ASSOCIATIVE CONDITIONS AND CO-MITIGATING FACTORS

RESPIRATORY

It is common for children with cerebral palsy, especially severe forms, to experience respiratory complications. Proper respiratory function depends on the ability to breath properly, cough correctly, and identify respiratory infections promptly. Children with cerebral palsy, especially those who are not able to communicate, are often unable to disclose discomfort while problems go undetected for long periods of time.

Typically, a child with cerebral palsy has a lower activity level than most children. When a child is unable to exercise in a manner that causes deep breathing, air passages are more likely to become infected and the muscles used for breathing aren’t fully exercised. Exercising the lungs to clear phlegm.

If children experience trouble controlling muscle function and have feeding or swallowing difficulties, they may also be unable to cough up material left in the passageways, which can contribute to infection.

If a child has a structural deformity, such as curvature of the spine, muscle tone and gravity may contribute to chest wall deformity, which, in turn, can lead to restricted lung function and the potential for unequal lung expansion. When breathing is labored, it predisposes a child to respiratory dysfunction and, in some extreme cases, failure.

Children with cerebral palsy are often born preterm. Premature babies frequently arrive with serious lung conditions, like bronchopulmonary dysplasia and respiratory distress syndrome. Lack of oxygen during pregnancy or during birth can cause cerebral palsy.

Malnourished or undernourished children are subject to atrophy and weakness that can also reduce lung function and lead to a weakened resistance to infection. Those with frequent aspiration are more prone to develop pneumonia, as well, which is a serious condition for young children.

Respiratory Health Must Be Monitored

Parents are urged to monitor their child’s respiratory health. If the child experiences recurrent chest infections, pneumonia, frequent aspiration, or persistent coughs, a respiratory specialist is warranted. Upon evaluation they may even refer the child to a gastroenterologist, a dietician or a speech and language therapist for additional assessment.

If the child is unable to control and coordinate facial muscles – properly sealing lips around a mouthpiece, for example – some tests required to assess respiratory conditions, as well as some therapy options, may be recommended.

Respiratory Functioning is a Factor in Life Expectancy

Respiratory difficulties can lead to serious health risks including aspiration, pneumonia and respiratory failure. Maintaining optimal respiratory health is a key component to life expectancy in those with cerebral palsy.

Respiratory functioning, as well as swallowing and chewing difficulties, is a factor in reduced life expectancy for children with cerebral palsy. Respiratory dysfunction can lead to malnutrition. Respiratory distress makes it difficult for the body to function and can lead to life-threatening heart conditions.

Difficulty in swallowing and feeding can lead to the inhalation of food particles. This can cause infection in the lungs or pneumonia, which are also of concern. Severity and frequency of respiratory infection is a significant life expectancy factor.

For more information, Life Expectancy of Cerebral Palsy

Respiratory Interventions Promote Healthy Breathing

Lung function, sleep apnea, breathing functions and coughing mechanisms can be assessed. Nutritional assessments recommend to feeding interventions which can improve respiratory function.

Respiratory intervention may include a number of potential options; respiratory supports, inhalers, feeding instructions, speech therapy, dietary changes, nutrition counseling, prophylactic antibiotics, and options that involve nasogastic intubation in the short-term, or gastrostomy for long-term intervention.

The goal of respiratory intervention is to increase quality-of-life, promote healthier breathing options, and reduce risk of (or prevent) life-threatening health conditions.

Respiratory conditions commonly associated with cerebral palsy which requires identification, treatment and prevention, include:

  • Aspiration
  • Aspiration pneumonia
  • Asthma
  • Breathing problems
  • Bronchiolitis
  • Bronchopulmonary dysplasia
  • Bronchitis
  • Chronic lung disease
  • Gastro-esophageal reflux (GER)
  • Gastroesophageal reflux disease (GERD)
  • Respiratory complications
  • Respiratory distress syndrome (RDS)

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 oral motor 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: