What is Cerebral Palsy?
Cerebral palsy (CP) is a term for a group of conditions where the brain does not communicate well with muscles of the body. These conditions affect a child’s ability to move, maintain balance and hold their posture. Children with CP may have additional health concerns. These concerns can include seizures and learning disabilities. The condition is lifelong.
Cerebral palsy affects one in 323 children in the United States. It is the most common physical disability in children. It is more common in boys than girls.
The effects of cerebral palsy range from mild to severe. Early diagnosis and treatment can help to improve movement, balance and life skills that bring independence.
Cerebral Palsy Causes
Cerebral palsy develops because of brain damage that take place during the early stages of brain development. This damage can happen before, during or after birth, up to about the age of 3.
The damage affects the message pathways that control movement from the brain to the spinal cord. It can happen for many reasons, including:
- Infections, bleeding or abnormal formations in the baby’s brain
- Medical problems, viruses or infections in mom during pregnancy
- Seizures at birth or in the first month after birth
- Jaundice (a build-up of bilirubin in the blood) that is not treated
- Genetic disorders
- Being shaken as a baby or other injury from trauma (such as a car accident)
- Lack of oxygen during delivery (this is the cause for about 5 to 10% of children with cerebral palsy)
A child’s risk for cerebral palsy is higher if they:
- Were born early (before 37 weeks’ gestation)
- Had a low birth weight
- Are a twin, triplet or part of a higher multiple birth
- Had a stroke (bleeding in the brain) before, during or after delivery. In babies older than 1 month, stroke is the most common cause of cerebral palsy.
Cerebral Palsy Types
Experts classify cerebral palsy in many ways. Classifications help families and doctors know what kind of therapies a child needs to reach their potential.
CP can be classified by the movement problems the child has because of the disease. Looking at CP in this way, there are two main classifications (or types) of CP: hypertonic cerebral palsy and dyskinetic (or other) cerebral palsy.
Hypertonic Cerebral Palsy
Hypertonic cerebral palsy is the most common type of CP. Children with these types of CP have spasticity or dystonia, or both.
- Spasticity causes uneven and changing muscle tightness. This affects motor control. It may reduce joint range of motion. Tasks like walking or picking up small objects can be difficult.
- Dystonia causes muscles to contract on their own. This leads to unintended positions or twisting postures.
Dyskinetic and Other Cerebral Palsy
The other types are dyskinetic and other cerebral palsy. Children can have one or more of the following types:
- Athetoid cerebral palsy causes abnormal, uncontrolled movements. Children with athetoid CP may experience tremors (shaking), balance and posture problems, trouble feeding and motor coordination issues.
- Choreiform cerebral palsy causes uneven, jumpy or sudden movements of the hands, feet and face.
- Ataxic cerebral palsy causes problems with balance. It leads to jerky, uncontrolled movements. A child with ataxic cerebral palsy may have trouble with coordination.
- Hypotonic cerebral palsy is shown by low muscle tone. Weakness may be a problem.
Cerebral Palsy is also described by the parts of the body that are most affected.
- Quadriparetic (or quadriplegic) Cerebral Palsy affects the whole body
- Diparetic (or diplegic) Cerebral Palsy affects mostly the legs
- Hemiparetic (or hemiplegic) Cerebral Palsy affects one side of the body. For example, the left arm and leg, or right arm and leg.
Functional classificationsFor people with CP, gross motor function, hand function, visual function, communication and eating / drinking function can be described with specific scales. These scales describe function in five functional groups (called the “five strata”). They allow quick understanding of a person’s abilities. Therapists or other providers can help patients with CP and their families understand their classification(s) on these scales.
Non-Movement Problems Related to Cerebral Palsy
Cerebral palsy is a movement disorder. It can cause problems that are not related to movement.
For example, many children with cerebral palsy have orthopaedic conditions:
- Bones or joints that are not formed or lined up properly
- Shortening of muscles and tendons as a child grows (called contractures)
- Scoliosis (curved spine)
- Hip subluxation that can progress to hip dislocation
Children with CP also can have:
- Learning or intellectual disabilities
- Behavior problems
- Vision issues, such as strabismus (when the eyes are not aligned) and nystagmus (rapid and uncontrolled eye movement) and cortical visual impairment (when the brain struggles to understand vision signals)
- Hearing loss
- Sleep issues
- Breathing or swallowing concerns
Doctors who specialize in cerebral palsy know to watch for early signs of these problems and provide expert care. This may help your child avoid certain problems or have less severe effects of CP.
