Cerebral Palsy

Cerebral Palsy is a neurodevelopmental disorder caused by a non-progressive or abnormal development of the brain that occurs while a child’s brain is still developing — before birth, during birth, or immediately after birth. The Centers for Disease Control and Prevention estimates that, worldwide, 1.5 to 4 of every 1,000 infants are born with cerebral palsy. It was once thought that Cerebral Palsy was caused by complications during the birthing process. While this does happen, it is now widely agreed that birthing complications account for only a small percentage, an estimated 10 percent, of Cerebral Palsy cases. Current research suggests the majority of Cerebral Palsy cases result from abnormal brain development or brain injury prior to birth or during labor and delivery. Accidents, abuse, medical malpractice, negligence, infections, and injury are some known risk factors that may lead to Cerebral Palsy.

Every case of cerebral palsy is unique to the individual. One person may have total paralysis and require constant care, while another with partial paralysis might have slight movement tremors but require little assistance. This is due in part by the type of injury and the timing of the injury to the developing brain. There are several types of cerebral palsy, classified by the kind of movement affected, the body parts affected, and how severe the symptoms are. They are:

  • Spastic cerebral palsy: This type is the most common form of the disorder. People with spastic cerebral palsy have stiff muscles which cause jerky or repeated movements. There are different forms of spastic cerebral palsy, depending on the body parts affected.
  • Dyskinetic cerebral palsy: This type involves slow and uncontrollable jerky movements of the hands, feet, arms, or legs. The face muscles and tongue may be overactive and cause some children to drool or make faces. People with this type often have trouble sitting straight or walking. People with dyskinetic cerebral palsy do not usually have intellectual problems.
  • Ataxic cerebral palsy: This form of the disorder affects balance and depth perception. People with ataxic cerebral palsy walk in an unsteady manner and have a hard time with quick or precise movements such as writing, buttoning a shirt, or reaching for a book.
  • Mixed types: This kind of cerebral palsy includes symptoms that are a mix of the other types.

Cerebral Palsy affects body movement, muscle control, muscle coordination, muscle tone, reflex, posture and balance. It can also impact fine motor skills, gross motor skills and oral motor functioning. Individuals with cerebral palsy may also experience seizures, abnormal speech, hearing and visual impairments, and mental retardation. 1 in 4 children with cerebral palsy have epilepsy. When children have cerebral palsy and an intellectual disability, the incidence of epilepsy is higher – 48%. Seizures can affect speech, intellectual and physical functioning.
The signs of cerebral palsy usually appear in the first few months of life, but many children are not diagnosed until age 2 or later. In general, early signs of cerebral palsy include:

  • Developmental delays. The child is slow to reach milestones such as rolling over, sitting, crawling, and walking. Developmental delays are the main clues that a child might have cerebral palsy.
  • Abnormal muscle tone. Body parts are floppy or too stiff.
  • Abnormal posture. The child might also use one side of the body more than the other when reaching, crawling, or moving.

If a health care provider finds signs of cerebral palsy during an examination, he or she may then use one or more brain scanning methods to look for damage in the brain. These methods may include

  • Ultrasound
  • Computed Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
  • Electroencephalogram (EEG)

Even though the symptoms of cerebral palsy often differ from person to person, they can include:

  • Ataxia, the loss of muscle coordination when making movements
  • Spasticity, stiff or tight muscles; jerky, repeated movements; and stronger-than-normal reflexes (for example, the knee-jerk reflex)
  • Weakness in arms or legs
  • Walking on the toes
  • Walking in a crouched position
  • Muscle tone that is either too stiff or too floppy
  • Drooling
  • Trouble with swallowing or speaking
  • Shaking (tremor) of arms, legs, hands, or feet
  • Sudden, uncontrolled movements
  • In infants and toddlers, delays in motor skills (such as sitting, crawling, walking)
  • Trouble with precise movements such as writing or buttoning a shirt

A majority of children with Cerebral Palsy will experience difficulty moving around in their environment. This can range from problems turning over in bed to not being able to move on the floor or difficulties with walking due to poor balance and random, involuntary movements of their muscles. The child may need more time to get around, or need to use a walking aid or a wheelchair. Children with cerebral palsy may not be able to walk, talk, eat, or play in the same ways as most other children. Cerebral palsy can include milder or more severe symptoms which lead to total dependency. Although cerebral palsy is a lifelong condition, training and therapy can help improve overall physical and cognitive functioning of the individual.
Children with cerebral palsy may experience specific learning difficulties. These may include a short attention span, motor planning difficulties (organization and sequencing of movement), perceptual difficulties and language difficulties. Learning may also be affected by difficulties in fine motor and gross motor coordination and communication. Students with cerebral palsy need to put more effort into concentrating on their movements and sequence of actions than others, so they may tire more easily. Social problems with Cerebral Palsy, usually stem from difficulty communicating, making it more challenging to have social interactions. Poor coordination of the tongue and mouth muscles can affect speech ability in Cerebral Palsy patients, making interactions with their peers very difficult.

A child may need one or several different types of treatment depending on how severe the symptoms are and what parts of the body are affected. Common types of treatment for cerebral palsy include:

  • Physical therapy and rehabilitation: It involves exercises and activities that can maintain or improve muscle strength, balance, and movement. Other types of therapy include:
    • Occupational therapy
    • Recreational therapy
    • Speech and language therapy
  • Orthotic devices: Braces, splints, and casts can be placed on the affected limbs and can improve movement and balance.
  • Assistive devices and technologies
  • Medication: Certain medications can relax stiff or overactive muscles and reduce abnormal movement.
  • Surgery: A child may need surgery if symptoms are severe.

Not all therapies are appropriate for everyone with cerebral palsy. It is important for parents, patients, and health care providers to work together to come up with the best treatment plan for the patient.