THE PROBLEMS
The first problem faced by the parent of a hurt child is to discover just what it is that their child is, or has. Whether the child's problem is discovered at birth, or a week, a month, or years after birth, or even if the problem is created by some trauma such as an automobile accident during the teenage years, the problem of discovering exactly what has happened is immense for most parents. Most people are extremely ignorant in regards to hurt children. Their limited information usually comprises a collection of "old wives tales," and a few details about a child belonging to some distant relative or neighbor. As traumatic as the discovery that you have a hurt child is, the lack of information intensifies that trauma all the more. The family physician who helped you through your last case of the flu, or who correctly diagnosed your neighbor's heart condition often disappoints you in regards to your hurt child. He frequently cannot even tell you what is wrong with your child, let alone what to do about it. All too often his suggestion is to institutionalize the child as soon as possible. Doctors commonly wish that the problem would simply go away. Either at your doctor's recommendation, or because of our own need for information, you may search further for answers by going to see a “specialist." The specialist usually takes the form of a neurologist, neurosurgeon, orthopedist, or a psychiatrist. The visit with the specialist often is an even more upsetting and frustrating experience than the visit with the family doctor, because the "specialist" should know. Why doesn't your doctor know? Why doesn't the specialist know? Quite frankly, they don't know because almost no one knows!
What is known about the brain today is extremely limited, and of what is known, much of it has just been learned in the last twenty years. Some diagnoses are relatively easy to make, such as Down syndrome, with physical signs which can be seen and chromosome tests which can be used for confirmation. Or to a lesser degree, cerebral palsy, which is used to describe most children with obvious motor problems. But even with these problems, if you ask the physician exactly where the problem is, or what is going to happen to the child, the answers will probably be vague. Unfortunately however, of all the questions asked, the one which is generally answered with the greatest frequency and confidence is the one about which the least is known. That is, what is to become of my child, or what is the prognosis (outlook). Every hurt child is different and almost every hurt child has a chance, if given the opportunity. If every doctor's response to the question of prognosis is simply that he doesn't know, and not that it is hopeless, many, many, more hurt children would improve, and some would have the opportunity for “normal" lives.
SYMPTOMATIC DIAGNOSIS
In order for the parent to begin to understand the nature of their child's problem, it will be necessary to explore the vague and contradictory terminology applied to children with problems. Of the many terms used to categorize children with problems, few are attempts to describe the source of the problem, rather they are descriptions of the symptoms. In that a child may possess a variety of symptoms, a number of different symptomatic labels may be attached to each child. In addition to the problem of more than one term being applicable to an individual child, there is within the fields dealing with such children tremendous difference of opinion and controversy over the definitions and applications of specific terms. A thorough discussion of terms could easily comprise an entire volume in itself, and is outside the scope of this particular text. I wish only to give the parent some understanding of terms which may be applied to their child. In order to simplify the parent's task of acquiring some understanding of the various terms, I will endeavor to define each specific term as it relates to the general term of cerebral palsy, and as it affects or relates to a child's functional abilities.
CEREBRAL PALSY
Cerebral Palsy is a term applied to a group of individuals whose primary handicap is physical, as opposed to mental. These children, as a group, exhibit problems which affect their ability to gain mobility (crawling, creeping, walking), to use their hands (eating, writing, dressing), and to verbalize or talk. This large group is subdivided into lesser groups based primarily upon the specific way in which their muscles, or the control of their muscle function, is abnormal. Within each group the level of severity varies, as well as the areas of the body which are affected. There is also a great deal of overlap. That is, within one child you may see many types of cerebral palsy, or the child may exhibit different forms at various times during development. Except in very severe cases where an obvious injury has occurred (generally around the time of birth) a child may not be diagnosed until six to twenty-four months following birth, as it may be this long before the symptoms become obvious. Cerebral palsy may develop as the result of an injury to the central nervous system before, during, or after birth. Triplegia: Involvement of three extremities, usually both legs and one arm. Monoplegia: Involvement of only one limb. The classifications of cerebral palsy according to syndrome, and in order of frequency are:
SPASTIC
The most common form of cerebral palsy is spastic cerebral palsy. The term "spasticity" refers to the function of individual muscles within the child's body. When a child with spasticity attempts to move the involved limb, or if someone attempts to stretch an involved muscle, the muscle responds with a strong contraction, or tightening. In that the muscle flexion is centered in the flexor muscles, the opposing extensor muscles often become stretched and lose some of their functional ability. If a limb remains in a state of extreme tightening of the flexor muscle, causing a stretching of the extensor for extended periods of time, a condition develops which is known as a "contracture," in which the function of the limb is almost completely inhibited. Spastic involvement of the legs generally results in some degree of "scissoring." The spastic muscles of the legs tend to limit knee movement, while the spastic adductor muscles (inner thigh) of the legs draw the legs inward until they actually cross each other. This motion also tends to rotate the legs inward at the hips, pulling the leg away from the hip socket. In addition, the flexor within the calf tends to pull the heel up which pushes the toes down and rotates the foot inward.
