Understanding cerebral palsy

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Two in every 1 000 babies will have cerebral palsy according to the World Health Organization, but with therapeutic treatment you can do a great deal to help your child, says Dr Birgit Schlegel, paediatric neurologist at Mediclinic Constantiaberg.

What are the signs that my child might have cerebral palsy?
Cerebral palsy, or CP, covers a range of neurological disorders that typically appear in babies or children under the age of three. A baby or child with CP is usually slow to reach developmental milestones. So your baby might not be rolling over, sitting or walking when others of the same age are doing so. A small child would also show signs in the way they move. They may drag a leg, walk on their toes, or walk in a scissored or crouching way, or have exaggerated reflexes or spasticity, and their speech and other functions could be affected.

When should I see a doctor?
Should you be worried about any possible delays in your child’s development or any difficulties with their movement, muscle tone or co-ordination, see a doctor so that you could get prompt diagnosis should there be a problem.

Why would my child have CP?
While CP manifests itself in the way your child moves or as a muscular disorder, it actually stems from the brain. Brought on by a lack of development in the area of the brain that controls muscle movement, or by damage to the brain, it can stem from pregnancy due to illness, infection or drug or alcohol use. It could also be brought during birth by a very premature birth, a lack of oxygen or injury, or in a small child by brain infections, head trauma or shortage of oxygen.

Whatever the cause, CP can have a permanent effect on the way a child moves, co-ordinates and sometimes on their mental and speech ability. But don’t lose heart. There are things you can do.

What can I do for a child with CP?
While this is not a condition that can be cured, you can often improve your child’s abilities tremendously with therapeutic treatment, and while some children are severely affected, many children with CP go to mainstream schools and live to lead near-normal adulthoods the same as anybody else.

However, the sooner you can get going on treatments the better their chances.
The first line of treatment for a child with cerebral palsy might include physical therapy to help with their physical strength, balance and motor development, speech therapy should they need help with this, speech therapists can also help with such issues as eating or swallowing, and medication, which can loosen tight muscles, manage pain or some of the complications of spasticity.

Corrective surgery may be recommended for some children. This in general focuses on loosening tight muscles to increase the range and control of movement, or on cutting the nerves of the affected limbs – a selective dorsal rhizotomy – for children with severely tight muscles in their legs. The aim is to reduce muscle stiffness or spams and introduce more control.

Read Dan Skinstad’s story here on living with CP and how he’s changed his life – with a 2 300km kayak adventure around Iceland’s shore, no less.

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Vasectomy 101

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Close to 100% effective in preventing pregnancies, less costly than long-term birth control, a vasectomy is worth considering if you are certain you no longer want children.  Dr Karlheinz Jehle of Cape Urology, Mediclinic Cape Town the things you need to weigh up before taking the cut.

My wife and I have three children and we’ve decided it’s enough. I am considering a vasectomy but how extreme is this decision?
This is such a personal decision, and it can be a tough one. The procedure itself is simple and not something to worry about. However the chances are high that it is irreversible. Performed under local anaesthetic you will need no more than half an hour to get it done and you may experience mild discomfort and bruising for a week thereafter.  And when you weigh up the risks of female contraception and female sterilisation, vasectomy comes out tops in terms of efficacy and it is a much easier and more minor operation than female sterilisation.

How reversible is a vasectomy?
What you need consider very carefully, and to discuss with your wife, is that it is pretty much a permanent procedure. Yes, in theory it can be reversed but your chances of a successful recanalisation are not high enough to count upon. In Europe the recommended age for a vasectomy is over 30.

Your chances of fathering a child after a reversal will be dependent on your age and how long after the vasectomy you do the reversal. For example, should you do the reversal within three years, there is up to a 70% success rate, but it you leave it for 20 years it drops to 25%.

What about complications?
Vasectomies are considered very safe procedures and complications, beyond some post-op swelling and bruising, are rare. Your biggest concern is being certain you no longer want to father a child. Beyond that, most men have no noticeable side effects, pain is minor and complications are rare.

There have been pregnancies after vasectomy, but it is very rare. It is 99,85% safe (webmed.com), making it the safest of form of contraception available.

What can I expect afterwards?
It is worth getting someone else to drive you after the procedure and then to lie quietly with a cold pack and tight underwear to ward off any discomfort or swelling. But remember it will take a couple of months before it is considered a safe means of birth control so wait for your doctor’s confirmation before you stop using other methods of birth control.

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Tension headaches

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Do you know what causes a tension headache and who gets them? Dr Peter Haug, a neurologist at Mediclinic Milnerton in Cape Town, explains.

