ASSOCIATIVE CONDITIONS AND CO-MITIGATING FACTORS

SKIN HEALTH

Children with cerebral palsy are at risk for skin disorders due to the nature, care, and the treatment of their impairments. Skin disorders include minor skin inflammation, allergic reactions to medications, skin irritations from frequent rubbing, scars from surgical procedures, and self-injury (whether voluntary or involuntary).

Skin disorders are either non-infectious or infectious.

Non-Infectious Skin Disorders

Non-infectious skin disorders cannot be spread from one person to another. They include problems caused by adaptive equipment, accidents, trauma, or self-injury, mostly associated with events specific to the individual’s impairment and associative conditions.

For example:

  • Vision impairment – Those with vision loss are more likely to bump into objects they cannot see and therefore have more propensity for traumatic scarring.
  • Hearing impairment – Those with hearing loss may walk into the path of vehicles they do not sense, making them more prone to accidents.
  • Intellectual impairment – Those with intellectual impairment are more likely to exhibit self-injurious behavior.
  • Assistive services and technologies – Those with more rigorous physical therapy or ill-fitting adaptive equipment may have more callus formations where the skin repetitively rubs against clothing or equipment.
  • Oromotor dysfunction – Individuals that experience excessive drooling from oromotor dysfunction may be vulnerable to non-infectious skin irritations, as well.

Infectious Skin Disorders

Infectious skin disorders are communicable and can be spread to others.

There are four types of infectious skin disorders:

  • Bacterial - occurs when the skin is irritated by scratching and itching, or a surgical wound becomes infected. Bacterial infections may involve boils, pimples, folliculitis, and impetigo. Staph infections (clinically referred to as staphylococcus) can spread infection throughout the body. MRSA (clinically referred to as methicillin-resistant staphylococcus aureaus) is a type of staph bacteria resistant to antibiotic treatment commonly used to treat other staph infections.
  • Fungal – is inflammation from exposure to fungus, such as athlete’s foot, yeast infection, nail infection, or ringworm. Warm and moist skin is particularly susceptible to fungal infections.
  • Parasitic – occurs when the skin encounters a parasite, such as head lice, dust mites, fleas, or scabies. Parasites can live on the skin (ectoparasites) or live inside the body (endoparasites). Some parasites reside in the gastrointestinal tract, a condition generally caused by poor hygiene or coming into contact with feces.
  • Viral – infections caused by a virus within the body. A virus will infect body tissue, including the brain and skin. Viruses are fought by the body’s immune system and do not respond to antibiotic treatment.

Skin disorders can result from:

  • genetic predisposition
  • nutritional deficiencies
  • vitamin deficiencies
  • exposure to contagions
  • poor hygiene
  • constant irritation

Prevention Measures to Avoid Skin Disorders

It is recommended that children maintain healthy diets, exercise, wash, and adhere to healthy sleep routines. Measures should be taken to avoid accidents, irritation and self-inflicted injuries.

Prevention measures include:

  • Moisturizing skin – Skin must be washed, moisturized, and kept dry.
  • Washing hands - Hands should be washed often, especially after sneezing, coughing, toileting, play, and before meals.
  • Cleansing hair – Hair should be washed and moisturized. Clothing should be washed and changed often.
  • Trimming nails – Nails should be trimmed, and care should be taken to not use the same trimmers on abnormal nails.
  • Maintaining orthotics – Orthotics and adaptive equipment should be properly washed, dried, positioned, and checked for proper fit.
  • Positioning for circulation – If the child is not mobile, care must be taken to increase blood circulation through posture, positioning, and massage.
  • Changing incontinence products timely – Diapers, under pads, or incontinence products must be changed often and checked for proper sizing.
  • Freshening bedding – Bedding should be changed regularly. Bed sheets should be periodically checked for bed bugs or dust mites, hair checked for lice, and skin checked, particularly underarms, buttocks, groin, arms and legs for skin irritation.
  • Checking for allergic reactions – Care should be taken to ensure the child does not have an allergic reaction to such things as deodorants, moisturizers, lotions, laundry detergent, fabric softeners, soaps, perfume, under pads, or medications.
  • Sizing clothing properly – Clothing should not be too tight or too loose. Shoes should be checked for proper sizing.
  • Keep open wounds clean – Scars, bed sores, pressure sores, surgical incisions, and wounds should be properly cared for.

Treatment Options for Skin Disorders

The child’s primary care physician is the first line of defense against infections or skin disorders that are not easily treated by proper hygiene and over-the-counter topical medication. Your child may be referred to a dermatologist for skin disorders, gastroenterologist for intestinal concerns, or urologist (or gynecologist) for urinary tract infections or infections around genitalia.

Skin disorders include:

  • Bacterial infection
  • Boils
  • Congenital skin disorders
  • Folliculitis
  • Fungal infection
  • MRSA infection
  • Nail infection
  • Parasitic infection
  • Pimples
  • Pressure sores
  • Psoriasis
  • Ringworm
  • Scabies
  • Skin infections
  • Skin irritation
  • Skin ulcers
  • Staph infection
  • Viral infection
  • Yeast infection

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: