Cerebral palsy (CP) is a disorder that affects muscle tone, movement, and motor skills (the ability to move in a coordinated and purposeful way). Cerebral palsy can also lead to other health issues, including vision, hearing, and speech problems, and learning disabilities.
CP is usually caused by brain damage that occurs before or during a child's birth, or during the first 3 to 5 years of a child's life. There is no cure for CP, but treatment, therapy, special equipment, and, in some cases, surgery can help a child who is living with the condition
Types of cerebral palsy are as follows:
- Spastic (pyramidal): Increased muscle tone is the defining characteristic of this type. The muscles are stiff (spastic), and movements are jerky or awkward. This type is classified by which part of the body is affected: diplegia (both legs), hemiplegia (one side of the body), or quadriplegia (the entire body). This is the most common type of CP, accounting for about 70% to 80% of cases.
- Dyskinetic (extrapyramidal): This includes types that affect coordination of movements. There are two subtypes.
- Athetoid: The person has uncontrolled movements that are slow and writhing. The movements can affect any part of the body, including the face, mouth, and tongue. About 10% to 20% of cerebral palsy cases are of this type.
- Ataxic: This type affects balance and coordination. Depth perception is usually affected. If the person can walk, the gait is probably unsteady. He or she has difficulty with movements that are quick or require a great deal of control, such as writing. About 5% to 10% of cases of cerebral palsy are of this type.
- Mixed: This is a mixture of different types of cerebral palsy. A common combination is spastic and athetoid.
Despite advances in medical care, cerebral palsy remains a significant health problem. The number of people affected by cerebral palsy has increased over time. This may be because more and more premature infants are surviving. In the United States, about 2 to 3 children per 1,000 have cerebral palsy. As many as 1,000,000 people of all ages are affected. Cerebral palsy affects both sexes and all ethnic and socioeconomic groups.
cerebral palsy causes
Cerebral palsy results from damage to certain parts of the developing brain.
- This damage can occur early in pregnancy when the brain is just starting to form, during the birth process as the child passes through the birth canal, or after birth in the first few years of life.
- In many cases, the exact cause of the brain damage is never known.
- We now know that fewer than 10% of cases of cerebral palsy begin during birth (perinatal).
- In fact, current thinking is that at least 70% to 80% of cases of cerebral palsy begin before birth (prenatal).
- Some cases begin after birth (postnatal).
- In all likelihood, many cases of cerebral palsy are a result of a combination of prenatal, perinatal, and postnatal factors.
- Infection, seizure disorder, thyroid disorder, and/or other medical problems in the mother
- Birth defects, especially those affecting the brain, spinal cord, head, face, lungs, or metabolism
- Rh factor incompatibility, a difference in the blood between mother and fetus that can cause brain damage in the fetus (Fortunately, this is almost always detected and treated in women who receive proper prenatal medical care.)
- Certain hereditary and genetic conditions
- Complications during labor and delivery
- Premature birth
- Low birth weight (especially if less than 2 pounds at birth)
- Severe jaundice after birth
- Multiple births (twins, triplets)
- Lack of oxygen (hypoxia) reaching the brain before, during, or after birth
- Brain damage early in life, due to infection (such as meningitis), head injury, lack of oxygen, or bleeding
cerebral palsy symptoms
person with cerebral palsy will generally show symptoms during the first three years of life. A child/baby with cerebral palsy may have some of the signs and symptoms below:
- Achieves developmental milestones, such as crawling, walking, or speaking, later than his/her peers.
- Crawls in an unusual way.
- Has abnormal muscle tone - the child will slouch while sitting. Muscle tone refers to a person's automatic ability to tighten and relax muscle when required.
- Has difficulty feeding and sucking.
- Lies down in awkward positions.
- Can be easily startled.
- Favors one side of the body over the other.
- Has overdeveloped or underdeveloped muscles (has floppy or stiff movements).
- Has bad coordination and balance (ataxia).
- Has involuntary, slow writing movements (athetosis).
- Muscles are stiff and contract abnormally (spastic paralysis).
- Has hearing problems.
- Has problems with eyesight.
- Has bladder control problems.
- Has bowel movement control problems.
- Has seizures.
- Has problems swallowing.
- Range of movements are limited.
There are several types of cerebral palsy
- Spastic hemiplegeia
A child with spastic hemiplegeia will typically have spasticity (muscle stiffness) on one side of the body - usually just a hand and arm, but may also involve a leg. The side that is affected may not develop properly. The child may have speech problems. In the majority of cases intelligence is not affected. Some children will have seizures.
