Understanding Cerebral Palsy

Definition of Cerebral palsy

Cerebral palsy is a medical condition that affects people and occurs during the early years of life and may persist through the entire lifetime of the affected patients. The condition results from brain development defects during the prenatal stages of life and its manifestation occurs within the first 18 months of the child development and or later in life (Abbaskhanian et al. 2015). This study defines cerebral palsy as a group of movement disorders that appear in childhood. The disorders are manifested with difficulties in sensation, vision, hearing, swallowing and speaking due to defects in the respective muscles and brain parts responsible for movement and coordination (NICE 2017).

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The manifestation of cerebral palsy is varying and can thus be classified into categories. This classification is based on motor impairment of the limbs or organs and restrictions on the activities the affected person may perform (Ashehri & Bach, 2014). However, some studies have also used communication function classification system to classify cerebral palsy (Abbaskhanian et al. 2015). Spastic cerebral palsy is a type of condition where spasticity or the stiffness of muscles is the exclusive or almost exclusive impairment. This condition is the most common and accounts for over 70% of all the cases of cerebral palsy. Patients with this kind of condition have difficulties in movement due to the stiffness of the muscles and are hypertonic (NSW 2017). Stiffness of the muscles results from the neuromuscular mobility impairment by the development of upper motor neuron lesion in the brain and corticospinal tract or the motor cortex.

Ataxic cerebral palsy accounts for 5 to 10% of all cases of cerebral palsy and occurs following the damage of the cerebellar tissues. This results in coordination problems of the arms, legs, and trunk of the patients with this type of condition (Abbaskhanian et al. 2015). On the other hand, athetoid also known as dyskinetic cerebral palsy results from the damage to the basal ganglia and the substantia nigra through the lesions during brain development (NSW 2017). This is condition accounts for 2-5% of all the cases and manifests through motor functions and neuroimaging techniques. Mixed cerebral palsy is a rare condition but individuals with these conditions manifest symptoms athetoid, ataxic and spastic cerebral palsy simultaneously at varying degrees (NSW 2017). This is the most difficult condition to manage.

Regardless of the type of cerebral palsy affecting the people, there are particular causes that have been attributed to cerebral palsy. Brain damage during the brain development stage is the most pronounced cause of the condition (NICE 2017). The damage affects the brain part responsible for coordination and movement. This makes it difficult for some body parts such as muscles to function properly. Interference in oxygen supply is another cuase of cerebral palsy. This can occur in different stages of human development especially when the baby is still in the womb or during delivery. Bleeding, separation of the placenta and compression of the cord are common instances for interference of oxygen supply between mother and baby (Ashehri & Bach, 2014).

Nutritional deficiencies during the prenatal period may lead to poor brain development of the foetus. Lack of proper feeding during pregnancy may impact negatively impact the nourishment of the baby, brain development included (Abbaskhanian et al. 2015). Furthermore, babies born prematurely have immature blood vessels which can lead to the cerebral haemorrhage.Regardless of the category of cerebral palsy and the affected part of development, movement, and coordination, pain is a common feeling to patients with this condition.

Pain management nursing

Patients with cerebral palsy report continuous pains that disturb their life and the activities that could otherwise bring them happiness and satisfaction. These pains range from physical pains to psychological. Physical pains include muscles and body parts pains whereas psychological pains include stress and depressions occasioning from numerous feelings of isolation, discrimination, and self-doubt. Thus, nursing intervention is crucial in helping such patients. Bearing in mind that these pains can be prolonged and patients may need intensive care, the nursing practice provides the systematic guide to nurses in providing care to the patients (IASP 2011).

Assessment is the primary phase for nursing intervention. The initial contact between the nurse and the patients is the beginning of the assessment to establish the magnitude of the pains that the patient experience (Hammilton & Price 2013). The nurse relies on the self-report of pain from the patient for assessment. In an instance where the patient is a child, the parent can provide the report of the pain experienced by the patient

The assessment phase captures crucial information for the entire nursing intervention. The patient’s information regarding the history of the patient and the medical condition, neurological as well as physical examination can help in understanding the pain experienced by the patient (Yildrim & Ozkahraman 2011). This information will be quite useful in the assessment and other stages of intervention.

To acquire this information, the nurse can interview the patient through select and specific questions. In case the patient with cerebral palsy is the child, the parent or guardian will provide crucial information required by the nurse.

