Cerebral palsy often causes or contributes to secondary conditions and those living with cerebral palsy, such as I am are at risk for arthritis, the pain and stiffness in joints resulting from wear and tear on the cartilage over time. To ensure compliance, explaining to children the daily life protocols to cope must be delivered in easy to understand language. Children with cerebral palsy benefit from preventative strategies, pain management, surgery, and other treatments for arthritis, given there are more than 100 types and it’s important to follow progression at the point of diagnosis. It can be like a runaway train. Ask me! I know!
Currently, I’m doing battle with inflammation of both hands; shoulders, elbows and wrists are involved as well. Inflammation in the joints, which causes swelling, pain, stiffness, redness, and difficulty moving the joint can take a shot at any part of the body, including the knuckles, elbows, shoulders, hips, and knees. Cartilage degradation is a key player in the destruction, so adopting the ‘we are what we eat’ philosophy contributes to improving outcomes in the long term.
Risk factors for the development of arthritis include a family history of arthritis; another risk factor is having a condition that causes unusual or excessive wear on joints, like cerebral palsy. I’m two for two!
Living with cerebral palsy is a risk factor for osteoarthritis, but the degree of risk, which joints are affected, and age of onset varies by individual. The joint or joints affected depend on the type of disability that a person with cerebral palsy has. For instance, for a child who struggles to walk, having a gait that makes the hips or knees move abnormally can lead to arthritis in those joints. As children with CP age and enter adulthood, the risk of developing arthritis increases. When a child has pains beyond ‘growth spurt’ markers, seek consult with rheumatologist.
Persons with cerebral palsy have different degrees of abnormalities in the neuromuscular system which may cause unusual movements in the joints, overuse of joints, excessive wear on joint cartilage, and compression of the joints that ultimately lead to osteoarthritis. My upper body, my arms, are assistive devices for walking and they’ve been compromised which concurrently impacts my safety.
Hip arthritis is relatively common for this reason in people with cerebral palsy. Even joints not involved in walking can be affected. Muscle imbalance across a joint is common in cerebral palsy. This can cause unusual shoulder or elbow joint movements, leading to premature cartilage wear.
While many people with cerebral palsy will not experience arthritis until they become adults, it is possible to develop it as children. Parents should be aware of the signs of arthritis because earlier intervention will produce better outcomes. The symptoms of osteoarthritis in any joint include: pain that occurs during or after movement in the joint; stiffness in the joint, often after sleeping or a long period of little movement; tenderness when the joint is touched; inability to move or flex the joint through a full range; a feeling of grating inside a joint when moving.
Treatment plans are individualized and monitored. The least invasive types of treatment don’t treat inflammation but help with pain and mobility. These include painkillers, such as over-the-counter acetaminophen, or nonsteroidal anti-inflammatory drugs, such as ibuprofen.
Treatment can also include physical therapy and gentle exercises that help to strengthen specific muscles and make moving a joint easier and less painful. When arthritis becomes more severe or debilitating, and these non-invasive treatments provide little relief, more invasive strategies can be used, such as surgery.
It is sometimes possible for a problem causing the abnormal movements or overuse of the joint to be improved with surgery. This is highly variable by the individual. For advanced cases of arthritis in a joint, replacing the entire joint with an artificial one may relieve pain and restore mobility. Hip replacement surgery is a relatively safe way to treat adults with cerebral palsy who suffer from severe osteoarthritis in the hip joint.
Many living cerebral palsy will develop some form of arthritis and prevention may ultimately not be possible. There are ways to prevent it and minimize damage and symptoms. Knowledge is power.
However, the critical step is diagnosing and beginning treatment for cerebral palsy early in childhood. The more comprehensive and consistent treatment a child gets, the better the chances of reducing joint damage over time. The first 13 years of my life I was exercised 4 times per day. That early and critical daily therapy to ‘grow into CP’ contributed to me being able to still walk at 70!
Early and ongoing treatment that can help children and adults with cerebral palsy move in healthier ways will minimize the development of arthritis. This may mean surgery to correct bone or joint deformities, physical therapy and exercise to develop muscle strength and balance around joints, and mobility aids.
Lifestyle habits can also minimize and prevent arthritis. Maintaining a healthy weight, for instance, can take the pressure off the joints. Occupational therapy is also helpful in promoting the performance of daily tasks in a manner best for the joints.
Arthritis is a painful condition that most people don’t expect to experience until they are elderly. Unfortunately for people with cerebral palsy, the deterioration of joints that causes osteoarthritis begins early in life and is more significant than for other people.
With good overall treatment, watching for early signs of arthritis, and treating pain and other symptoms, a young person with arthritis can continue to enjoy life with improved mobility and minimal pain.
Carla MacInnis Rockwell is a freelance writer and disability rights advocate living outside Fredericton, NB with Miss Lexie, a rambunctious Maltese and Mr. Malcolm, a boisterous Havanese. She can be reached via email at Carla MacInnis Rockwell
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