- Spastic diplegia
The lower limbs are affected, and there is no or little upper body spasticity. The child's leg and hip muscles are tight. Legs cross at the knees, making walking more difficult. The crossing of the legs when the child is upright is often referred to as scissoring.
- Spastic quadriplegia
The child's legs, arms, and body are affected. This is the severest from of spastic cerebral palsy. Children with this kind of cerebral palsy are more likely to have mental retardation. Walking and talking will be difficult. Some children have seizures.
Diagnosis of and Tests for Cerebral Palsy
In severe cases, the child may be diagnosed soon after birth, but for the majority, diagnosis can be made in the first two years.
For those with milder symptoms, a diagnosis may not be rendered until the brain is fully developed at three to five years of age. For example, the average age of diagnosis for a child with spastic diplegia, a very common form of cerebral palsy, is 18 months.
This can be a difficult time for parents who suspect something might be different about their child. Often, parents are first to notice their child has missed one of the age-appropriate developmental milestones.
If a growth factor is delayed, parents may hope their child is just a slow starter who will “catch up.” While this may be the case, parents should inform the child’s doctor of concerns, nonetheless.
Confirming cerebral palsy can involve many steps. The first is monitoring for key indicators such as:
- When does the child reach development milestones and growth chart standards for height and weight?
- How do the child’s reflexes react?
- Does it seem as if the child is able to focus on and hear his or her caregivers?
- Does posture and movement seem abnormal?
A diagnosis is important for many reasons:
- To understand the child’s health status
- To begin early intervention and treatment
- To remove doubt and fear of not knowing
- To find and secure benefits to offset the cost of raising a child with cerebral palsy
The process for diagnosing cerebral palsy usually begins with observations made by the child’s primary care physician, usually a pediatrician, and the child’s parents. There are some exceptions.
If a baby is born prematurely, or at a low birth weight, he or she is monitored closely in the neonatal intensive care unit of the hospital from time of birth. In extreme cases of child abuse, or shaken baby syndrome a pediatric neurologist called to the hospital’s emergency or NICU unit will diagnosis the child’s condition. In the majority of cases the child will attend regular well-baby visits where the pediatrician first uncovers signs of cerebral palsy during examination. In some cases, it is the parents who notice symptoms they relay to the child’s doctor during these visits.
Developmental delay, abnormal growth charts, impaired muscle tone, and abnormal reflexes are early indications of cerebral palsy. Because there is no test that definitely confirms or rules out cerebral palsy, other conditions must be excluded from the list of possible causes, and cerebral palsy must be fully considered. Other disorders and conditions can appear as cerebral palsy, and cerebral palsy is often accompanied by associated conditions that complicate the process of diagnosis.
The medical examination process can involve multiple doctors, tests, and appointments. During this time doctors will rule out other similar conditions such as:
- Degenerative nervous disorders
- Genetic diseases
- Muscle diseases
- Metabolism disorders
- Nervous system tumors
- Coagulation disorders
- Other injuries or disorders which delay early development, some of which can be “outgrown”
Infants who test positive for a developmental disorder may be referred to medical specialists for further evaluations.
A child may be sent to an orthopedic surgeon to ascertain delay in motor development, record persistence of primitive reflexes, examined for dislocated hips, and assessed for abnormal posture.
Medical specialists are brought in to test hearing, vision, and perception, as well as cognitive, behavioral, and physical development.
A genetic specialist may be consulted for hereditary components.
The pediatrician will document all surveillance, screening, evaluation, and referral activities in the child’s health record.
The lengthy and detailed process can help rule out or confirm cerebral palsy. A formal diagnosis is usually made once the brain is fully developed between 2 to 5 years of age.
- Pediatrician
- Developmental Behavioral Pediatrician
- Geneticist
- Neurologist
- Neuroradiologist
- Ophtalmologists
- Orthopedic Surgeon
- Otologists
- Neonatologists
- Pediatric Geneticists
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Treatment options that this website explores includes behavioral therapy, counseling, braces, drugs, mechanical aids, music therapy, dance therapy, physical therapy, occupational therapy, play therapy, speech & language therapy and surgery including specialists such as audiologists, developmental pediatricians, neurologists, nutritionists, occupational therapists, orthopedic surgeons, and speech pathologists.
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