title: Coeliac disease

text: Refractory coeliac disease should not be confused with the persistence of symptoms despite gluten withdrawal caused by transient conditions derived from the intestinal damage, which generally revert or improve several months after starting a gluten-free diet, such as small intestinal bacterial overgrowth, lactose intolerance, fructose, sucrose, and sorbitol malabsorption, exocrine pancreatic insufficiency, and microscopic colitis among others.


title: Coeliac disease

text: Globally coeliac disease affects between 1 in 100 and 1 in 170 people. Rates, however, vary between different regions of the world from as few as 1 in 300 to as many as 1 in 40. In the United States it is thought to affect between 1 in 1750 (defined as clinical disease including dermatitis herpetiformis with limited digestive tract symptoms) to 1 in 105 (defined by presence of IgA TG in blood donors). Due to variable signs and symptoms it is believed that about 85% of people affected are undiagnosed. The percentage of people with clinically diagnosed disease (symptoms prompting diagnostic testing) is 0.05–0.27% in various studies. However, population studies from parts of Europe, India, South America, Australasia and the USA (using serology and biopsy) indicate that the percentage of people with the disease may be between 0.33 and 1.06% in children (but 5.66% in one study of children of the predisposed Sahrawi people) and 0.18–1.2% in adults. Among those in primary care populations who report gastrointestinal symptoms, the rate of coeliac disease is about 3%. In Australia, approximately 1 in 70 people have the disease. The rate amongst adult blood donors in Iran, Israel, Syria and Turkey is 0.60%, 0.64%, 1.61% and 1.15%, respectively.


title: Coeliac disease

text: People of African, Japanese and Chinese descent are rarely diagnosed; this reflects a much lower prevalence of the genetic risk factors, such as HLA-B8. People of Indian ancestry seem to have a similar risk to those of Western Caucasian ancestry. Population studies also indicate that a large proportion of coeliacs remain undiagnosed; this is due, in part, to many clinicians being unfamiliar with the condition and also due to the fact it can be asymptomatic. Coeliac disease is slightly more common in women than in men. A large multicentre study in the U.S. found a prevalence of 0.75% in not-at-risk groups, rising to 1.8% in symptomatic people, 2.6% in second-degree relatives (like grandparents, aunt or uncle, grandchildren, etc.) of a person with coeliac disease and 4.5% in first-degree relatives (siblings, parents or children). This profile is similar to the prevalence in Europe. Other populations at increased risk for coeliac disease, with prevalence rates ranging from 5% to 10%, include individuals with Down and Turner syndromes, type 1 diabetes, and autoimmune thyroid disease, including both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid).


title: Coeliac disease

text: Historically, coeliac disease was thought to be rare, with a prevalence of about 0.02%. The reason for the recent increases in the number of reported cases is unclear. It may be at least in part due to changes in diagnostic practice. There also appears to be an approximately 4.5 fold true increase that may be due to less exposure to bacteria and other pathogens in Western environments. In the United States, the median age at diagnosis is 38 years. Roughly 20 percent of individuals with coeliac disease are diagnosed after 60 years of age.


title: Coeliac disease

text: The term "coeliac" is from the Greek κοιλιακός ("koiliakós", "abdominal") and was introduced in the 19th century in a translation of what is generally regarded as an Ancient Greek description of the disease by Aretaeus of Cappadocia.


title: Coeliac disease

text: Humans first started to cultivate grains in the Neolithic period (beginning about 9500 BCE) in the Fertile Crescent in Western Asia, and, likely, coeliac disease did not occur before this time. Aretaeus of Cappadocia, living in the second century in the same area, recorded a malabsorptive syndrome with chronic diarrhoea, causing a debilitation of the whole body. His "Cœliac Affection" ("coeliac" from Greek κοιλιακός "koiliakos", "abdominal") gained the attention of Western medicine when Francis Adams presented a translation of Aretaeus's work at the Sydenham Society in 1856. The patient described in Aretaeus' work had stomach pain and was atrophied, pale, feeble, and incapable of work. The diarrhoea manifested as loose stools that were white, malodorous, and flatulent, and the disease was intractable and liable to periodic return. The problem, Aretaeus believed, was a lack of heat in the stomach necessary to digest the food and a reduced ability to distribute the digestive products throughout the body, this incomplete digestion resulting in diarrhoea. He regarded this as an affliction of the old and more commonly affecting women, explicitly excluding children. The cause, according to Aretaeus, was sometimes either another chronic disease or even consuming "a copious draught of cold water."


title: Coeliac disease

text: The paediatrician Samuel Gee gave the first modern-day description of the condition in children in a lecture at Hospital for Sick Children, Great Ormond Street, London, in 1887. Gee acknowledged earlier descriptions and terms for the disease and adopted the same term as Aretaeus (coeliac disease). He perceptively stated: "If the patient can be cured at all, it must be by means of diet." Gee recognised that milk intolerance is a problem with coeliac children and that highly starched foods should be avoided. However, he forbade rice, sago, fruit, and vegetables, which all would have been safe to eat, and he recommended raw meat as well as thin slices of toasted bread. Gee highlighted particular success with a child "who was fed upon a quart of the best Dutch mussels daily." However, the child could not bear this diet for more than one season.


title: Coeliac disease

text: Christian Archibald Herter, an American physician, wrote a book in 1908 on children with coeliac disease, which he called "intestinal infantilism". He noted their growth was retarded and that fat was better tolerated than carbohydrate. The eponym "Gee-Herter disease" was sometimes used to acknowledge both contributions. Sidney V. Haas, an American paediatrician, reported positive effects of a diet of bananas in 1924. This diet remained in vogue until the actual cause of coeliac disease was determined.


title: Coeliac disease

text: While a role for carbohydrates had been suspected, the link with wheat was not made until the 1940s by the Dutch paediatrician Dr Willem Karel Dicke. It is likely that clinical improvement of his patients during the Dutch famine of 1944 (during which flour was scarce) may have contributed to his discovery. Dicke noticed that the shortage of bread led to a significant drop in the death rate among children affected by coeliac disease from greater than 35% to essentially zero. He also reported that once wheat was again available after the conflict, the mortality rate soared to previous levels. The link with the gluten component of wheat was made in 1952 by a team from Birmingham, England. Villous atrophy was described by British physician John W. Paulley in 1954 on samples taken at surgery. This paved the way for biopsy samples taken by endoscopy.


title: Coeliac disease

text: Throughout the 1960s, other features of coeliac disease were elucidated. Its hereditary character was recognised in 1965. In 1966, dermatitis herpetiformis was linked to gluten sensitivity.


title: Coeliac disease

text: Speaking generally, the various denominations of Christians celebrate a Eucharist in which a wafer or small piece of sacramental bread from wheat bread is blessed and then eaten. A typical wafer weighs about half a gram.


title: Coeliac disease

text: Many Christian churches offer their communicants gluten-free alternatives, usually in the form of a rice-based cracker or gluten-free bread. These include the United Methodist, Christian Reformed, Episcopal, the Anglican Church (Church of England, UK) and Lutheran. Catholics may receive from the Chalice alone, or ask for gluten-reduced hosts; gluten-free ones however are not considered to still be wheat bread and hence invalid matter.


title: Coeliac disease

text: Roman Catholic doctrine states that for a valid Eucharist, the bread to be used at Mass must be made from wheat. Low-gluten hosts meet all of the Catholic Church's requirements, but they are not entirely gluten free. Requests to use rice wafers have been denied.


title: Coeliac disease

text: The issue is more complex for priests. As a celebrant, a priest is, for the fullness of the sacrifice of the Mass, absolutely required to receive under both species. On 24 July 2003, the Congregation for the Doctrine of the Faith stated, "Given the centrality of the celebration of the Eucharist in the life of a priest, one must proceed with great caution before admitting to Holy Orders those candidates unable to ingest gluten or alcohol without serious harm."


title: Coeliac disease

text: By January 2004, extremely low-gluten Church-approved hosts had become available in the United States, Italy and Australia. As of July 2017, the Vatican still outlawed the use of gluten-free bread for Holy Communion.


title: Coeliac disease

text: Coeliac disease is the preferred spelling in British English, while celiac disease is typically used in North American English.


title: Coeliac disease

text: The search for environmental factors that could be responsible for genetically susceptible people becoming intolerant to gluten has resulted in increasing research activity looking at gastrointestinal infections. Research published in April 2017 suggests that an often-symptomless infection by a common strain of reovirus can increase sensitivity to foods such as gluten.


title: Coeliac disease

text: Various treatment approaches are being studied, including some that would reduce the need for dieting. All are still under development, and are not expected to be available to the general public for a while.


title: Coeliac disease

text: Three main approaches have been proposed as new therapeutic modalities for coeliac disease: gluten detoxification, modulation of the intestinal permeability, and modulation of the immune response.


title: Coeliac disease

text: Using genetically engineered wheat species, or wheat species that have been selectively bred to be minimally immunogenic, may allow the consumption of wheat. This, however, could interfere with the effects that gliadin has on the quality of dough. Alternatively, gluten exposure can be minimised by the ingestion of a combination of enzymes (prolyl endopeptidase and a barley glutamine-specific cysteine endopeptidase (EP-B2)) that degrade the putative 33-mer peptide in the duodenum.


title: Coeliac disease

text: Alternative treatments under investigation include the inhibition of zonulin, an endogenous signalling protein linked to increased permeability of the bowel wall and hence increased presentation of gliadin to the immune system. One inhibitor of this pathway is larazotide acetate, which is currently scheduled for phase 3 clinical trials. Other modifiers of other well-understood steps in the pathogenesis of coeliac disease, such as the action of HLA-DQ2 or tissue transglutaminase and the MICA/NKG2D interaction that may be involved in the killing of enterocytes.


title: Coeliac disease

text: Attempts to modulate the immune response concerning coeliac disease are mostly still in phase I of clinical testing; one agent (CCX282-B) has been evaluated in a phase II clinical trial based on small-intestinal biopsies taken from people with coeliac disease before and after gluten exposure.


