Post-Impairment Syndrome

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A common condition that adults with cerebral palsy live with, post-impairment syndrome, is a collection of symptoms and health problems that cause a great deal of discomfort, pain, and trouble with mobility. The disabilities this condition causes vary by individual, but often include fatigue, joint pain and arthritis, difficulty walking, poor posture, and weakness.

Post-Impairment syndrome arises in adults with cerebral palsy due to decades of damage to the bones, muscles, and other tissues in the body. This arises from the accumulated effects of moving and living with abnormalities in those parts of the body, causing dysfunction leading to painful complications.

Consistent lifelong therapy is important for preventing or post-impairment syndrome, but when it occurs, there are treatments that can help minimize the effects and make people more comfortable.

What is Post-Impairment Syndrome?

Cerebral palsy is a condition that starts in the brain and results from acquired brain damage, which largely affects the functioning of the body. This damage impacts muscle tone and control, bones, joints, posture, balance, and coordination, and how a person moves.

Everyone with cerebral palsy struggles with a loss of motor control and function to some degree, from challenges that are barely noticeable to an almost complete inability to walk, and everything in between.

These motor issues can cause significant disability in childhood, but usually, go on to cause even more as a person ages. The years of moving in ways that are not optimal and living with spastic muscles or malformed joints and bones ultimately cause damage that can lead to arthritis, pain, and weakness.

Fatigue is also common because it requires more energy to coordinate and maintain movements when these functions are abnormal. Together, this disability and the symptoms it causes are called a post-impairment syndrome. [1]

When post-impairment syndrome begins actually depends on each individual, as does the severity of the condition. Those with minor disabilities may never experience post-impairment syndrome or may only have mild symptoms that come about later in life.

Children with severe cerebral palsy symptoms are more likely to experience the syndrome earlier and for the effects to be more serious.

Common Symptoms and Conditions Associated with Post-Impairment Syndrome

Post-impairment syndrome is not a condition that is strictly defined by its symptoms because it can cause different effects with varying degrees in different individuals. However, there are some problems that tend to be frequently seen in adults with cerebral palsy who are experiencing post-impairment syndrome:

• Arthritis and pain. The abnormal movements and deformities that people with cerebral palsy have can cause damage over the years that nearly always results in some degree of pain. The pain may come from repetitive use injuries, from arthritis, scoliosis, or from sore or imbalanced muscles.
• Weakness. When the nerves bring abnormal signals to the muscles, they can be either too tight or too floppy. Either way, this can cause muscle weakness that worsens over time, making movements even more challenging.
• Fatigue. Estimates are that people with cerebral palsy use three to five times more energy to try and move than people without the condition use for regular movement. Over time, this leads to both generalized fatigue and exhaustion. For many people with post-impairment syndrome, fatigue is the biggest hurdle.
• Depression. Although not always included as a symptom of post-impairment syndrome because it is not physical, adults with cerebral palsy may be susceptible to depression after years of struggling with the condition and its resultant painful symptoms and poor mobility.

Preventing Post-Impairment Syndrome

It may not be possible in some cases to prevent the development of post-impairment syndrome, but good and consistent treatment throughout a child’s life can certainly improve the outcome. There are many elements to the treatment of cerebral palsy, from medications and surgery to physical and mental health therapies.

The approach depends upon the needs of each individual, but the more comprehensive and consistent treatment is, the better chance a child has of minimizing future post-impairment syndrome symptoms.

What is essential to developing lifelong mobility and avoiding damage that can lead to later pain and disability, is correcting muscle imbalances, muscle tone, and bone and joint deformities. For some children, surgery may make corrections that lead to improvements in muscle use that will create less damage over the years.

Most can also benefit from ongoing physical therapy that improves muscle tone, coordination, and movement by balancing strength in pairs of muscles. The results of these and other interventions may help to normalize overall function which will prevent future pain and disability.

Treating Post-Impairment Syndrome

Even with treatment that was started early in life, some children with cerebral palsy will end up with post-impairment syndrome. There are many different ways it can be treated, although, like cerebral palsy itself, it cannot be cured. Some of the underlying issues may be treatable, such as bone and muscle abnormalities that can be helped with surgery, but most treatment involves addressing symptoms.

For instance, managing the pain of post-impairment syndrome may involve a combination of medications, physical therapy, and gentle exercise, like yoga. Fatigue and weakness can also be improved with physical therapy and exercise. [2]

Lifestyle changes can be beneficial, like promoting good sleep habits and eating a healthy and nutritious diet. Using mobility aids and working with an occupational therapist can make doing daily tasks easier and safer, as falls are more likely when weakness, pain, and fatigue increase.

For depression and other mental health issues, there are many treatments that can help. Working with a therapist or counselor can help to change negative thoughts and behaviors. Medications used appropriately can relieve anxiety, lack of focus, and depression.

People living with this difficult condition can greatly benefit from support groups and chatting online or in-person with others who may be experiencing similar challenges.

It is also important to have and rely on a close network of friends and family for social support and even assistance with ordinary tasks when pain and fatigue become overwhelming.

Consequences of Post-Impairment Syndrome

In addition to dealing with the challenges of living with cerebral palsy, like pain and fatigue, the symptoms of post-impairment syndrome can impact other areas of life. The pain, for instance, can make sleep more difficult, which in turn increases fatigue and sometimes depression.

Being fatigued can lead to missing work or social engagements, which can cause social isolation and financial hardship. It is important to get help for post-impairment syndrome, because its effects go well beyond just causing pain and exhaustion and can clearly impact all areas of life.

Living with cerebral palsy as a child isn’t easy, but as an adult, the challenges do not necessarily get easier. The years of living with this disability can cause this uncomfortable, painful, and damaging condition. If you live with cerebral palsy or have a child with the condition, be sure to get the best, most consistent treatment early on to prevent the on-going damage that contributes to post-impairment syndrome later in life.

Be aware of the symptoms that can occur in later years and seek professional help so that quality of life can be brought to its full potential even when living with a lifelong disability like cerebral palsy.