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Brain Injury in Children - Cerebral Palsy
Children with brain injuries have the best of all worlds and the worst of all worlds. Having a brain injury when the brain is still developing can be devastating because the brain injury happens before the brain cells have the ability to differentiate and develop. This can mean greater injury to the brain than would be seen in adults.
On the other hand, the young person's brain has a great deal of plasticity. Plasticity means that other areas of the brain can be recruited to perform functions that were lost when the brain was damaged. Plasticity of the brain is more common, with greater recovery, in the baby or child with a brain injury.
Brain injury can happen in utero. There can be bleeding into the brain, medical problems in the mother or birth defects and cord injury that can cause bleeding or a lack of oxygenation of the brain cells while the baby is still in the womb. Brain cells die very quickly, within a few minutes, if lacking in oxygen or damaged by bleeding and they cannot regenerate or repair themselves.
Brain injury can happen at the time of birth. The baby can be born breech and may sustain a long period of time without adequate oxygen due to collapse of the umbilical cord. The umbilical cord may be insufficient for other reasons, including having the umbilical cord exit the uterus before the baby's head or having a knot in the umbilical cord. Even the placenta can be insufficient so less oxygen gets to the baby. These problems can lead to cognitive delays in the child or perhaps to cerebral palsy.
Brain injury can happen when the baby is born prematurely or is born weighing less than two pounds, regardless of the gestational age of the infant. Small babies have a greater chance of bleeding into the brain and episodes of hypoxia (low oxygen), which lead to brain injury.
Children can suffer from brain injury long after the neonatal period. They can be involved in serious falls or motor vehicle accidents. They can be subject to child abuse involving trauma to the head or abnormal shaking of the baby's head and body. If this occurs anytime up to age 2-3, the brain is still developing rapidly and brain injury can result in obvious defects in speech, motor development or coordination.
The two most common causes of brain injury in children are lack of oxygen and bleeding in the brain. The lack of oxygen is an obvious cause of brain injury. It can occur in the womb, at the time of birth or even after birth - in cases where the child stops breathing for a period of time or if the child suffers a near drowning incident. Bleeding can happen with a traumatic fall, a car accident or bleeding in the brain from child abuse or shaken baby syndrome. In such cases, the blood itself impairs the ability of the cells of the brain to get enough oxygen and the cells die. Bleeding can be from crucial blood vessels that, when damaged, fail to oxygenate the cells they are supposed to. These cells die as a result.
Because the cells of the brain are highly specialized, the type of injury you can see to the entire body depends on the areas of the brain involved. If primarily the motor system is involved, you can see paralysis, contractures of the extremities and abnormal movements. If the thinking or cortical functions are damaged, you will see learning disabilities that sometimes rise to the level of mental retardation or developmental delay. If the hearing parts of the brain are affected or the seeing parts of the brain are affected, those areas will be a part of the disability. Brain injury can look like just about anything, depending on the cells killed in the injury.
Children can have significant brain injuries by having strokes within the brain. Most childhood strokes are from a major bleed in the brain but certain abnormalities of the arteries can lead to strokes as well. A stroke can involve a major part of the brain, including half the brain. This leaves paralysis of one side of the body, the possibility of speech impairment and the possibility of other sensory impairments. Kids can have strokes even in infancy and these can be severely disabling and possibly life threatening.
The one thing that kids have that is an advantage over adults when it comes to brain injury is what's known as plasticity. What this means is that there are many cells in the brain that don't do anything in and of themselves except to wait for damaged cells to happen in the brain. The exact mechanism of how this happens is unclear. What's known is that scans show that other areas of the brain become active in doing things that the damaged areas of the brain used to do. The younger the child, the greater is the plasticity of the brain and the greater is the chance of recovery of some function that was lost at the time of the brain injury.
What plasticity looks like is a gradual recovery of lost function after an episode of brain injury. It is something that is more likely to happen if the child has immediate physical and occupational or speech therapies following the injury. In a sense, brain cells are recruited that had nothing else to do and become functional areas of brain doing tasks that they would not normally be intended to do.
This phenomenon can be demonstrated in PET scans or positron emission tomography scans. It involves giving radioactive glucose to the individual to see what area of the brain "lights up" or utilizes the radioactive glucose when a certain functions are performed by the body. The results can be striking, with cortical areas of the brain lighting up that would normally not be associated with movement when the child moves the extremity.
The child with a brain injury has a dramatic chance of some return of function. It depends on the area of the brain affected and on the age of the child.LAWYER HELPLINE: ☎ 1800 339 353