title: Coeliac disease

text: Although popularly used as an alternative treatment for people with autism, there is no good evidence that a gluten-free diet is of benefit in the treatment of autism. In the subset of people who have gluten sensitivity there is limited evidence that suggests that a gluten free diet may improve some autistic behaviors.


title: Cerebral palsy

text: Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, vision, hearing, and speaking. Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children of their age. Other symptoms include seizures and problems with thinking or reasoning, which each occur in about one-third of people with CP. While symptoms may get more noticeable over the first few years of life, underlying problems do not worsen over time.


title: Cerebral palsy

text: Cerebral palsy is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. Most often, the problems occur during pregnancy, but they may also occur during childbirth or shortly after birth. Often, the cause is unknown. Risk factors include preterm birth, being a twin, certain infections during pregnancy, such as toxoplasmosis or rubella, exposure to methylmercury during pregnancy, a difficult delivery, and head trauma during the first few years of life, among others. About 2% of cases are believed to be due to an inherited genetic cause. A number of sub-types are classified, based on the specific problems present. For example, those with stiff muscles have spastic cerebral palsy, those with poor coordination in locomotion have ataxic cerebral palsy, and those with writhing movements have dyskinetic cerebral palsy. Diagnosis is based on the child's development over time. Blood tests and medical imaging may be used to rule out other possible causes.


title: Cerebral palsy

text: Some of the causes of CP are preventable through immunization of the mother, and through efforts to prevent head injuries in children such as through improved safety. There is no known cure for CP, but supportive treatments, medication and surgery may help many individuals. This may include physical therapy, occupational therapy and speech therapy. Medications such as diazepam, baclofen and botulinum toxin may help relax stiff muscles. Surgery may include lengthening muscles and cutting overly active nerves. Often, external braces and other assistive technology are helpful. Some affected children can achieve near normal adult lives with appropriate treatment. While alternative medicines are frequently used, there is no evidence to support their use.


title: Cerebral palsy

text: Cerebral palsy is the most common movement disorder in children. It occurs in about 2.1 per 1,000 live births. Cerebral palsy has been documented throughout history, with the first known descriptions occurring in the work of Hippocrates in the 5th century BCE. Extensive study of the condition began in the 19th century by William John Little, after whom spastic diplegia was called "Little's disease". William Osler first named it "cerebral palsy" from the German (cerebral child-paralysis). A number of potential treatments are being examined, including stem cell therapy. However, more research is required to determine if it is effective and safe.


title: Cerebral palsy

text: Cerebral palsy is defined as "a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain." While movement problems are the central feature of CP, difficulties with thinking, learning, feeling, communication and behavior often co-occur, with 28% having epilepsy, 58% having difficulties with communication, at least 42% having problems with their vision, and 2356% having learning disabilities. Muscle contractions in people with cerebral palsy are commonly thought to arise from overactivation.


title: Cerebral palsy

text: Cerebral palsy is characterized by abnormal muscle tone, reflexes, or motor development and coordination. The neurological lesion is primary and permanent while orthopedic manifestations are secondary and progressive. In cerebral palsy unequal growth between muscle-tendon units and bone eventually leads to bone and joint deformities. At first, deformities are dynamic. Over time, deformities tend to become static, and joint contractures develop. Deformities in general and static deformities in specific (joint contractures) cause increasing gait difficulties in the form of tip-toeing gait, due to tightness of the Achilles tendon, and scissoring gait, due to tightness of the hip adductors. These gait patterns are among the most common gait abnormalities in children with cerebral palsy. However, orthopaedic manifestations of cerebral palsy are diverse. Additionally, crouch gait (excessive knee flexion gait) is prevalent among children who possess the ability to walk. The effects of cerebral palsy fall on a continuum of motor dysfunction, which may range from slight clumsiness at the mild end of the spectrum to impairments so severe that they render coordinated movement virtually impossible at the other end of the spectrum. Although most people with CP have problems with increased muscle tone, some have normal or low muscle tone. High muscle tone can either be due to spasticity or dystonia.


title: Cerebral palsy

text: Babies born with severe cerebral palsy often have irregular posture; their bodies may be either very floppy or very stiff. Birth defects, such as spinal curvature, a small jawbone, or a small head sometimes occur along with CP. Symptoms may appear or change as a child gets older. Babies born with cerebral palsy do not immediately present with symptoms. Classically, CP becomes evident when the baby reaches the developmental stage at 6 to 9 months and is starting to mobilise, where preferential use of limbs, asymmetry, or gross motor developmental delay is seen.


title: Cerebral palsy

text: Drooling is common among children with cerebral palsy, which can have a variety of impacts including social rejection, impaired speaking, damage to clothing and books, and mouth infections. It can additionally cause choking.


title: Cerebral palsy

text: An average of 55.5% of people with cerebral palsy experience lower urinary tract symptoms, more commonly excessive storage issues than voiding issues. Those with voiding issues and pelvic floor overactivity can deteriorate as adults and experience upper urinary tract dysfunction.


title: Cerebral palsy

text: Children with CP may also have sensory processing issues. Adults with cerebral palsy have a higher risk of respiratory failure.


title: Cerebral palsy

text: For bones to attain their normal shape and size, they require the stresses from normal musculature. People with cerebral palsy are at risk of low bone mineral density. The shafts of the bones are often thin (gracile), and become thinner during growth. When compared to these thin shafts (diaphyses), the centres (metaphyses) often appear quite enlarged (ballooning). Due to more than normal joint compression caused by muscular imbalances, articular cartilage may atrophy, leading to narrowed joint spaces. Depending on the degree of spasticity, a person with CP may exhibit a variety of angular joint deformities. Because vertebral bodies need vertical gravitational loading forces to develop properly, spasticity and an abnormal gait can hinder proper or full bone and skeletal development. People with CP tend to be shorter in height than the average person because their bones are not allowed to grow to their full potential. Sometimes bones grow to different lengths, so the person may have one leg longer than the other.


title: Cerebral palsy

text: Children with CP are prone to low trauma fractures, particularly children with higher Gross Motor Function Classification System (GMFCS) levels who cannot walk. This further affects a child's mobility, strength, and experience of pain, and can lead to missed schooling or child abuse suspicions. These children generally have fractures in the legs, whereas non-affected children mostly fracture their arms in the context of sporting activities.


title: Cerebral palsy

text: Hip dislocation and ankle equinus or plantar flexion deformity are the two most common deformities among children with cerebral palsy. Additionally, flexion deformity of the hip and knee can occur. Torsional deformities of long bones such as the femur and tibia are also encountered, among others. Children may develop scoliosis before the age of 10 – estimated prevalence of scoliosis in children with CP is between 21% and 64%. Higher levels of impairment on the GMFCS are associated with scoliosis and hip dislocation. Scoliosis can be corrected with surgery, but CP makes surgical complications more likely, even with improved techniques. Hip migration can be managed by soft tissue procedures such as adductor musculature release. Advanced degrees of hip migration or dislocation can be managed by more extensive procedures such as femoral and pelvic corrective osteotomies. Both soft tissue and bony procedures aim at prevention of hip dislocation in the early phases or aim at hip containment and restoration of anatomy in the late phases of disease. Equinus deformity is managed by conservative methods especially when dynamic. If fixed/static deformity ensues surgery may become mandatory.


title: Cerebral palsy

text: Due to sensory and motor impairments, those with CP may have difficulty preparing food, holding utensils, or chewing and swallowing. An infant with CP may not be able to suck, swallow or chew. Gastro-oesophageal reflux is common in children with CP. Children with CP may have too little or too much sensitivity around and in the mouth. Poor balance when sitting, lack of control of the head, mouth, and trunk, not being able to bend the hips enough to allow the arms to stretch forward to reach and grasp food or utensils, and lack of hand-eye coordination can make self-feeding difficult. Feeding difficulties are related to higher GMFCS levels. Dental problems can also contribute to difficulties with eating. Pneumonia is also common where eating difficulties exist, caused by undetected aspiration of food or liquids. Fine finger dexterity, like that needed for picking up a utensil, is more frequently impaired than gross manual dexterity, like that needed for spooning food onto a plate. Grip strength impairments are less common.


title: Cerebral palsy

text: Children with severe cerebral palsy, particularly with oropharyngeal issues, are at risk of undernutrition. Triceps skin fold tests have been found to be a very reliable indicator of malnutrition in children with cerebral palsy.


title: Cerebral palsy

text: Speech and language disorders are common in people with cerebral palsy. The incidence of dysarthria is estimated to range from 31% to 88%, and around a quarter of people with CP are non-verbal. Speech problems are associated with poor respiratory control, laryngeal and velopharyngeal dysfunction, and oral articulation disorders that are due to restricted movement in the oral-facial muscles. There are three major types of dysarthria in cerebral palsy: spastic, dyskinetic (athetotic), and ataxic.


title: Cerebral palsy

text: Early use of augmentative and alternative communication systems may assist the child in developing spoken language skills. Overall language delay is associated with problems of cognition, deafness, and learned helplessness. Children with cerebral palsy are at risk of learned helplessness and becoming passive communicators, initiating little communication. Early intervention with this clientele, and their parents, often targets situations in which children communicate with others so that they learn that they can control people and objects in their environment through this communication, including making choices, decisions, and mistakes.


title: Cerebral palsy

text: Pain is common and may result from the inherent deficits associated with the condition, along with the numerous procedures children typically face. When children with cerebral palsy are in pain, they experience worse muscle spasms. Pain is associated with tight or shortened muscles, abnormal posture, stiff joints, unsuitable orthosis, etc. Hip migration or dislocation is a recognizable source of pain in CP children and especially in the adolescent population. Nevertheless, the adequate scoring and scaling of pain in CP children remains challenging. Pain in CP has a number of different causes, and different pains respond to different treatments.


title: Cerebral palsy

text: There is also a high likelihood of chronic sleep disorders secondary to both physical and environmental factors. Children with cerebral palsy have significantly higher rates of sleep disturbance than typically developing children. Babies with cerebral palsy who have stiffness issues might cry more and be harder to put to sleep than non-disabled babies, or "floppy" babies might be lethargic. Chronic pain is under-recognized in children with cerebral palsy, even though three out of four children with cerebral palsy experience pain. Adults with CP also experience more pain than the general population.


