(no subject)
So I learned something the other day.
I learned why many presentations of cerebral palsy are not diagnosed until later in childhood.
Cerebral palsy is an umbrella term for a group of conditions that relate to motor and/or mental disabilities which are the result of damge done to the brain in utero or shortly after birth. Cerebral palsy (CP) is the diagnosis that gets a lot of obstetricians sued, because the thought is that if the child is denied oxygen during the delivery process it leads to CP. That is why there is so much documentation nowadays during the delivery, we need to state that absolutely nothing went wrong and that the child came out fine, or alternatively what exactly went wrong and how the obstetrician did everything they could to fix the situation.
But interestingly enough, only 10-20% of brain damage is thought occur during the delivery process. 80% of accidents that cause cerebral palsy occur in utero. The causes are numerous, and include viral infection, problems with the placenta, with implantation, and anything and everything that can cause hypoxia or stroke. A lot of CP is due to the fetus having a stroke in utero. Some is also due to premature babies developing an intercerebral hemorrhage, a bleed inside the brain that is more common in premature infants because their brains aren't finished developing and are more vulnerable to hypoxic accidents.
But the thing is, many of these kids look fine for their first year. Or even for there first three or five years. We've got several babies in the NICU now who pass their neurological exams with flying colours, but that doesn't mean they don't have cerebral palsy. That's because the infant's brain is non-myelinated. Myelin is the fatty coat that covers a grand percentage of our nervous system. It helps our nerves conduct electrical impulses faster. Our brain selectively myelinates the important pathways so information travels faster. For example, our muscle systems are myelinated. But our pain sensors are not. Pain information is still sent around the brain, but it is sent slower. One would think this would be disaterous, since when things hurt we need to move fast! But even without myelination our nerves can still conduct quickly, and our spinal cord has taken over several of the pain-induced reflexes that we have, which makes our response to a painful stimulus quicker than it would other wise be.
The interesting thing in infants brains is that they have virtually no myleination. They are basically brain-stem creatures. All their magnificant wonder at the world - and their wonderful neurological exams, which are fun to do - are all brain-stem level thinking. As they grow, they begin to myelinate and use the rest of their brains. And this is when we begin to realise that brain damage has occured. There is no way to know, for example, if the infant has brain damage that affects the control of their legs if they aren't using the part of the brain that controls the gross motor of their legs. Sure infants move their legs, they can even learn to stand, but they don't walk. And so it's impossible to know if they have difficulty with the part of their brain that controls walking until they get older enough to stand up and try it.
I found that very interesting.
The good thing about cerebral palsy is that most of the brain damage it's associated with is purely motor. Some children do have learning disabilities or other indications of 'mental processing' damage, but its more rare. This is because the parts of the brain that are more susceptible to hypoxia in utero and during/after delivery are the motor areas. This is because the nerve fibers that control our limbs - and most especially the lower limbs - happen to cross to the brain stem near an area that is susceptible to hypoxic damage. It's purely a function of geography in the brain.
Okay, that's my teaching session for today. Just something I found neat about babies brains. It's wonderful for me to think that their insatiable curiosity comes because they are laying down the myelination patterns that will set them up for life. Not only are they learning about the world, they are learning what they can do in the world. They are learning where their hands and feet are, how to turn their head and discover a whole new side of the room! Their eyes are wide and questioning because they are absorbing information at a fantastic rate - and shaping the myelination pattern of their brains while they do it. Fascinating!
I learned why many presentations of cerebral palsy are not diagnosed until later in childhood.
Cerebral palsy is an umbrella term for a group of conditions that relate to motor and/or mental disabilities which are the result of damge done to the brain in utero or shortly after birth. Cerebral palsy (CP) is the diagnosis that gets a lot of obstetricians sued, because the thought is that if the child is denied oxygen during the delivery process it leads to CP. That is why there is so much documentation nowadays during the delivery, we need to state that absolutely nothing went wrong and that the child came out fine, or alternatively what exactly went wrong and how the obstetrician did everything they could to fix the situation.
But interestingly enough, only 10-20% of brain damage is thought occur during the delivery process. 80% of accidents that cause cerebral palsy occur in utero. The causes are numerous, and include viral infection, problems with the placenta, with implantation, and anything and everything that can cause hypoxia or stroke. A lot of CP is due to the fetus having a stroke in utero. Some is also due to premature babies developing an intercerebral hemorrhage, a bleed inside the brain that is more common in premature infants because their brains aren't finished developing and are more vulnerable to hypoxic accidents.
But the thing is, many of these kids look fine for their first year. Or even for there first three or five years. We've got several babies in the NICU now who pass their neurological exams with flying colours, but that doesn't mean they don't have cerebral palsy. That's because the infant's brain is non-myelinated. Myelin is the fatty coat that covers a grand percentage of our nervous system. It helps our nerves conduct electrical impulses faster. Our brain selectively myelinates the important pathways so information travels faster. For example, our muscle systems are myelinated. But our pain sensors are not. Pain information is still sent around the brain, but it is sent slower. One would think this would be disaterous, since when things hurt we need to move fast! But even without myelination our nerves can still conduct quickly, and our spinal cord has taken over several of the pain-induced reflexes that we have, which makes our response to a painful stimulus quicker than it would other wise be.
The interesting thing in infants brains is that they have virtually no myleination. They are basically brain-stem creatures. All their magnificant wonder at the world - and their wonderful neurological exams, which are fun to do - are all brain-stem level thinking. As they grow, they begin to myelinate and use the rest of their brains. And this is when we begin to realise that brain damage has occured. There is no way to know, for example, if the infant has brain damage that affects the control of their legs if they aren't using the part of the brain that controls the gross motor of their legs. Sure infants move their legs, they can even learn to stand, but they don't walk. And so it's impossible to know if they have difficulty with the part of their brain that controls walking until they get older enough to stand up and try it.
I found that very interesting.
The good thing about cerebral palsy is that most of the brain damage it's associated with is purely motor. Some children do have learning disabilities or other indications of 'mental processing' damage, but its more rare. This is because the parts of the brain that are more susceptible to hypoxia in utero and during/after delivery are the motor areas. This is because the nerve fibers that control our limbs - and most especially the lower limbs - happen to cross to the brain stem near an area that is susceptible to hypoxic damage. It's purely a function of geography in the brain.
Okay, that's my teaching session for today. Just something I found neat about babies brains. It's wonderful for me to think that their insatiable curiosity comes because they are laying down the myelination patterns that will set them up for life. Not only are they learning about the world, they are learning what they can do in the world. They are learning where their hands and feet are, how to turn their head and discover a whole new side of the room! Their eyes are wide and questioning because they are absorbing information at a fantastic rate - and shaping the myelination pattern of their brains while they do it. Fascinating!