| AGING
WITH CEREBRAL PALSY III The July Supplement to the Archives of Physical Medicine and Rehabilitation contains an excellent review of the problems of aging in several groups of individuals with disabilities including (among others) cerebral palsy, spina bifida, and the muscular dystrophies. It not only provides an extensive discussion of the late complications of cerebral palsy, but puts them in the perspective of other adults with disabilities and includes an extensive bibliography. The review covers general health, perineal hygiene, oral problems, osteoporosis, pain, contracture, scoliosis, joint dislocations, arthritis, spinal cord problems, and difficulties in obtaining preventive care. In several areas, the comments are brief, but there are references to other publications. In several areas, the authors stress that these issues become worse with advancing age. It emphasizes the importance of pain as outlined in the last two Research Fact Sheets. Scoliosis is often progressive and associated with pain. Curvature over 50 degrees at maturity progress more rapidly. Not only does this give rise to problems with sitting and positioning, but they give rise to progressive pulmonary and cardiac compromise. Just breathing takes more energy and respiratory difficulties may interfere with sleep patterns. Degenerative arthritis is also progressive, produces pain, and is accelerated by biomechanical abnormalities and the compensatory functional overuse. Many adults with CP will cease ambulation by age 45, due to the arthritic pain. More often gait is abandoned by the age of 25 because of fatigue, inefficiency of gait, and ease of using a motorized wheel chair. Adults with athetoid CP are at special risk for cervical cord injury. Although surgery may be helpful in the short term, the longer term studies suggest that new problems are likely to appear after 5 years. A particularly alarming paragraph deals with the relative lack of preventive care provided to these individuals. In one reported study, over 90% of 101 individuals lacked elements of preventive health evaluations. Prostate and female reproductive health care were especially neglected, but surveillance for cardiac risk factors was also commonly neglected. Comment: This excellent review article is a gold mine of references to the current
medical literature on the problems of the aging individual with cerebral
palsy. It clearly emphasizes the need for systematic follow-up of many
medical issues including those of preventive care and the need for educated
surveillance for complications affecting the musculoskeletal, pulmonary,
cardiac, and nervous systems. 1 Klingbeil, H., Baer, H.R., Wilson, P.E., Aging with a Disability. Archives
of Physical Medicine and Rehabilitation. July 2004; 85 (6 Suppl): 68-73. |