title: Cerebral palsy

text: Associated disorders include intellectual disabilities, seizures, muscle contractures, abnormal gait, osteoporosis, communication disorders, malnutrition, sleep disorders, and mental health disorders, such as depression and anxiety. In addition to these, functional gastrointestinal abnormalities contributing to bowel obstruction, vomiting, and constipation may also arise. Adults with cerebral palsy may have ischemic heart disease, cerebrovascular disease, cancer, and trauma more often. Obesity in people with cerebral palsy or a more severe Gross Motor Function Classification System assessment in particular are considered risk factors for multimorbidity. Other medical issues can be mistaken for being symptoms of cerebral palsy, and so may not be treated correctly.


title: Cerebral palsy

text: Related conditions can include apraxia, sensory impairments, urinary incontinence, fecal incontinence, or behavioural disorders.


title: Cerebral palsy

text: Seizure management is more difficult in people with CP as seizures often last longer. Epilepsy and asthma are common co-occurring diseases in adults with CP. The associated disorders that co-occur with cerebral palsy may be more disabling than the motor function problems.


title: Cerebral palsy

text: Cerebral palsy is due to abnormal development or damage occurring to the developing brain. This damage can occur during pregnancy, delivery, the first month of life, or less commonly in early childhood. Structural problems in the brain are seen in 80% of cases, most commonly within the white matter.


title: Cerebral palsy

text: More than three-quarters of cases are believed to result from issues that occur during pregnancy. Most children who are born with cerebral palsy have more than one risk factor associated with CP.


title: Cerebral palsy

text: While in certain cases there is no identifiable cause, typical causes include problems in intrauterine development (e.g. exposure to radiation, infection, fetal growth restriction), hypoxia of the brain (thrombotic events, placental insufficiency, umbilical cord prolapse), birth trauma during labor and delivery, and complications around birth or during childhood.


title: Cerebral palsy

text: In Africa birth asphyxia, high bilirubin levels, and infections in newborns of the central nervous system are main cause. Many cases of CP in Africa could be prevented with better resources available.


title: Cerebral palsy

text: Between 40% and 50% of all children who develop cerebral palsy were born prematurely. Most of these cases (75–90%) are believed to be due to issues that occur around the time of birth, often just after birth. Multiple-birth infants are also more likely than single-birth infants to have CP. They are also more likely to be born with a low birth weight.


title: Cerebral palsy

text: In those who are born with a weight between 1 kg and 1.5 kg CP occurs in 6%. Among those born before 28 weeks of gestation it occurs in 8%. Genetic factors are believed to play an important role in prematurity and cerebral palsy generally. While in those who are born between 34 and 37 weeks the risk is 0.4% (three times normal).


title: Cerebral palsy

text: In babies that are born at term risk factors include problems with the placenta, birth defects, low birth weight, breathing meconium into the lungs, a delivery requiring either the use of instruments or an emergency Caesarean section, birth asphyxia, seizures just after birth, respiratory distress syndrome, low blood sugar, and infections in the baby.


title: Cerebral palsy

text: , it was unclear how much of a role birth asphyxia plays as a cause. It is unclear if the size of the placenta plays a role. it is evident that in advanced countries, most cases of cerebral palsy in term or near-term neonates have explanations other than asphyxia.


title: Cerebral palsy

text: Cerebral palsy is not commonly considered a genetic disease. About 2% of all CP cases are expected to be inherited, with glutamate decarboxylase-1 being one of the possible enzymes involved. Most inherited cases are autosomal recessive. However, the vast majority of CP cases are connected to brain damage during birth and in infancy. There is a small percentage of CP cases caused by brain damage that stemmed from the prenatal period, which is estimated to be less than 5% of CP cases overall. Moreover, there is no one reason why some CP cases come from prenatal brain damage, and it's not known if those cases have a genetic basis.


title: Cerebral palsy

text: After birth, other causes include toxins, severe jaundice, lead poisoning, physical brain injury, stroke, abusive head trauma, incidents involving hypoxia to the brain (such as near drowning), and encephalitis or meningitis.


title: Cerebral palsy

text: Infections in the mother, even those not easily detected, can triple the risk of the child developing cerebral palsy. Infections of the fetal membranes known as chorioamnionitis increases the risk.


title: Cerebral palsy

text: Rh blood type incompatibility can cause the mother's immune system to attack the baby's red blood cells.


title: Cerebral palsy

text: It has been hypothesised that some cases of cerebral palsy are caused by the death in very early pregnancy of an identical twin.


title: Cerebral palsy

text: The diagnosis of cerebral palsy has historically rested on the person's history and physical examination and is generally assessed at a young age. A general movements assessment, which involves measuring movements that occur spontaneously among those less than four months of age, appears most accurate. Children who are more severely affected are more likely to be noticed and diagnosed earlier. Abnormal muscle tone, delayed motor development and persistence of primitive reflexes are the main early symptoms of CP. Symptoms and diagnosis typically occur by the age of two, although depending on factors like malformations and congenital issues, persons with milder forms of cerebral palsy may be over the age of five, if not in adulthood, when finally diagnosed. Cognitive assessments and medical observations are also useful to help confirm a diagnosis. Additionally, evaluations of the child's mobility, speech and language, hearing, vision, gait, feeding and digestion are also useful to determine the extent of the disorder. Early diagnosis and intervention are seen as being a key part of managing cerebral palsy. Machine learning algorithms facilitate automatic early diagnosis, with methods such as deep neural network and geometric feature fusion producing high accuracy in predicting cerebral palsy from short videos. It is a developmental disability.


title: Cerebral palsy

text: Once a person is diagnosed with cerebral palsy, further diagnostic tests are optional. Neuroimaging with CT or MRI is warranted when the cause of a person's cerebral palsy has not been established. An MRI is preferred over CT, due to diagnostic yield and safety. When abnormal, the neuroimaging study can suggest the timing of the initial damage. The CT or MRI is also capable of revealing treatable conditions, such as hydrocephalus, porencephaly, arteriovenous malformation, subdural hematomas and hygromas, and a vermian tumour (which a few studies suggest are present 5–22% of the time). Furthermore, an abnormal neuroimaging study indicates a high likelihood of associated conditions, such as epilepsy and intellectual disability. There is a small risk associated with sedating children to facilitate a clear MRI.


title: Cerebral palsy

text: The age when CP is diagnosed is important, but medical professionals disagree over the best age to make the diagnosis. The earlier CP is diagnosed correctly, the better the opportunities are to provide the child with physical and educational help, but there might be a greater chance of confusing CP with another problem, especially if the child is 18 months of age or younger. Infants may have temporary problems with muscle tone or control that can be confused with CP, which is permanent. A metabolism disorder or tumors in the nervous system may appear to be CP; metabolic disorders, in particular, can produce brain problems that look like CP on an MRI. Disorders that deteriorate the white matter in the brain and problems that cause spasms and weakness in the legs, may be mistaken for CP if they first appear early in life. However, these disorders get worse over time, and CP does not (although it may change in character). In infancy it may not be possible to tell the difference between them. In the UK, not being able to sit independently by the age of 8 months is regarded as a clinical sign for further monitoring. Fragile X syndrome (a cause of autism and intellectual disability) and general intellectual disability must also be ruled out. Cerebral palsy specialist John McLaughlin recommends waiting until the child is 36 months of age before making a diagnosis because, by that age, motor capacity is easier to assess.


title: Cerebral palsy

text: CP is classified by the types of motor impairment of the limbs or organs, and by restrictions to the activities an affected person may perform. The Gross Motor Function Classification System-Expanded and Revised and the Manual Ability Classification System are used to describe mobility and manual dexterity in people with cerebral palsy, and recently the Communication Function Classification System, and the Eating and Drinking Ability Classification System have been proposed to describe those functions. There are three main CP classifications by motor impairment: spastic, ataxic, and dyskinetic. Additionally, there is a mixed type that shows a combination of features of the other types. These classifications reflect the areas of the brain that are damaged.


title: Cerebral palsy

text: Cerebral palsy is also classified according to the topographic distribution of muscle spasticity. This method classifies children as diplegic, (bilateral involvement with leg involvement greater than arm involvement), hemiplegic (unilateral involvement), or quadriplegic (bilateral involvement with arm involvement equal to or greater than leg involvement).


title: Cerebral palsy

text: Spastic cerebral palsy is the type of cerebral palsy characterized by spasticity or high muscle tone often resulting in stiff, jerky movements. Itself an umbrella term encompassing spastic hemiplegia, spastic diplegia, spastic quadriplegia and – where solely one limb or one specific area of the body is affected – spastic monoplegia. Spastic cerebral palsy affects the motor cortex of the brain, a specific portion of the cerebral cortex responsible for the planning and completion of voluntary movement. Spastic CP is the most common type of overall cerebral palsy, representing about 80% of cases. Botulinum toxin is effective in decreasing spasticity. It can help increase range of motion which could help mitigate CPs effects on the growing bones of children. There may be an improvement in motor functions in the children and ability to walk. however, the main benefit derived from botulinum toxin A comes from its ability to reduce muscle tone and spasticity and thus prevent or delay the development of fixed muscle contractures.


title: Cerebral palsy

text: Ataxic cerebral palsy is observed in approximately 5–10% of all cases of cerebral palsy, making it the least frequent form of cerebral palsy. Ataxic cerebral palsy is caused by damage to cerebellar structures. Because of the damage to the cerebellum, which is essential for coordinating muscle movements and balance, patients with ataxic cerebral palsy experience problems in coordination, specifically in their arms, legs, and trunk. Ataxic cerebral palsy is known to decrease muscle tone. The most common manifestation of ataxic cerebral palsy is intention (action) tremor, which is especially apparent when carrying out precise movements, such as tying shoe laces or writing with a pencil. This symptom gets progressively worse as the movement persists, making the hand shake. As the hand gets closer to accomplishing the intended task, the trembling intensifies, which makes it even more difficult to complete.