Spastic involvement of the arms results in some degree of tightening of the flexor muscles, so as to pull the elbows in toward the sides of the body, and the hands and wrists toward the chin. The backs of the hands tend to come together, and the fingers flex into a tight fist. The thumb generally is flexed to such a degree as to draw it against the palm of the hand, with the spastic fingers curled over it. Associated with the spastic child one often finds an exaggerated startle response to stimulation, inefficient respiration, curvature of the spine (which results from remaining in an upright position without the necessary development of the trunk muscles which would permit the child to support his spine), and failure to develop normal hip sockets because of his difficulty in achieving normal movement of his legs. Various visual problems, such as nystagmus (vibration of the eyes) or strabismus (lack of convergence the eyes' inability to work together in unison), are also evident. In addition, many spastic children exhibit abnormal electrical activity in their brains with associated seizure activity. In some cases, spastic children also suffer from some loss of mental ability. The author would be remiss if he were not to mention the role of orthopedic surgery in the spastic child. Although orthopedic surgery is thought by many to be indicated in some spastic children, particularly for heel cords, hamstrings, adductors, and hips, it is becoming less popular due to the understanding that the spastic child's problem is his brain and not his muscles, per se, that rehabilitation can often correct such problems without surgery, and that surgery often presents not only a delay to rehabilitative therapy, but a complication often greater than the original problem. For every action, there is a reaction. If the orthopedist cuts a spastic muscle because it is producing an abnormal pull, when the child reaches the developmental age when the cut muscle should be doing its normal job, that developmental movement of the limb will be lost or will be very abnormal. For example, if spastic adductor muscles are cut because they are causing the legs to scissor, their later function of holding the legs directly under the body, when creeping on the hands and knees or walking, will be lost and the legs will tend to spread, causing the child to have difficulties trying to hold the body up straight.
ATHETOSIS
The athetoid child is one of the most perplexing children there is to work with. He is generally an extremely happy child, a delightful, cheerful, optimistic, bright child, whose progress is often extremely slow and difficult. The athetoid child's muscles, although a bit hyper (increased) in tone, react in very abnormal fashion, and the harder the child tries to correct an activity the more uncontrolled his movements become The abnormal motor function of the athetoid is in the form of excessive movement and uncontrolled movement. This uncontrolled movement increases with the child's effort to move with his level of excitement or with environmental stimulation. With excessive stimulation, the athetoid's body flails rapidly and wildly. With relaxation, the abnormal function decreases, and with sleep, disappears. The ath
ปัญหาปัญหาแรกที่ต้องเผชิญ โดยแม่ของเด็กน้อยจะเที่ยวเพียงสิ่งที่ลูก หรือมี ว่าเป็นการค้นพบปัญหาของเด็กที่ เกิด หรือสัปดาห์ เดือน หรือปีหลังคลอด หรือกระทั่งปัญหาสร้าง โดยบาดเจ็บบางอย่างเช่นอุบัติเหตุรถยนต์ในช่วงปีวัยรุ่น ปัญหาของการค้นพบว่าสิ่งที่เกิดขึ้นเป็นอย่างมากสำหรับผู้ปกครองส่วนใหญ่ คนส่วนใหญ่ไม่รู้มากในการไปทำร้ายเด็กได้ ข้อมูลที่จำกัดของพวกเขามักจะประกอบด้วยชุดของ "นิทานภรรยาเก่า" และกี่รายละเอียดเกี่ยวกับเด็กที่อยู่ห่างไกลหรือใกล้เคียงบาง เจ็บปวดที่ดิสคัฟเวอรี่ที่คุณมีเด็กบาดเจ็บได้ ไม่มีข้อมูลมากขึ้น intensifies บาดเจ็บที่คอย แพทย์ครอบครัวที่ช่วยให้คุณผ่านเรื่องของคุณล่าสุดของไข้หวัด หรือที่ถูกวินิจฉัยโรคหัวใจเพื่อนบ้านมักจะลำบากคุณในเด็กบาดเจ็บ เขาบ่อยไม่ได้แจ้งสิ่งผิดปกติกับเด็ก ให้เพียงอย่างเดียวจะทำอะไรเกี่ยวกับมัน ทั้งหมดบ่อยเกินไปแนะนำเขาได้ institutionalize เด็กโดยเร็วที่สุด แพทย์ทั่วไปต้องว่า ปัญหาจะแค่ไป ที่แนะนำของแพทย์ผู้รักษา หรือ เพราะเราเองต้องการข้อมูล คุณอาจค้นหาเพิ่มเติมสำหรับคำตอบไปดู "เชี่ยวชาญ" ผู้เชี่ยวชาญมักจะใช้รูปแบบ ของการ neurologist โรง orthopedist จิตแพทย์ เข้าชม มีผู้เชี่ยวชาญมักจะได้เป็น upsetting ยิ่งยุ่งยากและประสบการณ์มากกว่าไปกับครอบครัวหมอ เพราะ "เชี่ยวชาญ" ควรรู้ ทำไมไม่แพทย์ของคุณทราบหรือไม่ ทำไมไม่เชี่ยวชาญรู้ ค่อนข้างตรงไปตรงมา พวกเขาไม่ทราบ เพราะแทบไม่มีใครรู้ สิ่งที่เรียกว่าเกี่ยวกับสมองวันนี้จำกัดมาก และของสิ่งที่เรียกว่า มากของมันมีเพียงการเรียนรู้ในช่วงยี่สิบปี วิเคราะห์บางง่ายต้องการ เช่นดาวน์ซินโดรม สัญญาณทางกายภาพที่สามารถมองเห็นและทดสอบโครโมโซมซึ่งสามารถใช้ยืนยันได้ หรือ ระดับน้อย สมอง ซึ่งใช้อธิบายเด็กส่วนใหญ่ มีปัญหามอเตอร์ที่ชัดเจน แต่แม้จะ มีปัญหาเหล่านี้ ถ้าคุณถามแพทย์ตรงที่เป็นปัญหา หรืออะไรจะเกิดขึ้นกับเด็ก คำตอบคงจะคลุมเครือ แต่อย่างไรก็ตาม ของทุกคำถามที่ถาม ซึ่งโดยทั่วไปจะตอบความถี่มากที่สุดและมั่นใจได้หนึ่งที่เป็นที่รู้จักน้อยที่สุด นั่นคือ อะไรคือการเป็นลูกของฉัน หรือสิ่งคาดคะเน (outlook) เด็กน้อยทุกคนจะแตกต่างกัน และเด็กน้อยเกือบทุกคนมีโอกาส ถ้าให้โอกาส ถ้า ตอบรับของแพทย์ทุกคำถามที่คาดคะเนนั้นที่เขาไม่รู้ว่า แล้วไม่งั้นจะตา มาก มาก มาย เด็กเจ็บมากต้องปรับปรุง และบางคนจะมีโอกาสสำหรับชีวิต "ปกติ"อาการการวินิจฉัยIn order for the parent to begin to understand the nature of their child's problem, it will be necessary to explore the vague and contradictory terminology applied to children with problems. Of the many terms used to categorize children with problems, few are attempts to describe the source of the problem, rather they are descriptions of the symptoms. In that a child may possess a variety of symptoms, a number of different symptomatic labels may be attached to each child. In addition to the problem of more than one term being applicable to an individual child, there is within the fields dealing with such children tremendous difference of opinion and controversy over the definitions and applications of specific terms. A thorough discussion of terms could easily comprise an entire volume in itself, and is outside the scope of this particular text. I wish only to give the parent some understanding of terms which may be applied to their child. In order to simplify the parent's task of acquiring some understanding of the various terms, I will endeavor to define each specific term as it relates to the general term of cerebral palsy, and as it affects or relates to a child's functional abilities.CEREBRAL PALSYCerebral Palsy is a term applied to a group of individuals whose primary handicap is physical, as opposed to mental. These children, as a group, exhibit problems which affect their ability to gain mobility (crawling, creeping, walking), to use their hands (eating, writing, dressing), and to verbalize or talk. This large group is subdivided into lesser groups based primarily upon the specific way in which their muscles, or the control of their muscle function, is abnormal. Within each group the level of severity varies, as well as the areas of the body which are affected. There is also a great deal of overlap. That is, within one child you may see many types of cerebral palsy, or the child may exhibit different forms at various times during development. Except in very severe cases where an obvious injury has occurred (generally around the time of birth) a child may not be diagnosed until six to twenty-four months following birth, as it may be this long before the symptoms become obvious. Cerebral palsy may develop as the result of an injury to the central nervous system before, during, or after birth. Triplegia: Involvement of three extremities, usually both legs and one arm. Monoplegia: Involvement of only one limb. The classifications of cerebral palsy according to syndrome, and in order of frequency are:SPASTICThe most common form of cerebral palsy is spastic cerebral palsy. The term "spasticity" refers to the function of individual muscles within the child's body. When a child with spasticity attempts to move the involved limb, or if someone attempts to stretch an involved muscle, the muscle responds with a strong contraction, or tightening. In that the muscle flexion is centered in the flexor muscles, the opposing extensor muscles