What is it and how does it feel?
Muscle-tension headaches can be one-sided or bilateral, and pain can be sudden and shooting, or constant and unrelenting. It can be a sharp pain, or feel like a heavy pressure that radiates from the back of your neck to the top of your head, or around the temples. Pain can also be above or behind one or both eyes, but it’s also often described as feeling like a tight band of pain around the head. Chronic muscle-tension headaches are often accompanied by extreme sensitivity to light, dizziness, difficulty focusing, imbalance, difficulty concentrating, and pain between the shoulder blade and spine, or neck, shoulder and arm pain.

Who gets it?
People with poor posture and those with muscle imbalance brought on by a sedentary lifestyle or poor sitting habits. Those who suffer from migraine headaches, or feel depressed, anxious or over-tired are also more likely to get these headaches. Highly-strung people who experience difficulty in sleeping tend to have worse headache symptoms.

What triggers it?
Muscle pain and/or spasm in the head, neck and shoulders. Pain in these areas can be accompanied by visible symptoms, like high shoulders, round back, squinty eyebrows and a chin that juts forward.

What treatment is available?
Muscle-tension headaches often don’t respond well to painkillers. When pain strikes, become aware of and correct your posture. Sit properly and stretch to ease muscle tension, then attempt breathing exercises to suppress your anxiety response to stress. A neck-and-shoulder massage may also help. The chronic intake of painkillers frequently worsens headaches, as it results in an analgesic-overuse headache.

When should I seek medical attention?
If you suffer from a long history of frequent or daily headaches, you have a low risk of brain abnormality but may benefit from counselling, especially if you’re regularly taking painkillers. People with the sudden onset of a new and severe headache (also called a thunderclap headache) and patients with persisting weakness or double vision, particularly when elderly, need urgent medical attention.

Would you like to know more about migraines? Read our post here.

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We bust some pacemaker myths

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Rumours abound about what you can and cannot do once you have had a cardiac pacemaker installed, but with rare exception your lifestyle is unlikely to change. Mediclinic Morningside cardiologist, Dr Leonard Steingo, looks at some of the myths around pacemakers…

Now I’ll have to slow down.
This is not so. Many people with pacemakers are golfers, play tennis, scuba dive and even run marathons. In the first month you will be advised to take it easy but thereafter there is no reason while your lifestyle should change, in fact you might have more breath now that your heartbeat is regular. The only thing you might want to avoid is full contact sport which might damage your pacemaker. Read footballer Fabrice Muamba’s story here  – although he no longer plays football professionally, having a pacemaker hasn’t slowed him down a bit.

I won’t be able to use a microwave oven or my power tools…
Some of the myths and notions around pacemakers are historic and therefore outdated, and this is one of them. This may have been correct in the past, but is not true of modern pacemakers. You can use all household appliances – TVs, TV remote controls, toasters, electric blankets, drills and tools.

However you may want to avoid exposure to arc-welding equipment and heavy-duty industrial motors that might generate interfering magnetic fields. Stand at least half a metre from power-generating equipment. If you are concerned about equipment you work with, speak to your doctor.

I won’t be able to use a cellphone.
You can use a cellphone, however it is a good precaution to keep it away from your pacemaker. In other words hold it to the ear opposite the pacemaker side and avoid keeping it in breast pocket near your pacemaker. It is unlikely, but you wouldn’t want it to interfere with your pacemaker.

My travelling days over.
You can travel at will, and it’s safe to pass through airport security systems as you ordinarily would. Just don’t forget your identification card that states you have a pacemaker. If airport security insist upon using a metal-detecting wand, tell them you have a pacemaker so that they don’t linger in that area.

Medical equipment can be dangerous.
It is always best to remind doctors that you have a pacemaker. Medical procedures that use intensive exposure to electromagnetic energy, such as an MRI scan (magnetic resonance imaging), radiation for the treatment of cancer, shock waves to break up large kidney or gallstones or electrocautery to control bleeding during surgery could interfere with your pacemaker.

Now my heart is in tiptop condition.
Having a pacemaker does not mean that you can stop your medication. Most people with pacemakers still take medication for such conditions as high blood pressure, angina, heart rhythm problems and such like.

It also won’t protect you from the possibility of a heart attack. While there are modern pacemakers which can help to strengthen the heart muscle, you can’t depend upon it to strengthen your heart or prevent blockages, so keep up a healthy lifestyle, make sure you exercise and eat well.