title: Cerebral palsy

text: Dyskinetic cerebral palsy (sometimes abbreviated DCP) is primarily associated with damage to the basal ganglia and the substantia nigra in the form of lesions that occur during brain development due to bilirubin encephalopathy and hypoxic-ischemic brain injury. DCP is characterized by both hypertonia and hypotonia, due to the affected individual's inability to control muscle tone. Clinical diagnosis of DCP typically occurs within 18 months of birth and is primarily based upon motor function and neuroimaging techniques.


title: Cerebral palsy

text: Dyskinetic cerebral palsy is an extrapyramidal form of cerebral palsy. Dyskinetic cerebral palsy can be divided into two different groups; choreoathetosis and dystonia. Choreo-athetotic CP is characterized by involuntary movements, whereas dystonic CP is characterized by slow, strong contractions, which may occur locally or encompass the whole body.


title: Cerebral palsy

text: Mixed cerebral palsy has symptoms of dyskinetic, ataxic and spastic CP appearing simultaneously, each to varying degrees, and both with and without symptoms of each. Mixed CP is the most difficult to treat as it is extremely heterogeneous and sometimes unpredictable in its symptoms and development over the lifespan.


title: Cerebral palsy

text: In patients with spastic hemiplegia or diplegia, various gait patterns can be observed, the exact form of which can only be described with the help of complex gait analysis systems. In order to facilitate interdisciplinary communication in the interdisciplinary team between those affected, doctors, physiotherapists and orthotists, a simple description of the gait pattern is useful. J. Rodda and H. K. Graham already described in 2001 how gait patterns of CP patients can be more easily recognized and defined gait types which they compared in a classification. They also described that gait patterns can vary with age. Building on this, the Amsterdam Gait Classification was developed at the free university in Amsterdam, the VU medisch centrum. A special feature of this classification is that it makes different gait patterns very easy to recognize and can be used in CP patients in whom only one leg and both legs are affected. According to the Amsterdam Gait Classification, five gait types are described. To assess the gait pattern, the patient is viewed visually or via a video recording from the side of the leg to be assessed. At the point in time at which the leg to be viewed is in mid stance and the leg not to be viewed is in mid swing, the knee angle and the contact of the foot with the ground are assessed on the one hand.


title: Cerebral palsy

text: Classification of the gait pattern according to the Amsterdam Gait Classification: In gait type 1, the knee angle is normal and the foot contact is complete. In gait type 2, the knee angle is hyperextended and the foot contact is complete. In gait type 3, the knee angle is hyperextended and foot contact is incomplete (only on the forefoot). In gait type 4, the knee angle is bent and foot contact is incomplete (only on the forefoot). With gait type 5, the knee angle is bent and the foot contact is complete.


title: Cerebral palsy

text: Because the causes of CP are varied, a broad range of preventive interventions have been investigated.


title: Cerebral palsy

text: Electronic fetal monitoring has not helped to prevent CP, and in 2014 the American College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and the Society of Obstetricians and Gynaecologists of Canada have acknowledged that there are no long-term benefits of electronic fetal monitoring. Before this, electronic fetal monitoring was widely used to prop up obstetric litigation.


title: Cerebral palsy

text: In those at risk of an early delivery, magnesium sulphate appears to decrease the risk of cerebral palsy. It is unclear if it helps those who are born at term. In those at high risk of preterm labor a review found that moderate to severe CP was reduced by the administration of magnesium sulphate, and that adverse effects on the babies from the magnesium sulphate were not significant. Mothers who received magnesium sulphate could experience side effects such as respiratory depression and nausea. However, guidelines for the use of magnesium sulfate in mothers at risk of preterm labour are not strongly adhered to. Caffeine is used to treat apnea of prematurity and reduces the risk of cerebral palsy in premature babies, but there are also concerns of long term negative effects. A moderate quality level of evidence indicates that giving women antibiotics during preterm labor before her membranes have ruptured (water is not yet not broken) may increase the risk of cerebral palsy for the child. Additionally, for preterm babies for whom there is a chance of fetal compromise, allowing the birth to proceed rather than trying to delay the birth may lead to an increased risk of cerebral palsy in the child. Corticosteroids are sometimes taken by pregnant women expecting a preterm birth to provide neuroprotection to their baby. Taking corticosteroids during pregnancy is shown to have no significant correlation with developing cerebral palsy in preterm births.


title: Cerebral palsy

text: Cooling high-risk full-term babies shortly after birth may reduce disability, but this may only be useful for some forms of the brain damage that causes CP.


title: Cerebral palsy

text: Over time, the approach to CP management has shifted away from narrow attempts to fix individual physical problems such as spasticity in a particular limb to making such treatments part of a larger goal of maximizing the person's independence and community engagement. However, the evidence base for the effectiveness of intervention programs reflecting the philosophy of independence has not yet caught up: effective interventions for body structures and functions have a strong evidence base, but evidence is lacking for effective interventions targeted toward participation, environment, or personal factors. There is also no good evidence to show that an intervention that is effective at the body-specific level will result in an improvement at the activity level or vice versa. Although such cross-over benefit might happen, not enough high-quality studies have been done to demonstrate it.


title: Cerebral palsy

text: Because cerebral palsy has "varying severity and complexity" across the lifespan, it can be considered a collection of conditions for management purposes. A multidisciplinary approach for cerebral palsy management is recommended, focusing on "maximising individual function, choice and independence" in line with the International Classification of Functioning, Disability and Health's goals. The team may include a paediatrician, a health visitor, a social worker, a physiotherapist, an orthotist, a speech and language therapist, an occupational therapist, a teacher specialising in helping children with visual impairment, an educational psychologist, an orthopaedic surgeon, a neurologist and a neurosurgeon.


title: Cerebral palsy

text: Various forms of therapy are available to people living with cerebral palsy as well as caregivers and parents. Treatment may include one or more of the following: physical therapy; occupational therapy; speech therapy; water therapy; drugs to control seizures, alleviate pain, or relax muscle spasms (e.g. benzodiazepines); surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; rolling walkers; and communication aids such as computers with attached voice synthesisers. A Cochrane review published in 2004 found a trend toward the benefit of speech and language therapy for children with cerebral palsy but noted the need for high-quality research. A 2013 systematic review found that many of the therapies used to treat CP have no good evidence base; the treatments with the best evidence are medications (anticonvulsants, botulinum toxin, bisphosphonates, diazepam), therapy (bimanual training, casting, constraint-induced movement therapy, context-focused therapy, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care) and surgery. There is also research on whether the sleeping position might improve hip migration, but there are not yet high-quality evidence studies to support that theory. Research papers also call for an agreed consensus on outcome measures which will allow researchers to cross-reference research. Also, the terminology used to describe orthoses needs to be standardised to ensure studies can be reproduced and readily compared and evaluated. Surgical intervention in CP children mainly includes orthopaedic surgery and neurosurgery (selective dorsal rhizotomy).


title: Cerebral palsy

text: To improve the gait pattern, orthotics can be included in the therapy concept. An orthosis can support physiotherapeutic treatment in setting the right motor impulses in order to create new cerebral connections. The orthosis must meet the requirements of the medical prescription. In addition, the orthosis must be designed by the orthotist in such a way that it achieves the effectiveness of the necessary levers, matching the gait pattern, in order to support the proprioceptive approaches of physiotherapy. The characteristics of the stiffness of the orthosis shells and the adjustable dynamics in the ankle joint are important elements of the orthosis to be considered. Due to these requirements, the development of orthoses has changed significantly in recent years, especially since around 2010. At about the same time, care concepts were developed that deal intensively with the orthotic treatment of the lower extremities in cerebral palsy. Modern materials and new functional elements enable the rigidity to be specifically adapted to the requirements that fits to the gait pattern of the CP patient. The adjustment of the stiffness has a decisive influence on the gait pattern and on the energy cost of walking. It is of great advantage if the stiffness of the orthosis can be adjusted separately from one another via resistances of the two functional elements in the two directions of movement, dorsiflexion and plantar flexion.


title: Cerebral palsy

text: CP is not a progressive disorder (meaning the brain damage does not worsen), but the symptoms can become more severe over time. A person with the disorder may improve somewhat during childhood if he or she receives extensive care, but once bones and musculature become more established, orthopedic surgery may be required. People with CP can have varying degrees of cognitive impairment or none whatsoever. The full intellectual potential of a child born with CP is often not known until the child starts school. People with CP are more likely to have learning disorders but have normal intelligence. Intellectual level among people with CP varies from genius to intellectually disabled, as it does in the general population, and experts have stated that it is important not to underestimate the capabilities of a person with CP and to give them every opportunity to learn.


title: Cerebral palsy

text: The ability to live independently with CP varies widely, depending partly on the severity of each person's impairment and partly on the capability of each person to self-manage the logistics of life. Some individuals with CP require personal assistant services for all activities of daily living. Others only need assistance with certain activities, and still others do not require any physical assistance. But regardless of the severity of a person's physical impairment, a person's ability to live independently often depends primarily on the person's capacity to manage the physical realities of his or her life autonomously. In some cases, people with CP recruit, hire, and manage a staff of personal care assistants (PCAs). PCAs facilitate the independence of their employers by assisting them with their daily personal needs in a way that allows them to maintain control over their lives.


title: Cerebral palsy

text: Puberty in young adults with cerebral palsy may be precocious or delayed. Delayed puberty is thought to be a consequence of nutritional deficiencies. There is currently no evidence that CP affects fertility, although some of the secondary symptoms have been shown to affect sexual desire and performance. Adults with CP were less likely to get routine reproductive health screening as of 2005. Gynecological examinations may have to be performed under anesthesia due to spasticity, and equipment is often not accessible. Breast self-examination may be difficult, so partners or carers may have to perform it. Women with CP reported higher levels of spasticity and urinary incontinence during menstruation in a study. Men with CP have higher levels of cryptorchidism at the age of 21.