Cerebral Palsy Diagnosis
Doctors can sometimes diagnose cerebral palsy soon after a child is born. The signs and symptoms of CP may not be seen for a few months or so after birth. Hopefully a child with CP will be diagnosed before their first birthday. But often, a diagnosis does not come until age 2 or later.
Parents are often the first to notice that a child is not reaching certain developmental milestones, such as sitting up or walking. They may recognize other problems like:
- Muscle weakness
- Using one hand over the other at an early age
- Unusual movement patterns while crawling
- Increased muscle tone
- Trouble controlling or coordinating movement
- Problems with balance or posture
- Abnormal walking, with a foot or leg dragging or toe-walking or toes turned in or out
If this is your situation, think about making an appointment with your child’s primary care doctor. If the doctor shares your concerns after seeing your child, the next step may be to see a cerebral palsy specialist.
A CP specialist will:
- Provide a physical exam
- Talk to you about your child’s birth and development
- Do tests to check your child’s strength and ability to move
The specialist may order medical tests to help make a diagnosis or understand what type of CP your child has. Tests can include brain imaging studies, such as magnetic resonance imaging (MRI). Sometimes an ultrasound or computed tomography (CT) scan of the brain is helpful. The doctor may order laboratory tests of your child’s blood, urine and cerebrospinal fluid. This can help screen for genetic issues or other problems.
Cerebral Palsy Treatment
Goals for managing cerebral palsy include:
- Keeping your child is as healthy as possible
- Avoiding complications
- Maximizing your child’s involvement in activities and the community
- Helping your child be as independent as possible
- Improving your child’s ability to move to their fullest potential
- Lessening the impact of any physical abnormalities and discomfort
Working on these goals early in childhood gives a child the best chance to achieve them. Effective treatment requires care over time from a team of medical specialists.
A child’s treatment plan may include:
Medications. A child may take medicines to improve movement, reduce pain or relax muscles. They may take them for other problems that are common with CP. Medicine might be taken by mouth or G-tube, as a patch, or by injection.
Physical therapy. Exercises and muscle training can help a child get stronger, become more flexible and move better. A physical therapist (PT) can help with everything related to movement and mobility. The therapist may refer your child to specialized treatment programs. A brace, splint, cast or another device may aid movement or help stretch stiff muscles. Other equipment such as canes, walkers, wheelchairs, or positioning equipment can help with mobility.
Occupational therapy. With help from an occupational therapist (OT), a child can gain independence in doing daily tasks at home and school. The child can learn skills in using a computer or technology to improve independence. OTs may focus on hand and arm function. They may assist with bracing or casting. They can help children with adaptive equipment (such as reachers, weighted spoons and computer interfaces).
Speech therapy. If a child has trouble with eating or swallowing, a speech therapist can help. A speech therapist can help the child learn to speak more clearly. They can help use communication devices, such as voice generation software on an iPad.
Orthopaedic surgery. Sometimes orthopaedic surgery is the best option to help reduce pain and prevent harmful changes in the shape or alignment of a bone or joint. It may help your child sit, walk or move their arms more easily. This type of surgery is first considered around ages 6 to 8.
A few examples of orthopaedic surgery for cerebral palsy are:
- Tendon transfer and muscle lengthening
- Osteotomy (cutting bone) to improve the way bones line up
- Fusing joints to provide long-term support
When possible, the orthopaedic surgeon does multiple procedures at once, rather than spreading them out over many years. This is called “single-event, multilevel surgery” (SEMLS). This helps to have fewer surgeries total.
Neurosurgery. Pediatric neurosurgeons offer two types of surgeries for children with cerebral palsy:
- Selective dorsal rhizotomy (SDR) involves cutting the nerves in the lower back (not the spinal cord itself and not the bony spine) that cause spasticity in the legs. The goal is to relax the muscles and reduce involuntary muscle contractions, pain and stiffness. In children who are able to move on their own, SDR can greatly improve their ability to walk. Children must take part in a strong postoperative therapy program to get the most benefit from this surgery.
- Baclofen pump implantation. This pump delivers medication that can reduce the symptoms of spasticity. This pump can give muscle-relaxing medicine directly to the spinal cord. After implantation, pump management is with a pediatric physiatrist.
Cerebral Palsy Prognosis
Most people with cerebral palsy live into late adulthood. They can enjoy fulfilling lives.
A child with a mild form of cerebral palsy will have an average life span. Children with severe motor and swallowing impairments or other health problems may not live as long. They need support from a caregiver to do the activities of daily life.
Children who get high-quality care from a multidisciplinary team tend to have a better quality of life and reach a higher level of independence than those who don’t.