Remember If you have any doubts, chat to your doctor.

To read more about how a pacemaker is fitted and what to expect after the procedure, click here.

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Stuttering: what you can do to help

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Stuttering is highly variable and usually affects individuals in different ways with varying degrees of severity. Speech therapist Dina Lilian gives her suggestions on what you can do when speaking to someone who stutters.
(Read Dina’s previous posts on what stuttering is and its possible effects.)

Tips when talking with your pre-school child who stutters:
1.    Speak with your child in an unhurried way, pausing frequently. Wait for a few seconds after your child finishes speaking before you begin to speak.
2.    Decrease time urgency – give your child the chance to answer one question before presenting another one. Provide a calmer, predictable, less-hurried life style within the home rather than maintaining a fast-paced, hectic or inconsistent family routine.
3.    Decrease interruptions – provide opportunities for your child to talk without interruptions. Encourage each person in the family to listen to each other. When one speaks, the other listens and waits for his/her turn.
4.    Be an attentive listener – when your child is talking to you, stop what you are doing and focus your attention on your child.
5.    Reduce the number of questions you ask your child – instead of asking questions, comment on what your child has said.
6.    Limit corrective advice – do not attempt to correct your child’s speech or give advice to your child such as ‘slow down’ and ‘think before you speak’.
7.    Avoid filling in or guessing what your child is about to say. Rather wait patiently for him/her to complete the sentence and focus on the content of the speech rather than the manner of the speech.

Helpful hints for teachers who have a student who stutters:
•    During everyday classroom discussion, it is important to allow increased response time for the child who stutters and encourage everyone to contribute their ideas.
•    If a child who stutters raises their hand, call on them immediately so that anxiety around speaking situation is not exacerbated.
•    When it is time for answering questions, teachers can help by not rewarding quick call-out answers. Taking turns, modelling thinking time, and random-selection styles are helpful strategies to implement.
•    Reading aloud in the classroom is a situation that may increase anxiety if the child who stutters must wait for his or her turn in the ‘down the row’ style of turn taking. To minimise this, the teacher may wish to consider using random styles of turn selection. In certain situations, exempting a child from speaking within a classroom situation (if this is what the child who stutters wants) until the child has learnt strategies to deal with their stuttering, may be a more desirable approach.
•    Classroom oral presentations may pose problems for children who stutter (as well as other children in your classroom). It is important to approach these presentations in a matter-of-fact way, and to develop a plan that supports the needs of the child who stutters – perhaps even allowing child to do an oral on a one-on-one basis. Flexibility may be necessary at times, but is important to provide opportunities for the child to be a successful contributor in the classroom.

How to talk to school-age child who stutters:
1.    Don’t tell the child to ‘think before you speak’, ‘take a deep breath’, ‘stop and start over’ or ‘just relax’.
2.    Be patient – don’t complete words, supply answers or interrupt.
3.    Don’t avert your eyes, turn your head away, or look pained/pitying.
4.    Avoid imposing time pressure and firing too many questions.
5.    Maintain natural eye contact – concentrate on what is being said (ie the content) and not how it is spoken (ie the manner).
6.    Don’t pretend that dysfluencies do not exist – be open with the child about their stutter. Ask the child how they feel about their stutter and what would make them more comfortable when they speak.

When speaking to an adult who stutters:
1. The person who stutters should be listened to patiently, not be hurried and not interrupted.
2. Never finish a person who stutters word unless asked to by them.
3. Don’t fill in words or supply answers.
4. Don’t look pained, pitying or impatient.
5. Do not withdraw eye contact, glance nervously at the person who stutters or stare vacantly into space.
6. Speak naturally.
7. Maintain an unhurried, calm and interested manner.

How employers can aid someone who stutters in the workplace
Employee-assistance programmes can be established by an employer to provide information on stuttering to their employees as well as refer them to an appropriate professional. The best way to approach an employee’s stuttering is through honest communication. By refraining from making assumptions about the individual’s job-related abilities and skills, it is possible and in most occasions probable that an employee who stutters can effectively achieve the employer’s goals.

People who stutter should be honest and open about their speaking abilities and the areas in which they feel they can perform effectively. They should be willing to discuss how their stuttering might impact particular areas of their job performance and what might be done to accommodate them. Simultaneously, understanding stuttering should be a part of an employer’s ongoing effort to make the work place more understanding for all employees. To an extent, consistent with their abilities, a person who stutters should be offered leadership opportunities and paths for promotion within an organisation. Greater understanding provides benefits for the organisation and all the people who work there.

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