title: Cerebral palsy

text: CP can significantly reduce a person's life expectancy, depending on the severity of their condition and the quality of care they receive. 5–10% of children with CP die in childhood, particularly where seizures and intellectual disability also affect the child. The ability to ambulate, roll, and self-feed has been associated with increased life expectancy. While there is a lot of variation in how CP affects people, it has been found that "independent gross motor functional ability is a very strong determinant of life expectancy". According to the Australian Bureau of Statistics, in 2014, 104 Australians died of cerebral palsy. The most common causes of death in CP are related to respiratory causes, but in middle age cardiovascular issues and neoplastic disorders become more prominent.


title: Cerebral palsy

text: For many children with CP, parents are heavily involved in self-care activities. Self-care activities, such as bathing, dressing, and grooming, can be difficult for children with CP, as self-care depends primarily on the use of the upper limbs. For those living with CP, impaired upper limb function affects almost 50% of children and is considered the main factor contributing to decreased activity and participation. As the hands are used for many self-care tasks, sensory and motor impairments of the hands make daily self-care more difficult. Motor impairments cause more problems than sensory impairments. The most common impairment is that of finger dexterity, which is the ability to manipulate small objects with the fingers. Compared to other disabilities, people with cerebral palsy generally need more help in performing daily tasks. Occupational therapists are healthcare professionals that help individuals with disabilities gain or regain their independence through the use of meaningful activities.


title: Cerebral palsy

text: The effects of sensory, motor, and cognitive impairments affect self-care occupations in children with CP and productivity occupations. Productivity can include but is not limited to, school, work, household chores, or contributing to the community.


title: Cerebral palsy

text: Play is included as a productive occupation as it is often the primary activity for children. If play becomes difficult due to a disability, like CP, this can cause problems for the child. These difficulties can affect a child's self-esteem. In addition, the sensory and motor problems experienced by children with CP affect how the child interacts with their surroundings, including the environment and other people. Not only do physical limitations affect a child's ability to play, the limitations perceived by the child's caregivers and playmates also affect the child's play activities. Some children with disabilities spend more time playing by themselves. When a disability prevents a child from playing, there may be social, emotional and psychological problems, which can lead to increased dependence on others, less motivation, and poor social skills.


title: Cerebral palsy

text: In school, students are asked to complete many tasks and activities, many of which involve handwriting. Many children with CP have the capacity to learn and write in the school environment. However, students with CP may find it difficult to keep up with the handwriting demands of school and their writing may be difficult to read. In addition, writing may take longer and require greater effort on the student's part. Factors linked to handwriting include postural stability, sensory and perceptual abilities of the hand, and writing tool pressure.


title: Cerebral palsy

text: Speech impairments may be seen in children with CP depending on the severity of brain damage. Communication in a school setting is important because communicating with peers and teachers is very much a part of the "school experience" and enhances social interaction. Problems with language or motor dysfunction can lead to underestimating a student's intelligence. In summary, children with CP may experience difficulties in school, such as difficulty with handwriting, carrying out school activities, communicating verbally, and interacting socially.


title: Cerebral palsy

text: Leisure activities can have several positive effects on physical health, mental health, life satisfaction, and psychological growth for people with physical disabilities like CP. Common benefits identified are stress reduction, development of coping skills, companionship, enjoyment, relaxation and a positive effect on life satisfaction. In addition, for children with CP, leisure appears to enhance adjustment to living with a disability.


title: Cerebral palsy

text: Leisure can be divided into structured (formal) and unstructured (informal) activities. Children and teens with CP engage in less habitual physical activity than their peers. Children with CP primarily engage in physical activity through therapies aimed at managing their CP, or through organized sport for people with disabilities. It is difficult to sustain behavioural change in terms of increasing physical activity of children with CP. Gender, manual dexterity, the child's preferences, cognitive impairment and epilepsy were found to affect children's leisure activities, with manual dexterity associated with more leisure activity. Although leisure is important for children with CP, they may have difficulties carrying out leisure activities due to social and physical barriers.


title: Cerebral palsy

text: Children with cerebral palsy may face challenges when it comes to participating in sports. This comes with being discouraged from physical activity because of these perceived limitations imposed by their medical condition.


title: Cerebral palsy

text: Participation is involvement in life situations and everyday activities. Participation includes self-care, productivity, and leisure. In fact, communication, mobility, education, home life, leisure, and social relationships require participation, and indicate the extent to which children function in their environment. Barriers can exist on three levels: micro, meso, and macro. First, the barriers at the micro level involve the person. Barriers at the micro level include the child's physical limitations (motor, sensory and cognitive impairments) or their subjective feelings regarding their ability to participate. For example, the child may not participate in group activities due to lack of confidence. Second, barriers at the meso level include the family and community. These may include negative attitudes of people toward disability or lack of support within the family or in the community. One of the main reasons for this limited support appears to be the result of a lack of awareness and knowledge regarding the child's ability to engage in activities despite his or her disability. Third, barriers at the macro level incorporate the systems and policies that are not in place or hinder children with CP. These may be environmental barriers to participation such as architectural barriers, lack of relevant assistive technology, and transportation difficulties due to limited wheelchair access or public transit that can accommodate children with CP. For example, a building without an elevator can prevent the child from accessing higher floors.


title: Cerebral palsy

text: A 2013 review stated that outcomes for adults with cerebral palsy without intellectual disability in the 2000s were that "60–80% completed high school, 14–25% completed college, up to 61% were living independently in the community, 25–55% were competitively employed, and 14–28% were involved in long term relationships with partners or had established families". Adults with cerebral palsy may not seek physical therapy due to transport issues, financial restrictions and practitioners not feeling like they know enough about cerebral palsy to take people with CP on as clients.


title: Cerebral palsy

text: A study in young adults (18–34) on transitioning to adulthood found that their concerns were physical health care and understanding their bodies, being able to navigate and use services and supports successfully, and dealing with prejudices. A feeling of being "thrust into adulthood" was common in the study.


title: Cerebral palsy

text: Children with CP may not successfully transition into using adult services because they are not referred to one upon turning 18, and may decrease their use of services. Quality of life outcomes tend to decline for adults with cerebral palsy. Because children with cerebral palsy are often told that it is a non-progressive disease, they may be unprepared for the greater effects of the aging process as they head into their 30s. Young adults with cerebral palsy experience problems with aging that non-disabled adults experience "much later in life". 25% or more adults with cerebral palsy who can walk experience increasing difficulties walking with age. Hand function does not seem to have similar declines. Chronic disease risk, such as obesity, is also higher among adults with cerebral palsy than the general population. Common problems include increased pain, reduced flexibility, increased spasms and contractures, post-impairment syndrome and increasing problems with balance. Increased fatigue is also a problem. When adulthood and cerebral palsy is discussed, , it is not discussed in terms of the different stages of adulthood.


title: Cerebral palsy

text: Like they did in childhood, adults with cerebral palsy experience psychosocial issues related to their CP, chiefly the need for social support, self-acceptance, and acceptance by others. Workplace accommodations may be needed to enhance continued employment for adults with CP as they age. Rehabilitation or social programs that include salutogenesis may improve the coping potential of adults with CP as they age.


title: Cerebral palsy

text: Cerebral palsy occurs in about 2.1 per 1000 live births. In those born at term rates are lower at 1 per 1000 live births. Within a population it may occur more often in poorer people. The rate is higher in males than in females; in Europe it is 1.3 times more common in males.


title: Cerebral palsy

text: There was a "moderate, but significant" rise in the prevalence of CP between the 1970s and 1990s. This is thought to be due to a rise in low birth weight of infants and the increased survival rate of these infants. The increased survival rate of infants with CP in the 1970s and 80s may be indirectly due to the disability rights movement challenging perspectives around the worth of infants with a disability, as well as the Baby Doe Law.


title: Cerebral palsy

text: As of 2005, advances in the care of pregnant mothers and their babies have not resulted in a noticeable decrease in CP. This is generally attributed to medical advances in areas related to the care of premature babies (which results in a greater survival rate). Only the introduction of quality medical care to locations with less-than-adequate medical care has shown any decreases. The incidence of CP increases with premature or very low-weight babies regardless of the quality of care. , there is a suggestion that both incidence and severity are slightly decreasing – more research is needed to find out if this is significant, and if so, which interventions are effective. It has been found that high-income countries have lower rates of children born with cerebral palsy than low or middle-income countries.


title: Cerebral palsy

text: Prevalence of cerebral palsy is best calculated around the school entry age of about six years; the prevalence in the U.S. is estimated to be 2.4 out of 1000 children.


title: Cerebral palsy

text: Cerebral palsy has affected humans since antiquity. A decorated grave marker dating from around the 15th to 14th century BCE shows a figure with one small leg and using a crutch, possibly due to cerebral palsy. The oldest likely physical evidence of the condition comes from the mummy of Siptah, an Egyptian Pharaoh who ruled from about 1196 to 1190 BCE and died at about 20 years of age. The presence of cerebral palsy has been suspected due to his deformed foot and hands.


title: Cerebral palsy

text: The medical literature of the ancient Greeks discusses paralysis and weakness of the arms and legs; the modern word "palsy" comes from the Ancient Greek words "παράλυση" or "πάρεση", meaning paralysis or paresis respectively. The works of the school of Hippocrates (460c. 370 BCE), and the manuscript "On the Sacred Disease" in particular, describe a group of problems that matches up very well with the modern understanding of cerebral palsy. The Roman Emperor Claudius (10 BCE54 CE) is suspected of having CP, as historical records describe him as having several physical problems in line with the condition. Medical historians have begun to suspect and find depictions of CP in much later art. Several paintings from the 16th century and later show individuals with problems consistent with it, such as Jusepe de Ribera's 1642 painting "The Clubfoot".


title: Cerebral palsy

text: The modern understanding of CP as resulting from problems within the brain began in the early decades of the 1800s with a number of publications on brain abnormalities by Johann Christian Reil, Claude François Lallemand and Philippe Pinel. Later physicians used this research to connect problems in the brain with specific symptoms. The English surgeon William John Little (18101894) was the first person to study CP extensively. In his doctoral thesis he stated that CP was a result of a problem around the time of birth. He later identified a difficult delivery, a preterm birth and perinatal asphyxia in particular as risk factors. The spastic diplegia form of CP came to be known as Little's disease. At around this time, a German surgeon was also working on cerebral palsy, and distinguished it from polio. In the 1880s British neurologist William Gowers built on Little's work by linking paralysis in newborns to difficult births. He named the problem "birth palsy" and classified birth palsies into two types: peripheral and cerebral.


