Post Impairment Syndrome and Cerebral Palsy
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 exact issues this condition causes vary by individual, but often include fatigue, joint pain and arthritis, difficulty walking, poor posture, and weakness.
Post-Impairment syndrome is an issue in adults with cerebral palsy because it results from years and decades of damage to the bones, muscles, and other tissues in the body. This damage comes from the accumulated effects of moving and living with joint, bone, and muscle abnormalities. Good, lifelong physiotherapy and treatment are important for minimizing or preventing post-impairment syndrome, but when it occurs, there are treatments that can help 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, but most people with it feel the condition in their bodies. The brain damage impacts muscle tone, muscle control, bones, joints, posture, balance, and how a person moves. Everyone with cerebral palsy struggles with the loss of motor control and function to some degree, from challenges that are barely noticeable to almost complete inability to walk, and everything in between.
These motor issues can cause significant problems in childhood, but as a person ages, they cause even more problems. The years of moving in ways that are not optimal and of 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 people with cerebral palsy use significantly more energy to move than people without motor issues. Together all of this damage and the symptoms it causes is called post-impairment syndrome.
When post-impairment syndrome begins depends on each individual, as does the severity of the condition. Those with more minor disabilities may never experience post-impairment syndrome or may only have mild symptoms that set in later in life. Children with severe cerebral palsy symptoms are more likely to experience the syndrome earlier and for it to be more serious.
Common Symptoms and Conditions Associated with Post-Impairment Syndrome
Post-impairment syndrome is not a strictly defined condition by symptoms because it can cause different symptoms and varying degrees of symptoms in different individuals. However, there are some challenges, conditions, and symptoms that are commonly 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 result in some degree of pain. The pain may come from repetitive use injuries, from arthritis, or from sore or imbalanced muscles.
- Weakness. Muscle abnormalities and many of the same causes of pain in post-impairment syndrome, also cause weakness over time, making movements even more challenging.
- Fatigue. Estimates are that people with cerebral palsy use three to five times the amount of energy to move in similar ways that people without the condition use. This leads over time to both weakness and fatigue. For many people with the 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 with painful symptoms and poor mobility.
Preventing Post-Impairment Syndrome
It may not be possible to prevent the development of post-impairment syndrome, but good and consistent treatment throughout a child’s life can prevent the worst. There are many elements to the treatment of cerebral palsy, from medications and surgery to physical therapy and mental health therapy. The treatments needed to depend on the needs of each individual, but the more comprehensive and consistent treatment is, the better chances a child has of minimizing later post-impairment syndrome symptoms.
What is important to developing lifelong mobility and avoiding as much damage as possible that can lead to later pain and disability, is correcting muscles imbalances, muscle tone, and bone and joint deformities. For some children, surgery may help make corrections that will lead to easier movements and less damage over the years. Most can also benefit from ongoing physical therapy that helps to develop muscles, balances strength in pairs of muscles, and teaches someone to walk and move in ways that will result in less damage.
Treating Post-Impairment Syndrome
Even with good lifelong treatment, many 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, like surgery to repair bone damage, but most of all treatment involves addressing symptoms.
For instance, treating the pain of post-impairment syndrome may involve a combination of medications for pain, physical therapy, and gentle types of exercise, like yoga. Fatigue and weakness can also be treated with physical therapy and exercise. Lifestyle changes can also help, like improving sleep habits and eating a healthy and nutritious diet. Using more mobility aids and working with an occupational therapist can help 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 counsellor can help to change negative thoughts and behaviours. Antidepressants may be useful as well. People going through this difficult condition can also benefit from support groups, chatting online or in person with other people experiencing the same challenges. It is also important to rely on a close network of friends and family for social support to boost mood, but also for assistance with ordinary tasks when pain and fatigue become overwhelming.
Consequences of Post-Impairment Syndrome
In addition to the direct consequences of the years of living with cerebral palsy, like pain and fatigue, living with 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 dropping out of social engagements or missing work, which can lead to social isolation and financial issues. It is important to get help for post-impairment syndrome because it goes well beyond just causing pain and tiredness to affect all areas of life and quality of life.
Living with Cerebral Palsy as a child isn’t easy, but even as an adult the challenges do not necessarily get easier. The accumulated damage of 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 and therapies to prevent the damage that causes post-impairment syndrome and to ask for help when you experience it later in life.
Specialist Information Officer and Cerebral Palsy Programme Lead
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