Proceedings of the Royal Society of Medicine [April 14, 1948] Infantile Cerebral Palsy By PHILIP RAINSFORD EVANS, M.D., M.Sc., F.R.C.P. INCIDENCE THE incidence of infantile cerebral palsy has been estimated by Duryea (1941) to be 50 patients per 100,000 of the population in the United States of America. According to Phelps (1941) the figures are similar in urban and rural districts, and may be expressed as: 7 born each year per 100,000 population:-1 dies in infancy; 2 are mentally defective; 4 are educable, of whom 1 is mildly, 2 moderately, and 1 severely afflicted. Thus for every 100,000 people there are probably about 30 children who are moderately affected and who need special education and therapy. At this rate London would have to cope with over 2,000 children with cerebral palsy who need these special methods, and per- haps another 3,000 who are so severely handicapped mentally or physically that they need to be cared for in institutions. It must, however, be emphasized that we have no figures upon which an estimate of the incidence in this country can be based. A survey is needed. All one can say at present is that the two residential units open in England accommodate some 50 children, and that the pathetic quest of the parents for adequate treatment for their handicapped sons and daughters is marked by recurring disappointment. Classification.-Cerebral palsy is a condition arising in early life, due to imperfect develop- ment or damage of the central nervous system above the segmental level, and characterized by motor disability. This disability may be associated with spasticity, rigidity, or flaccidity of the muscles, with ataxia, or with involuntary movements. W. J. Little (1843b) gave an excellent description of cerebral palsy in one of his "Lectures on Deformities of the Human Frame" in 1843. In a Paper read to the Obstetrical Society in 1862, he elaborated his early observations (1843a) on the association of prematurity and asphyxia with this type of disease. He has received and deserves great credit for his accurate and original observations but it is unfortunate that recognition of his merit has taken the form of a chapter heading: "Little's Disease (Spastic Diplegia)." He did not describe a uniform and clear-cut disease, but an association between certain abnormalities of labour and the newborn period and diverse mental and physical abnormalities seen later in life. Some of the children exhibited spastic diplegia, others paraplegia, hemiplegia, triplegia, fits, mental defect, and involuntary movements. The term athetosis was not invented until 1874. The classification of these conditions has become so much confused that it is possible for diplegia and paraplegia to be used in the same sense in the same table (Brockway, 1936), while a simple division of cases into spastic and athetoid has been known to arouse in a neurologist the unbecoming passion of anger. Classification may first be considered topographically. In Table I, diplegia has currently two different meanings, and here we will use the term paraplegia and quadriplegia instead. I will not attempt to defend the logic of this conventional division of paralyses. Starting with monoplegia, a one-stroke, we go on to a half-stroke which is twice as extensive as a mono- plegia; a diplegia or two-stroke is actually four times as extensive as a one-stroke but affects twice as many limbs as a half-stroke. TABLE I.-NOMENCLATURE AccoRDING To LIMB-INvoLVEMENT Limbs Neurological Theriapits involved Term Therapists Term OR 17 Monoplegia Monoplegia Hemiplegia Hemiplegia Triplegia Triplegia Paraplegia Diplegia Diplegia Quadriplegia* *The term "quadriplegia" is customary, although "tetraplegia" is more in keeping with Greek prefixes of the other types. We are in more difficulty when we come to disturbance of function (Table II). 402
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Related Documents