title: Cerebral palsy

text: Working in the US in the 1880s, Canadian-born physician William Osler (18491919) reviewed dozens of CP cases to further classify the disorders by the site of the problems on the body and by the underlying cause. Osler made further observations tying problems around the time of delivery with CP, and concluded that problems causing bleeding inside the brain were likely the root cause. Osler also suspected polioencephalitis as an infectious cause. Through the 1890s, scientists commonly confused CP with polio.


title: Cerebral palsy

text: Before moving to psychiatry, Austrian neurologist Sigmund Freud (18561939) made further refinements to the classification of the disorder. He produced the system still being used today. Freud's system divides the causes of the disorder into problems present at birth, problems that develop during birth, and problems after birth. Freud also made a rough correlation between the location of the problem inside the brain and the location of the affected limbs on the body and documented the many kinds of movement disorders.


title: Cerebral palsy

text: In the early 20th century, the attention of the medical community generally turned away from CP until orthopedic surgeon Winthrop Phelps became the first physician to treat the disorder. He viewed CP from a musculoskeletal perspective instead of a neurological one. Phelps developed surgical techniques for operating on the muscles to address issues such as spasticity and muscle rigidity. Hungarian physical rehabilitation practitioner András Pető developed a system to teach children with CP how to walk and perform other basic movements. Pető's system became the foundation for conductive education, widely used for children with CP today. Through the remaining decades, physical therapy for CP has evolved, and has become a core component of the CP management program.


title: Cerebral palsy

text: In 1997, Robert Palisano "et al." introduced the Gross Motor Function Classification System (GMFCS) as an improvement over the previous rough assessment of limitation as either mild, moderate, or severe. The GMFCS grades limitation based on observed proficiency in specific basic mobility skills such as sitting, standing, and walking, and takes into account the level of dependency on aids such as wheelchairs or walkers. The GMFCS was further revised and expanded in 2007.


title: Cerebral palsy

text: It is difficult to directly compare the cost and cost-effectiveness of interventions to prevent cerebral palsy or the cost of interventions to manage CP. Access Economics has released a report on the economic impact of cerebral palsy in Australia. The report found that, in 2007, the financial cost of cerebral palsy (CP) in Australia was A$1.47 billion or 0.14% of GDP. Of this:


title: Cerebral palsy

text: In per capita terms, this amounts to a financial cost of A$43,431 per person with CP per annum. Including the value of lost well-being, the cost is over $115,000 per person per annum.


title: Cerebral palsy

text: Individuals with CP bear 37% of the financial costs, and their families and friends bear a further 6%. The federal government bears around one-third (33%) of the financial costs (mainly through taxation revenues forgone and welfare payments). State governments bear under 1% of the costs, while employers bear 5% and the rest of society bears the remaining 19%. If the burden of disease (lost well-being) is included, individuals bear 76% of the costs.


title: Cerebral palsy

text: The average lifetime cost for people with CP in the US is US$921,000 per individual, including lost income.


title: Cerebral palsy

text: In the United States, many states allow Medicaid beneficiaries to use their Medicaid funds to hire their own PCAs, instead of forcing them to use institutional or managed care.


title: Cerebral palsy

text: In India, the government-sponsored program called "NIRAMAYA" for the medical care of children with neurological and muscular deformities has proved to be an ameliorating economic measure for persons with such disabilities. It has shown that persons with mental or physically debilitating congenital disabilities can lead better lives if they have financial independence.


title: Cerebral palsy

text: "Cerebral" means "of, or pertaining to, the cerebrum or the brain" and "palsy" means "paralysis, generally partial, whereby a local body area is incapable of voluntary movement". It has been proposed to change the name to "cerebral palsy spectrum disorder" to reflect the diversity of presentations of CP.


title: Cerebral palsy

text: Many people would rather be referred to as a person with a disability (people-first language) instead of as "handicapped". "Cerebral Palsy: A Guide for Care" at the University of Delaware offers the following guidelines:


title: Cerebral palsy

text: The term "spastic" denotes the attribute of spasticity in types of spastic CP. In 1952 a UK charity called The Spastics Society was formed. The term "spastics" was used by the charity as a term for people with CP. The word "spastic" has since been used extensively as a general insult to disabled people, which some see as extremely offensive. They are also frequently used to insult non-disabled people when they seem overly uncoordinated, anxious, or unskilled in sports. The charity changed its name to Scope in 1994. In the United States the word spaz has the same usage as an insult but is not generally associated with CP.


title: Cerebral palsy

text: Maverick documentary filmmaker Kazuo Hara criticises the mores and customs of Japanese society in an unsentimental portrait of adults with cerebral palsy in his 1972 film "Goodbye CP" (Sayonara CP). Focusing on how people with cerebral palsy are generally ignored or disregarded in Japan, Hara challenges his society's taboos about physical handicaps. Using a deliberately harsh style, with grainy black-and-white photography and out-of-sync sound, Hara brings a stark realism to his subject.


title: Cerebral palsy

text: "Spandan" (2012), a film by Vegitha Reddy and Aman Tripathi, delves into the dilemma of parents whose child has cerebral palsy. While films made with children with special needs as central characters have been attempted before, the predicament of parents dealing with the stigma associated with the condition and beyond is dealt in "Spandan". In one of the songs of "Spandan" "Chal chaal chaal tu bala" more than 50 CP kids have acted. The famous classical singer Devaki Pandit has given her voice to the song penned by Prof. Jayant Dhupkar and composed by National Film Awards winner Isaac Thomas Kottukapally.


title: Cerebral palsy

text: "My Left Foot" (1989) is a drama film directed by Jim Sheridan and starring Daniel Day-Lewis. It tells the true story of Christy Brown, an Irishman born with cerebral palsy, who could control only his left foot. Christy Brown grew up in a poor, working-class family, and became a writer and artist. It won the Academy Award for Best Actor (Daniel Day-Lewis) and Best Actress in a Supporting Role (Brenda Fricker). It was also nominated for Best Director, Best Picture and Best Writing, Screenplay Based on Material from Another Medium. It also won the New York Film Critics Circle Award for Best Film for 1989.


title: Cerebral palsy

text: "Call the Midwife" (2012–) has featured two episodes with actor Colin Young, who himself has cerebral palsy, playing a character with the same disability. His storylines have focused on the segregation of those with disabilities in the UK in the 1950s, and also romantic relationships between people with disabilities.


title: Cerebral palsy

text: Micah Fowler, an American actor with CP, stars in the ABC sitcom "Speechless" (2016–19), which explores both the serious and humorous challenges a family faces with a teenager with CP.


title: Cerebral palsy

text: "9-1-1" (2018–) is a procedural drama series on Fox. From season 2 onwards, it features Gavin McHugh (who himself has cerebral palsy) in the recurring role as Christopher Diaz – a young child who has cerebral palsy.


title: Cerebral palsy

text: "Special" (2019) is a comedy series that premiered on Netflix on 12 April 2019. It was written, produced and stars Ryan O'Connell as a young gay man with mild cerebral palsy. It is based on O'Connell's book "I'm Special: And Other Lies We Tell Ourselves".


title: Cerebral palsy

text: Australian drama serial "The Heights" (2019–) features a character with mild cerebral palsy, teenage girl Sabine Rosso, depicted by an actor who herself has mild cerebral palsy, Bridie McKim.


title: Cerebral palsy

text: Because of the false perception that cerebral palsy is mostly caused by trauma during birth, as of 2005, 60% of obstetric litigation was about cerebral palsy, which Alastair MacLennan, Professor of Obstetrics and Gynaecology at the University of Adelaide, regards as causing an exodus from the profession. In the latter half of the 20th century, obstetric litigation about the cause of cerebral palsy became more common, leading to the practice of defensive medicine.


title: Rashtriya Swayamsevak Sangh

text: The Rashtriya Swayamsevak Sangh ( ; , , ) is an Indian right-wing, Hindu nationalist, paramilitary volunteer organisation. The RSS is the progenitor and leader of a large body of organisations called the Sangh Parivar (Hindi for "Sangh family"), which have presence in all facets of the Indian society. RSS was founded on 27 September 1925. , it has a membership of 5–6million.


title: Rashtriya Swayamsevak Sangh

text: The initial impetus was to provide character training through Hindu discipline and to unite the Hindu community to form a Hindu Rashtra (Hindu nation). The organisation promotes the ideals of upholding Indian culture and the values of a civil society and spreads the ideology of Hindutva, to "strengthen" the Hindu community. It drew initial inspiration from European right-wing groups during World War II, such as the Italian Fascist Party. Gradually, RSS grew into a prominent Hindu nationalist umbrella organisation, spawning several affiliated organisations that established numerous schools, charities, and clubs to spread its ideological beliefs.


title: Rashtriya Swayamsevak Sangh

text: The RSS was banned once during British rule, and then thrice by the post-independence Indian government, first in 1948 when Nathuram Godse, an erstwhile member of RSS, assassinated Mahatma Gandhi; then during The Emergency (1975–1977); and for a third time after the demolition of Babri Masjid in 1992.


title: Rashtriya Swayamsevak Sangh

text: Hedgewar was a political protege of B. S. Moonje, a Tilakite Congressman, Hindu Mahasabha politician and social activist from Nagpur. Moonje had sent Hedgewar to Calcutta to pursue his medical studies and to learn combat techniques from the secret revolutionary societies of the Bengalis. Hedgewar became a member of the Anushilan Samiti, an anti-British revolutionary group, getting into its inner circle. The secretive methods of these societies were eventually used by him in organising the RSS.


title: Rashtriya Swayamsevak Sangh

text: After returning to Nagpur, Hedgewar organised anti-British activities through the "Kranti Dal" (Party of Revolution) and participated in independence activist Tilak's Home Rule campaign in 1918. According to the official RSS history, he came to realise that revolutionary activities alone were not enough to overthrow the British. After reading V. D. Savarkar's "", published in Nagpur in 1923, and meeting Savarkar in the Ratnagiri prison in 1925, Hedgewar was extremely influenced by him, and he founded the RSS with the objective of strengthening Hindu society.