The diagnosis phase of nursing intervention is focused on the examination of the exact pain affecting cerebral palsy patients. Having successfully assessed the patient, the nurse runs tests to establish and ascertain the pain experienced by the patient. Hogston (2011) explains that this stage is crucial since it will aid the nurse to provide focuses pain management care to the patient depending on their specific needs. This rides on the fact that despite the fact that patients may suffer from cerebral palsy, the manifestation and magnitude of associated pain are dynamic from one patient to the other. Thus, the nurse has an obligation to ensure that specific pain of the patient is identified for tailored and patient-centered care.

As a result of the diagnosis, the nurse may identify a number of activities that can bring pains associated with cerebral palsy that affect the patient. These include risk of injury, impaired physical mobility, self-care deficit, risk of aspiration and disturbed thought process (Pasero & Mccaffery, 2011). Other aspects are changes in growth and development, impaired verbal communication, medical operations, and deficient knowledge. These and other activities can result in an increased risk for prolonged pains to cerebral palsy patients.

The planning stage follows assessment and diagnosis and entails acquiring the relevant materials and resources needed for the execution phase. During planning phase, the nurse ensures that care to be accorded to cerebral palsy patient is organized and depend on the necessities and needs of the patient. However, the activity plan should be proof-based, practical and objective focused (NSW 2017).

The execution phase is the actual implementation of intervention. The nurse provides care to the patient in a practical way. During this phase, record keeping, follow-up, monitoring, and support are crucial in managing the pain of the patients (Hammilton & Price 2013). For patients with cerebral palsy, there are a number of interventions that the nurse can execute for effective pain management. It is important to note that the nurse might combine two or more interventions in order to effectively manage the pain of the patients.

Cognitive and psychological care is an intervention that can be used to manage the emotional and psychological pains of the patients. Since the cause of cerebral palsy originates during brain development, the patient may grapple with psychological pains during their life (NICE 2017). The nurse can ease this pain by providing emotional support, therapeutic communication, and self- esteem measures aimed at building the feeling of acceptance and self-worth of the patients.

Injury prevention is another intervention measure that can be accorded to patients with cerebral palsy. There are activities that can cause injury to patients with cerebral palsy and thus, the nurse should endeavour to help the patients avoid risky behaviours that can cause injury and thus reduce physical pain (Ashehri & Bach 2014).

Medical intervention entails providing prescriptions of medicines to patients with cerebral palsy to alleviate various pains that have a medical history. Medication can range from managing headaches to muscle and spinal/bone pains that might be accompanying the condition. In case of a serious condition, evaluation from specialized doctor would be helpful. Other interventions include mobility encouragement, enhancing self-care, and family support (Abbaskhanian et al. 2015). Patient-centred care will ideally help the nurse provide comprehensive pain management care. Evaluation is a crucial stage that comes after the execution of the intervention and aims at examining the objective and activity plan to establish whether the goals of the intervention were achieved (Hogston 2011). The post-implementation assessment helps the nurse evaluate the effectiveness of the intervention.

Conclusion

Understanding the fact that cerebral palsy is a lifelong condition and continues to affect people across the globe, nursing care is undoubtedly crucial. Patients with cerebral palsy grapple with different pains some of which are excruciating and thus the nurse’s role in pain management is crucial.

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References:

  • Abbaskhanian A, Rashedi V, Delpak A, et al. 2015. Rehabilitation interventions for children with cerebral palsy: a systematic review, journal of paediatric review.
  • Alshehri, A & Bach, C. 2014. Challenges of cerebral palsy management. University of Bridgeport, USA
  • Hamilton P, Price T 2013. The nursing process, holistic assessment and baseline observations. In: Brooker C, Waugh A (eds) Nursing Practice: Fundamentals of Holistic Care. Mosby Elsevier, London. 303–36
  • Hogston R 2011. Managing nursing care. In: Foundations of Nursing Practice: Themes, Concepts and Frameworks. 4th edn. Palgrave Macmillan, London. 2–21
  • International Association for the Study of Pain. 2011. IASP Declaration of Montreal. Statement of access to pain management as a fundamental human right.
  • NICE 2017. Cerebral palsy in children and young people, national institute for health and care excellence.
  • NSW (2017): Management of cerebral palsy in children; a guide to health for allied health professionals, ministry of health, North Sydney government.
  • Pasero, C., & McCaffery, M. 2011. Pain assessment and pharmacologic management. St. Louis: Mosby.
  • Yildirim B, Ozkahraman S 2011. Critical thinking in nursing process and education, Int. J Human Soc Sci Res 1(13): 257–62

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