often become stretched and lose some of their functional ability. If a limb remains in a state of extreme tightening of the flexor muscle, causing a stretching of the extensor for extended periods of time, a condition develops which is known as a "contracture," in which the function of the limb is almost completely inhibited. Spastic involvement of the legs generally results in some degree of "scissoring." The spastic muscles of the legs tend to limit knee movement, while the spastic adductor muscles (inner thigh) of the legs draw the legs inward until they actually cross each other. This motion also tends to rotate the legs inward at the hips, pulling the leg away from the hip socket. In addition, the flexor within the calf tends to pull the heel up which pushes the toes down and rotates the foot inward.Spastic involvement of the arms results in some degree of tightening of the flexor muscles, so as to pull the elbows in toward the sides of the body, and the hands and wrists toward the chin. The backs of the hands tend to come together, and the fingers flex into a tight fist. The thumb generally is flexed to such a degree as to draw it against the palm of the hand, with the spastic fingers curled over it. Associated with the spastic child one often finds an exaggerated startle response to stimulation, inefficient respiration, curvature of the spine (which results from remaining in an upright position without the necessary development of the trunk muscles which would permit the child to support his spine), and failure to develop normal hip sockets because of his difficulty in achieving normal movement of his legs. Various visual problems, such as nystagmus (vibration of the eyes) or strabismus (lack of convergence the eyes' inability to work together in unison), are also evident. In addition, many spastic children exhibit abnormal electrical activity in their brains with associated seizure activity. In some cases, spastic children also suffer from some loss of mental ability. The author would be remiss if he were not to mention the role of orthopedic surgery in the spastic child. Although orthopedic surgery is thought by many to be indicated in some spastic children, particularly for heel cords, hamstrings, adductors, and hips, it is becoming less popular due to the understanding that the spastic child's problem is his brain and not his muscles, per se, that rehabilitation can often correct such problems without surgery, and that surgery often presents not only a delay to rehabilitative therapy, but a complication often greater than the original problem. For every action, there is a reaction. If the orthopedist cuts a spastic muscle because it is producing an abnormal pull, when the child reaches the developmental age when the cut muscle should be doing its normal job, that developmental movement of the limb will be lost or will be very abnormal. For example, if spastic adductor muscles are cut because they are causing the legs to scissor, their later function of holding the legs directly under the body, when creeping on the hands and knees or walking, will be lost and the legs will tend to spread, causing the child to have difficulties trying to hold the body up straight.ATHETOSISThe athetoid child is one of the most perplexing children there is to work with. He is generally an extremely happy child, a delightful, cheerful, optimistic, bright child, whose progress is often extremely slow and difficult. The athetoid child's muscles, although a bit hyper (increased) in tone, react in very abnormal fashion, and the harder the child tries to correct an activity the more uncontrolled his movements become The abnormal motor function of the athetoid is in the form of excessive movement and uncontrolled movement. This uncontrolled movement increases with the child's effort to move with his level of excitement or with environmental stimulation. With excessive stimulation, the athetoid's body flails rapidly and wildly. With relaxation, the abnormal function decreases, and with sleep, disappears. The ath
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