title: Rashtriya Swayamsevak Sangh

text: Hedgewar believed that a handful of British were able to rule over the vast country of India because Hindus were disunited, lacked valour () and lacked a civic character. He recruited energetic Hindu youth with revolutionary fervour, gave them a uniform of a black forage cap, khaki shirt (later white shirt) and khaki shorts—emulating the uniform of the Indian Imperial Police—and taught them paramilitary techniques with (bamboo staff), sword, javelin, and dagger. Hindu ceremonies and rituals played a large role in the organisation, not so much for religious observance, but to provide awareness of India's glorious past and to bind the members in a religious communion. Hedgewar also held weekly sessions of what he called (ideological education), consisting of simple questions to the novices concerning the Hindu nation and its history and heroes, especially warrior king Shivaji. The saffron flag of Shivaji, the Bhagwa Dhwaj, was used as the emblem for the new organisation. Its public tasks involved protecting Hindu pilgrims at festivals and confronting Muslim resistance against Hindu processions near mosques.


title: Rashtriya Swayamsevak Sangh

text: Two years into the life of the organisation, in 1927, Hedgewar organised an "Officers' Training Camp" with the objective of forming a corps of key workers, whom he called (full-time functionaries or "propagators"). He asked the volunteers to first become "sadhus" (ascetics), renouncing professional and family lives and dedicating their lives to the cause of the RSS. Hedgewar is believed to have embraced the doctrine of renunciation after it had been reinterpreted by nationalists such as Aurobindo. The tradition of renunciation gave the RSS the character of a 'Hindu sect'. Developing a network of (branches) was the main preoccupation for Hedgewar throughout his career as the RSS chief. The first were responsible for establishing as many as possible, first in Nagpur, then across Maharashtra, and eventually in the rest of India. P. B. Dani was sent to establish a at the Benaras Hindu University; other universities were similarly targeted to recruit new followers among the student population. Three went to Punjab: Appaji Joshi to Sialkot, Moreshwar Munje to the DAV College in Rawalpindi and Raja Bhau Paturkar to the DAV College in Lahore. In 1940, Madhavrao Muley was appointed as the (regional head) for Punjab in Lahore.


title: Rashtriya Swayamsevak Sangh

text: Scholars differ on Hedgewar's motivations for forming the RSS, especially because he never involved the RSS in fighting the British rule. French political scientist Christophe Jaffrelot says that the RSS was intended to propagate the ideology of Hindutva and to provide "new physical strength" to the majority community.


title: Rashtriya Swayamsevak Sangh

text: After Tilak's demise in 1920, like other followers of Tilak in Nagpur, Hedgewar was opposed to some of the programmes adopted by Gandhi. Gandhi's stance on the Indian Muslim Khilafat issue was a cause for concern to Hedgewar, and so was the fact that the 'cow protection' was not on the Congress agenda. This led Hedgewar, along with other Tilakities, to part ways with Gandhi. In 1921, Hedgewar delivered a series of lectures in Maharashtra with slogans such as "Freedom within a year" and "boycott". He deliberately broke the law, for which he was imprisoned for a year. After being released in 1922, Hedgewar was distressed at the lack of organisation among the Congress volunteers for the independence struggle. Without proper mobilisation and organisation, he felt that the patriotic youth of India could never get independence for the country. Subsequently, he felt the need to create an independent organisation that was based on the country's traditions and history.


title: Rashtriya Swayamsevak Sangh

text: The decade of 1920s witnessed a significant deterioration in the relations between Hindus and Muslims. The Muslim masses were mobilised by the Khilafat movement, demanding the reinstatement of the Caliphate in Turkey, and Gandhi made an alliance with it for conducting his own Non-co-operation movement. Gandhi aimed to create Hindu–Muslim unity in forming the alliance. However, the alliance saw a "common enemy", not a "common enmity". When Gandhi called off the Non-co-operation movement due to outbreaks of violence, Muslims disagreed with his strategy. Once the movements failed, the mobilised Muslims turned their anger towards Hindus. The first major incident of religious violence was reportedly the Moplah rebellion in August 1921, it was widely narrated that the rebellion ended in large-scale violence against Hindu in Malabar. A cycle of inter-communal violence throughout India followed for several years. In 1923, there were riots in Nagpur, called "Muslim riots" by Hedgewar, where Hindus were felt to be "totally disorganized and panicky." These incidents made a major impression on Hedgewar and convinced him of the need to organise the Hindu society.


title: Rashtriya Swayamsevak Sangh

text: After acquiring about 100 "swayamsevaks" (volunteers) to the RSS in 1927, Hedgewar took the issue to the Muslim domain. He led the Hindu religious procession for Ganesha, beating the drums in defiance of the usual practice not to pass in front of a mosque with music. On the day of Lakshmi Puja on 4 September, Muslims are said to have retaliated. When the Hindu procession reached a mosque in the Mahal area of Nagpur, Muslims blocked it. Later in the afternoon, they attacked the Hindu residences in the Mahal area. It is said that the RSS cadres were prepared for the attack and beat the Muslim rioters back. Riots continued for 3 days and the army had to be called in to quell the violence. RSS organised the Hindu resistance and protected the Hindu households while the Muslim households had to leave Nagpur "en masse" for safety. Tapan Basu et al. note the accounts of "Muslim aggressiveness" and the "Hindu self-defence" in the RSS descriptions of the incident. The above incident vastly enhanced the prestige of the RSS and enabled its subsequent expansion.


title: Rashtriya Swayamsevak Sangh

text: Christophe Jaffrelot points out the theme of "stigmatisation and emulation" in the ideology of the RSS along with other Hindu nationalist movements such as the Arya Samaj and the Hindu Mahasabha. Muslims, Christians and the British were thought of as "foreign bodies" implanted in the Hindu nation, who were able to exploit the disunity and absence of valour among the Hindus in order to subdue them. The solution lay in emulating the characteristics of these "Threatening Others" that were perceived to give them strength, such as paramilitary organisation, emphasis on unity and nationalism. The Hindu nationalists combined these emulatory aspects with a selective borrowing of traditions from the Hindu past to achieve a synthesis that was uniquely Indian and Hindu.


title: Rashtriya Swayamsevak Sangh

text: The Hindu Mahasabha, which was initially a special interest group within the Indian National Congress and later an independent party, was an important influence on the RSS, even though it is rarely acknowledged. In 1923, prominent Hindu leaders like Madan Mohan Malaviya met together on this platform and voiced their concerns on the 'division in the Hindu community'. In his presidential speech to Mahasabha, Malaviya stated: "Friendship could exist between equals. If the Hindus made themselves strong and the rowdy section among the Mahomedans were convinced they could not safely rob and dishonour Hindus, unity would be established on a stable basis." He wanted the activists 'to educate all boys and girls, establish "akharas" (gymnasiums), establish a volunteer corps to persuade people to comply with decisions of the Hindu Mahasabha, to accept untouchables as Hindus and grant them the right to use wells, enter temples, get an education.' Later, Hindu Mahasabha leader V. D. Savarkar's 'Hindutva' ideology also had a profound impact on Hedgewar's thinking about the 'Hindu nation'.


title: Rashtriya Swayamsevak Sangh

text: The initial meeting for the formation of the Sangh on the Vijaya Dashami day of 1925 was held between Hedgewar and four Hindu Mahasabha leaders: B. S. Moonje, Ganesh Savarkar, L. V. Paranjpe and B. B. Tholkar. RSS took part as a volunteer force in organising the Hindu Mahasabha annual meeting in Akola in 1931. Moonje remained a patron of the RSS throughout his life. Both he and Ganesh Savarkar worked to spread the RSS "shakhas" in Maharashtra, Panjab, Delhi, and the princely states by initiating contacts with local leaders. Savarkar merged his own youth organisation "Tarun Hindu Sabha" with the RSS and helped its expansion. V. D. Savarkar, after his release in 1937, joined them in spreading the RSS and giving speeches in its support. Officials in the Home Department called the RSS the "volunteer organisation of the Hindu Mahasabha."


title: Rashtriya Swayamsevak Sangh

text: After the formation of the RSS, which portrays itself as a social movement, Hedgewar kept the organisation from having any direct affiliation with the political organisations then fighting British rule. RSS rejected Gandhi's willingness to co-operate with the Muslims.


title: Rashtriya Swayamsevak Sangh

text: In accordance with Hedgewar's tradition of keeping the RSS away from the Indian Independence movement, any political activity that could be construed as being anti-British was carefully avoided. According to the RSS biographer C.P. Bhishikar, Hedgewar talked only about Hindu organisations and avoided any direct comment on the Government. The "Independence Day" announced by the Indian National Congress for 26 January 1930 was celebrated by the RSS that year but was subsequently avoided. The Tricolor of the Indian national movement was shunned.


title: Rashtriya Swayamsevak Sangh

text: Hedgewar personally participated in the 'Satyagraha' launched by Gandhi in April 1930, but he did not get the RSS involved in the movement. He sent information everywhere that the RSS would not participate in the Satyagraha. However, those wishing to participate individually were not prohibited. In 1934 Congress passed a resolution prohibiting its members from joining RSS, Hindu Mahasabha, or the Muslim League.


title: Rashtriya Swayamsevak Sangh

text: M. S. Golwalkar, who became the leader of the RSS in 1940, continued and further strengthened the isolation from the independence movement. In his view, the RSS had pledged to achieve freedom through "defending religion and culture", not by fighting the British. Golwalkar lamented the anti-British nationalism, calling it a "reactionary view" that, he claimed, had disastrous effects upon the entire course of the freedom struggle. It is believed that Golwalkar did not want to give the British an excuse to ban the RSS. He complied with all the strictures imposed by the Government during the Second World War, even announcing the termination of the RSS military department. The British Government believed that the RSS was not supporting any civil disobedience against them, and their other political activities could thus be overlooked. The British Home Department took note of the fact that the speakers at the RSS meetings urged the members to keep aloof from the anti-British movements of the Indian National Congress, which was duly followed.The Home Department did not see the RSS as a problem for law and order in British India.The Bombay government appreciated the RSS by noting that the Sangh had scrupulously kept itself within the law and refrained from taking part in the disturbances (Quit India Movement) that broke out in August 1942. It also reported that the RSS had not, in any way, infringed upon government orders and had always shown a willingness to comply with the law. The Bombay Government report further noted that in December 1940, orders had been issued to the provincial RSS leaders to desist from any activities that the British Government considered objectionable, and the RSS, in turn, had assured the British authorities that "it had no intentions of offending against the orders of the Government".


