Cerebral Palsy and Post-Impairment Syndrome

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Post-impairment syndrome occurs commonly in adults with cerebral palsy. It is a combination of symptoms, like pain, fatigue, weakness, and depression, resulting from the high-energy demands of living with cerebral palsy. Prevention, therapy, and other treatments help manage post-impairment syndrome.

What Is Post-Impairment Syndrome and How Is It Related to Cerebral Palsy?

Post-impairment syndrome is a condition characterized by pain, muscle weakness, and fatigue caused by bone and muscle abnormalities, overuse, and arthritis.

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

Everyone with cerebral palsy struggles with a loss of motor control and function to some degree. The spectrum includes 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. As a person with cerebral palsy ages, motor issues can cause a more significant disability. 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 post-impairment syndrome.[1]

When post-impairment syndrome begins 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 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 strictly defined by its symptoms because it can cause different effects with varying degrees in different individuals. However, some problems tend to be more frequent 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 that nearly always results in some degree of pain over the years. The pain may come from repetitive use injuries, arthritis, scoliosis, or sore or imbalanced muscles.
• Overuse Injuries. Overuse or repetitive motion injuries are caused by repeating a specific movement over and over again. People with cerebral palsy are susceptible to this because they often move in unusual ways and may use mobility aids that require repetitive movements.
• Weakness. When the nerves bring abnormal signals to the muscles, they can either be too tight or floppy. 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 when moving and doing activities than people without the condition. 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 consistent treatment throughout a child’s life can certainly improve the outcome. There are many elements to treating 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 the 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 improve muscle use and create less damage over the years.

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

Treating Post-Impairment Syndrome

Even with treatment that starts early in life, some children with cerebral palsy will have post-impairment syndrome. There are many different ways it can be treated, although, like cerebral palsy itself, it cannot be cured.

Some underlying issues, such as bone and muscle abnormalities that benefit from surgery, may be treatable, 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.

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

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

People living with this challenging condition can significantly benefit from support groups and engaging in online or in-person discussions with others who are 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 essential to get help for post-impairment syndrome because its effects go well beyond just causing pain and exhaustion and can impact all areas of life.

Living with cerebral palsy as a child isn’t easy, but the challenges do not necessarily get easier as an adult. 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, get the best, most consistent treatment early on to prevent the ongoing damage that contributes to post-impairment syndrome later in life.

Be aware of the symptoms in later years and seek professional help to bring the quality of life to its full potential, even when living with a lifelong disability like cerebral palsy.