Neuromuscular Disabilities in Children

Chairman Perlstein.’ In neuromuscular disabilities there are many problems to consider. However, about half of these comprise that group of diseases we know as cerebral palsy. We will start by orientating ourselves toward cerebral palsy, and in the discussion taking up the question of differential diagnosis and related subjects. Cerebral palsy is not a single disease but a group of conditions which have in common a disorder of the motor system. It can be paralysis, incoordination, tremors or excessive motions, due to involve. ment of the motor centers of the brain. In other words, palsy and cerebral are defined. The important thing about cerebral is that the motor centers must be involved. If the problem is lack of development because of mental deficiency, you can exclude it. Likewise, spinal palsy, polio, and other causes of motor defects not due to involvement of the motor center are excluded. In schools for children with physical handicaps of all types, about half the children are cerebral palsied. So, from the viewpoint of frequency, cerebral palsy is the most frequent of the disabling conditions. Much confusion exists in the terminology and classification of cerebral palsy. The term ‘ ‘Little’s disease’ ‘ has often been used as a generic term to cover all forms of cerebral palsy. Actually, Little described only one of the many types. Likewise, the term “spastic’ ‘ is often used by the doctor and laymen to cover all categories. This tendency is conducive to loose thinking. A logical classification of the types of cerebral palsy would help to clarify this confused subject. Classification may be according to: (1) anatomic site of lesion; (2) the qualitative nature of the clinical symptom present; (3) the topographic involvement; (4) the degree of tonicity, (5) severity of involvement and (6) etiology. These naturally overlap.