Athetoid Palsy: A Case Study

command in the rise of muscle tone is sent to the spinal cord from the nerves from the muscle itself, which are called the sensory nerve fibers. The muscles of the patient appear stiff and rather than create smooth and swift movement, appear rigid and jerky. When contracting or moving a muscle to create movement, some muscles are turned on, while others are turned off, making it extremely challenging to move normally. Spasticity, depending on severity, can greatly affects one’s ability to walk, stand, sit in the correct posture and even perform daily tasks such as bathe, get dressed, eat, write, and using the restroom. It can also have an impact on speech, causing the patient to have slow oral movements, slurred speech, and a tight or hoarse

voice. A personal account of spastic cerebral palsy said, “I have always liked writing. Having high-tone CP, many may pre-judge me on my body movements. My writing [by comparison] can take 10 minutes or 10 hours to construct and I am judged on the final outcome — not how I got there...They see my body constantly moving, they see me in the wheelchair, etc. Automatically the mind goes into preconceived judgment on my intellectual ability…” (2014 Dan Reimold)
Within the category of spastic CP, there is an even more distinct category called, spastic quadriplegia. This very specific group affects the entire body. Patients suffering from this are unable to walk and have moderate to severe intellectual disabilities.
The next type of CP is Athetoid Palsy, which affects 10 to 20% of patients.

It is associated with the damage of the basal ganglia, which is essential to coordination of movement. and usually develops around 18 months of age. The symptoms of Athetoid CP are low, involuntary movement, such a thrashing or writhing of the hands, arms, and legs. Involuntary grimacing of the face, drooling, and inability to hold or perform deliberate actions may also occur. In some cases, speaking, eating, and swallowing can also be impaired, resulting in lack of nutrients. Regarding muscles, this disorder can cause too loose or too tight muscle tone, leading to possible muscle spasms. Patients can also develop complications in cervical spine, hip, and feet, usually resulting them to be entirely disabled. Fortunately, a patient’s mental capacity is usually not altered in effect to this specific type, in which most patients have normal or potentially above average of intelligence. Symptoms such as fetal stroke causing infant’s brain to bleed, blood clots in the placenta causing to block the infant’s circulation, or severe Jaundice can all result in athetoid Cerebral Palsy. This is a personal account of a person affected by athetoid Cerebral Palsy, “As a teen with CP it was easy for me to get overlooked, discouraged, or even patronized simply because I wasn't considered "normal." This became especially apparent when doctors began prescribing "special devices" to help me re-establish or maintain a

"suitable range of motion." These devices were to be worn while doing everyday activities, including school-time activities...Because my CP mostly affects my legs and the way I walk, I had to wear knee-high, white-plastic, custom-made leg braces at all times during my first couple of years of high school.” (2015 Children’s Healthcare of Atlanta Inc.)
Ataxic Palsy is the rarest type of CP, therefore, only affects about 5% of patients diagnosed with Cerebral Palsy. This specific type involves a loss of muscle coordination such as depth perception and balance. Patients suffering from Ataxic Palsy often walk with long unusual strides due to impaired depth perception and struggle doing activities such as inserting a coin into a slot, which involves precision movements. Intention tremor is a symptom that is common within patients, when reaching for an object, the fingers, hand, or arm begins to quiver or shake; worsening the closer they are to the object. Mental retardation can be a factor of this type of Cerebral Palsy but intelligence as a whole is usually unaffected. Similar to the other types of CP, Ataxic can be caused by abnormality of the brain, usually formed from infections of the mother or the unborn baby or by lesions, holes, in the brain’s white matter that is essential to signaling the nervous system.
The last type of Cerebral Palsy is Mixed CP, which is when symptoms of spasticity and athetoid occur together. Signs of spasticity will usually be detected before because involuntary movement of athetoid usually doesn’t occur until nine months to three years. When symptoms of both types of Cerebral Palsy collide, muscles of patient may appear spastic as well as limp. Having both characteristics, make it extremely difficult to create treatments for mixed CP. Mental retardation, speaking impairment, Strabismus, known as “cross-eyes or “lazy eye”, and seizures caused by unusual electrical activity in the cerebrum are very common factors of mixed CP. Cortical blindness is another symptom that occurs in patients affected by mixed CP, in which the eyes appear unaffected by the actual vision is damaged. A cause of this specific type is a condition called Rh incompatibility, which the mothers’ and fetus’ blood type is opposite, resulting in the mother taking in anti-bodies against the baby’s blood. Maternal infections, inflammatory pelvic diseases, and thyroid problems within the mother can all lead to mixed Cerebral Palsy.
One of the most complicating factors of Cerebral Palsy is mental impairment.

Patients affected by this can have a difficult time comprehending and pronouncing words, staying focused on one task, limiting being able to multi-task, such as read and speak simultaneously, and inability to retain information as quickly. Though these characteristics of intellectual disability may occur, the patient is still able to improve and learn new skills, just at a slower pace. Diagnosis for this is through a process of observation between kids their age. Things such as being able to feed, bathe, and clothe one self, communicate with other children, and ability to solve, understand, and react to daily life

problems.
Seizures are symptoms that affect almost half of the patients affected with Cerebral Palsy. A specific type, tonic-clonic seizures, which can cause the patient to go unconscious, twitch and tighten muscles of the body, cry or groan, and jerk arms, legs, and head. Partial seizures, also occur, in which contractions can appear on one side of the body, skin begins to feel numb or tingly sensation, unusual head or eye movement, abdominal pains, nausea, and a sense of mood change. These can be caused by unmonitored bursts of electricity that interfere or disrupt the brain’s normal functions or routine of electrical activity.
There are many factors that contribute to neurologic disorder of Cerebral Palsy. Though, each patient’s symptoms may appear different, reasoning for the symptoms may appear different as well. Ultimately, CP is caused from damage in the brain or brain malformation that occurs before, during, or after brain development. Depending on the severity of the damage to the brain along with the location, a vary of Cerebral Palsy types can develop. Ranging from Spastic Cerebral Palsy to Mixed Cerebral Palsy. Factors that can cause CP is inadequate oxygen reaching baby during pregnancy and birth, maternal infections within the mother during pregnancy, and premature birth. Diseases within the mother that can lead to Cerebral Palsy are:
• German Measles: a viral disease that cause major birth defects