title: Rashtriya Swayamsevak Sangh

text: Golwalkar later openly admitted the fact that the RSS did not participate in the Quit India Movement. He agreed that such a stance led to a perception of the RSS as an inactive organisation, whose statements had no substance in reality.


title: Rashtriya Swayamsevak Sangh

text: Before World War II, the RSS leaders admired Adolf Hitler and Benito Mussolini. Golwalkar allegedly took inspiration from Adolf Hitler's ideology of racial purity. However, the RSS's stance changed during the war; the organization firmly supported the British war effort against Hitler and the Axis Powers.


title: Rashtriya Swayamsevak Sangh

text: This prewar sympathy did not imply any antipathy towards Jews. The RSS leaders were supportive of the formation of Jewish State of Israel. Golwalkar admired the Jews for maintaining their "religion, culture and language".


title: Rashtriya Swayamsevak Sangh

text: The Partition of India affected millions of Sikhs, Hindus, and Muslims attempting to escape the violence and carnage that followed. During the partition, the RSS helped the Hindu refugees fleeing West Punjab; its activists also played an active role in the communal violence during Hindu-Muslim riots in North India, though this was officially not sanctioned by the leadership. To the RSS activists, the partition was a result of mistaken soft-line towards the Muslims, which only confirmed the natural moral weaknesses and corruptibility of the politicians. The RSS blamed Gandhi, Nehru and Patel for their 'naivety which resulted in the partition', and held them responsible for the mass killings and displacement of the millions of people.


title: Rashtriya Swayamsevak Sangh

text: The first ban on the RSS was imposed in Punjab Province (British India) on 24 January 1947 by Malik Khizar Hayat Tiwana, the premier of the ruling Unionist Party, a party that represented the interests of the landed gentry and landlords of Punjab, which included Muslims, Hindus, and Sikhs. Along with the RSS, the Muslim National Guard was also banned. The ban was lifted on 28 January 1947.


title: Rashtriya Swayamsevak Sangh

text: The Rashtriya Swayamsevak Sangh initially did not recognise the Tricolor as the National Flag of India. The RSS-inspired publication, the "Organiser", demanded, in an editorial titled "National Flag", that the "Bhagwa Dhwaj" (Saffron Flag) be adopted as the National Flag of India. After the Tricolor was adopted as the National Flag by the Constituent Assembly of India on 22 July 1947, the "Organiser" viciously attacked the Tricolor and the Constituent Assembly's decision. In an article titled "Mystery behind the "Bhagwa Dhwaj"", the "Organiser" stated In an essay titled "Drifting and Drafting" published in "Bunch of Thoughts", Golwalkar lamented the choice of the Tricolor as the National Flag, and compared it to an intellectual vacuum/void. In his words, The RSS hoisted the National Flag of India at its Nagpur headquarters only twice, on 14 August 1947 and on 26 January 1950, but stopped doing so after that. This issue has always been a source of controversy. In 2001 three activists of "Rashtrapremi Yuwa Dal" president Baba Mendhe, and members Ramesh Kalambe and Dilip Chattani, along with othersallegedly entered the RSS headquarters in Reshimbagh, Nagpur, on 26 January, the Republic Day of India, and forcibly hoisted the national flag there amid patriotic slogans. They contended that the RSS had never before or after independence, ever hoisted the tri-colour in their premises. Offences were registered by the Bombay Police against the trio, who were then jailed. They were discharged by the court of Justice R. R. Lohia after eleven years in 2013. The arrests and the flag-hoisting issue stoked a controversy, which was raised in the Parliament as well. Hoisting of flag was very restrictive till the formation of the Flag code of India (2002). Subsequently, in 2002 the National Flag was raised in the RSS headquarters on the occasion of Republic Day for the first time in 52 years.


title: Rashtriya Swayamsevak Sangh

text: The Rashtriya Swayamsevak Sangh initially did not recognise the Constitution of India, strongly criticising it because the Indian Constitution made no mention of "Manu's laws"from the ancient Hindu text "Manusmriti". When the Constituent Assembly finalised the constitution, the RSS mouthpiece, the "Organiser", complained in an editorial dated 30 November 1949: On 6 February 1950 the "Organizer" carried another article, titled "Manu Rules our Hearts", written by a retired High Court Judge named Sankar Subba Aiyar, that reaffirmed their support for the "Manusmriti" as the final lawgiving authority for Hindus, rather than the Constitution of India. It stated: The RSS' opposition to, and vitriolic attacks against, the Constitution of India continued post-independence. In 1966 Golwalkar, in his book titled "Bunch of Thoughts" asserted:


title: Rashtriya Swayamsevak Sangh

text: In January 1948, Mahatma Gandhi was assassinated by a member of the RSS, Nathuram Godse. Following the assassination, many prominent leaders of the RSS were arrested, and the RSS as an organisation was banned on 4 February 1948. During the court proceedings in relation to the assassination Godse began claiming that he had left the organisation in 1946. A Commission of Inquiry into Conspiracy to the murder of Gandhi was set, and its report was published by India's Ministry of Home Affairs in the year 1970. Accordingly, the Justice Kapur Commission noted that the "RSS as such were not responsible for the murder of Mahatma Gandhi, meaning thereby that one could not name the organisation as such as being responsible for that most diabolical crime, the murder of the apostle of peace. It has not been proved that they (the accused) were members of the RSS." However, the then Indian Deputy Prime Minister and Home Minister, Sardar Vallabhbhai Patel had remarked that the "RSS men expressed joy and distributed sweets after Gandhi's death".


title: Rashtriya Swayamsevak Sangh

text: RSS leaders were acquitted of the conspiracy charge by the Supreme Court of India. Following his release in August 1948, Golwalkar wrote to Prime Minister Jawaharlal Nehru to lift the ban on RSS. After Nehru replied that the matter was the responsibility of the Home Minister, Golwalkar consulted Vallabhai Patel regarding the same. Patel then demanded an absolute pre-condition that the RSS adopt a formal written constitution and make it public, where Patel expected RSS to pledge its loyalty to the Constitution of India, accept the Tricolor as the National Flag of India, define the power of the head of the organisation, make the organisation democratic by holding internal elections, authorisation of their parents before enrolling the pre-adolescents into the movement, and to renounce violence and secrecy. Golwalkar launched a huge agitation against this demand during which he was imprisoned again. Later, a constitution was drafted for RSS, which, however, initially did not meet any of Patel's demands. After a failed attempt to agitate again, eventually the RSS's constitution was amended according to Patel's wishes with the exception of the procedure for selecting the head of the organisation and the enrolment of pre-adolescents. However, the organisation's internal democracy which was written into its constitution, remained a 'dead letter'.


title: Rashtriya Swayamsevak Sangh

text: On 11 July 1949 the Government of India lifted the ban on the RSS by issuing a communique stating that the decision to lift the ban on the RSS had been taken in view of the RSS leader Golwalkar's undertaking to make the group's loyalty towards the Constitution of India and acceptance and respect towards the National Flag of India more explicit in the Constitution of the RSS, which was to be worked out in a democratic manner.


title: Rashtriya Swayamsevak Sangh

text: After India had achieved independence, the RSS was one of the socio-political organisations that supported and participated in movements to decolonise Dadra and Nagar Haveli, which at that time was ruled by Portugal. In early 1954 volunteers Raja Wakankar and Nana Kajrekar of the RSS visited the area round about Dadra, Nagar Haveli, and Daman several times to study the topography and get acquainted with locals who wanted the area to change from being a Portuguese colony to being an Indian union territory. In April 1954 the RSS formed a coalition with the National Movement Liberation Organisation (NMLO) and the Azad Gomantak Dal (AGD) for the annexation of Dadra and Nagar Haveli into the Republic of India. On the night of 21 July, United Front of Goans, a group working independently of the coalition, captured the Portuguese police station at Dadra and declared Dadra independent. Subsequently, on 28 July, volunteer teams from the RSS and AGD captured the territories of Naroli and Phiparia and ultimately the capital of Silvassa. The Portuguese forces that had escaped and moved towards Nagar Haveli, were assaulted at Khandvel and forced to retreat until they surrendered to the Indian border police at Udava on 11 August 1954. A native administration was set up with Appasaheb Karmalkar of the NMLO as the Administrator of Dadra and Nagar Haveli on 11 August 1954.


title: Rashtriya Swayamsevak Sangh

text: The capture of Dadra and Nagar Haveli gave a boost to the movement against Portuguese colonial rule in the Indian subcontinent. In 1955 RSS leaders demanded the end of Portuguese rule in Goa and its integration into India. When Prime Minister Jawaharlal Nehru refused to provide an armed intervention, RSS leader Jagannath Rao Joshi led the Satyagraha agitation straight into Goa. He was imprisoned with his followers by the Portuguese police. The nonviolent protests continued but met with repression. On 15 August 1955, the Portuguese police opened fire on the "satyagrahis", killing thirty or so civilians.


title: Rashtriya Swayamsevak Sangh

text: Goa was later annexed into the Indian union in 1961 through an army operation, codenamed 'Operation Vijay', that was carried out by the Nehru government.


title: Rashtriya Swayamsevak Sangh

text: During the Chinese war of 1962, the RSS provided active help to the civil administration. There are claims that then Prime Minister Jawaharlal Nehru was impressed with the help extended and allowed the RSS to field a contingent of 100 swayamsevaks in the 1963 Republic Day Parade. However, the Government of India has no record of the Republic Day Parade composition or of the RSS being a part of it.