speech or activity may momentarily stop.

Intellectual Impairment is Found in a Majority of Cerebral Palsy Cases

It is estimated that two-thirds of cerebral palsy cases will also be diagnosed with an intellectual impairment. This is more common in cases of spastic quadriplegia than other forms of cerebral palsy. Intellectual impairment affects a person’s ability to communicate, care for self, and socialize. A person with intellectual impairment may have trouble learning, thinking, solving problems, and reasoning.

Neurological damage can impair a person’s speech capabilities. With cerebral palsy, the brain damage results in a muscular control condition. It does not result in an intellectual impairment, although both conditions can co-exist.

Other Neurologic Conditions May Co-Exist with Cerebral Palsy

A child’s perception is sometimes affected. Partial or total hearing and/or vision loss is also common. In most cases, the brain damage that caused cerebral palsy differs from the brain damage that lead to other neurologic conditions. When this happens, they are referred to as co-mitigating factors, meaning they are seperate conditions both requiring treatment.

Neurologic conditions which may be associated or co-existing with cerebral palsy include:

  • Apraxia
  • Autism
  • Cognitive impairment
  • Communication difficulties
  • Epilepsy
  • Learning disabilities
  • Intellectual impairment
  • Mental health
  • Neurological impairment
  • Pervasive developmental disorder
  • Progressive development disease
  • Psychosocial problems
  • Psychological disorder
  • Seizure disorder

Every Child’s Condition Is Unique

The list of possible primary, secondary, and associative conditions, as well as co-mitigating factors, can be grouped into categories, but not all conditions will be experienced by an individual with cerebral palsy. Some may encounter conditions not listed, as well.

Cerebral palsy can take a mild, moderate, or severe form depending on a host of factors. The type, location, and extent of impairment are considered, as well as any associative conditions and co-mitigating factors, when creating a treatment plan. Over the course of the person’s life, he or she may encounter any number of associative or co-mitigating factors.

Cerebral palsy is non-progressive, meaning the brain injury or malformation will not progress in severity. However, secondary conditions resulting from the brain damage may develop and change over time. For example, brain injury can cause facial muscle impairment which doesn’t change over time. Chewing, swallowing and aspiration can occur when facial muscles are impaired. Aspiration can lead to pneumonia, and pneumonia is a health condition that can become worse or better over time.

Impairments can change with – or without – proper management. As a person ages, the muscular-skeletal structure may age prematurely depending on postural conditions, care, treatment and therapy. Other health conditions or life circumstances may also affect the individual’s condition over time. These can include access to health care, health insurance benefits, exposure to toxins, new health conditions, socialization, exercise, and traumatic accidents or events.

MyChild™ lists the possibilities in hope of providing families with a better understanding of the types of conditions – and categories of conditions – an individual with cerebral palsy may encounter over their lifespan. An overview of the different types of professionals likely to treat these conditions is also contained here. It should be noted that MyChild™ does not dispense medical advice. Any conditions your child may experience should be discussed with his or her medical team for proper diagnosis and treatment. In the case of emergencies, contact 911 immediately.

ASSOCIATIVE CONDITIONS AND CO-MITIGATING FACTORS Proper Terminology

Because the terminology used is so specific, yet remarkably similar, terms such as primary, secondary, associative and co-mitigating conditions are used interchangeably, yet incorrectly. It is helpful to know the difference between the terms when attempting to understand cerebral palsy.

Primary condition - These are a direct result of the brain lesion or brain malformation. Primary conditions affect motor coordination, motor control, muscle tone, posture and balance. Gross motor, fine motor, and oromotor functioning are also considered primary conditions of cerebral palsy.

Secondary condition - Primary conditions, in turn, may lead to secondary conditions such as inability to chew, inability to swallow, breathing difficulties, bladder and bowel control issues, and communication difficulties. If the brain lesion or malformation that caused cerebral palsy did not exist, these secondary conditions would not be present.

Associative conditions - Research has shown that individuals with cerebral palsy often have associative conditions not caused by the same brain injury or malformation which caused cerebral palsy, but proven to be common with individuals who have cerebral palsy. If the brain injury or malformation that caused the cerebral palsy did not occur, these conditions may still be present in the individual. Associative conditions include intellectual impairment, epileptic seizures, hearing impairment, and vision impairment.

Co-mitigating factors - An individual may also have health conditions separate from cerebral palsy. Unlike associative conditions, researchers have not concluded that these conditions have a high correlation to cerebral palsy. Co-mitigating factors exist regardless of cerebral palsy. Examples of co-mitigating conditions of cerebral palsy include autism, attention deficit hyperactivity disorder (ADHD), and asthma.

Associative Conditions and Co-Mitigating Factors

There are eight major categories of associative conditions and co-mitigating factors. To learn more about them, click one of the following: