Cerebral Palsy

Cerebral palsy (CP) is a disorder that affects muscle tone, movement, and motor skills (the ability to move in a coordinated and purposeful way). 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.

The brain damage that leads to cerebral palsy can also lead to other health issues, including vision, hearing, and speech problems, and learning disabilities.

Cerebral palsy affects muscle control and coordination, so even simple movements – like standing still – are difficult. Other vital functions that also involve motor skills and muscles – such as breathing, bladder and bowel control, eating, and learning – may also be affected when a child has CP. Cerebral palsy does not get worse over time.

Cerebral palsy is classified according to the main type of movement disorder involved. Depending on which areas of the brain are affected, one or more of the following movement disorders can occur:

• Stiff muscles (spasticity)
• Uncontrollable movements (dyskinesia)
• Poor balance and coordination (ataxia)

There are four main types of CP:

• Spastic cerebral palsy
• Dyskinetic cerebral palsy
• Ataxic cerebral palsy
• Mixed cerebral palsy

Spastic cerebral palsy

Spastic CP is the most common and affects about 80 percent of children and adults with CP. Children with spastic CP have increased muscle tone. This means their muscles are stiff and, as a result, their movements can be awkward. Spastic CP is usually described by what parts of the body are affected:

• Spastic diplegia/diparesis―In this type of CP, muscle stiffness is mainly in the legs, with the arms less affected or not affected at all. Children, teens and young adults with spastic diplegia might have difficulty walking because tight hip and leg muscles cause their legs to pull together, turn inward, and cross at the knees (also known as scissoring).
• Spastic hemiplegia/hemiparesis―This type of CP affects only one side of the body; in most cases the arm is more affected than the leg.
• Spastic quadriplegia/quadriparesis―Spastic quadriplegia is the most severe form of spastic CP and affects all four limbs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.

Dyskinetic cerebral palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies)

If your child is diagnosed with dyskinetic CP, he or she may have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk. The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected and your child may have a hard time sucking, swallowing and talking. A person with dyskinetic CP has muscle tone that can change (varying from too tight to too loose) not only from day to day, but even during a single day.

Ataxic cerebral palsy

Ataxic CP causes problems with balance and coordination. Your child might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something, and this may result in dropping things.

Mixed cerebral palsy

Sometimes children, teens, and adults will have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.

Cerebral palsy is one of the most common congenital (existing before birth or at birth) disorders of childhood. Less than one percent of children are born with it. About 500,000 children and adults of all ages in the United States have the condition.

The exact causes of most cases of CP are unknown, but many are the result of problems during pregnancy in which the brain is either damaged or doesn't develop normally. This can be due to infections, maternal health problems, a genetic disorder, or something else that interferes with normal brain development. Problems during labor and delivery can cause CP in some cases. but this is the exception.

Premature babies – particularly those who weigh less than 3.3 pounds (1,510 grams) – have a higher risk of CP than babies that are carried full-term, as are other low birth weight babies and multiple births, such as twins and triplets.

Brain damage in infancy or early childhood can also lead to CP. A baby or toddler might suffer this damage because of lead poisoning, bacterial meningitis, malnutrition, being shaken as an infant (shaken baby syndrome), or being in a car accident while not properly restrained.

Some injuries that may damage the nervous system include:

• Infections during pregnancy that damage the baby's developing nervous system and brain, such as German measles (rubella).
• Severe or untreated jaundice in infants and babies such as the type caused by Rh incompatibility. In this case, the mother's antibodies attack the baby's blood cells while the baby is in the womb, resulting in a severe form of jaundice
• Cerebrovascular incidents, like stroke, which can occur before a baby is even born.
• Head injuries that occur before or during the baby's birth
• Malnutrition
• Reduced oxygen flow to the brain both before and during birth

The following are the most common symptoms of cerebral palsy. However, each child may experience different symptoms and have one or more of the following:

• Muscle weakness
• Poor motor control
• Shaking, also called spasticity, of the arms or legs
• Muscle stiffness such as stiff legs or clenched fists
• The type of Cerebral palsy your child has will be classified according to the kind of motor function, or movement, he she may have, including:
• Spastic diplegia is when spastic movements occur either in the arms or legs; Diplegia is also called paraplegia.
• Spastic quadriplegia is when your child has spastic movements in all four limbs (arms and legs)
• Spastic hemiplegia is when spasticity affects one half, or side, of the body (such as right arm and right leg)
• Spastic double hemiplegia occurs in both sides of the body, but the amount of shaking is different in the right side compared to the left side
• Athetoid (or dyskinetic). Involuntary (unable to control), purposeless, and rigid movement
• Ataxic. Affects balance, leading to an unsteady gait, and motions, which require fine coordination, such as writing
• Children with cerebral palsy may have additional problems, including the following:
• Seizures
• Vision, hearing, or speech problems
• Learning disabilities and behavior problems
• Mental retardation
• Respiratory problems
• Bowel and bladder problems
• Bone abnormalities, including scoliosis (a lateral, or sideways, curvature and rotation of the back bones, giving the appearance that the person is leaning to one side)

CP may be diagnosed very early in an infant known to be at risk for developing the condition because of premature birth or other health problems. If your child is at risk, your pediatrician and neurology team will follow your child closely from birth so that they can identify and address any developmental delays or problems with muscle function that might indicate that your child has CP.

In many case, it may be difficult to diagnose the disorder, especially in the first year of life. Often doctors aren't able to diagnose CP until they see a delay in normal developmental milestones (such as reaching for toys by 4 months or sitting up by 7 months), which can be a sign of CP.

Abnormal muscle tone, poorly coordinated movements, and the persistence of infant reflexes beyond the age at which they are expected to disappear also can be signs. If these developmental milestones are only mildly delayed, the diagnosis of CP may not be made until the child is a toddler.

If your doctor does suspect that your child has cerebral palsy, a complete medical history, including a family medical history, and physical exam will be performed. Diagnostic testing may include the following:

• Neurological examination: This is to evaluate reflexes and brain and motor function.
• X-rays: A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Feeding studies
• Electroencephalogram (EEG): A procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp.
• Blood tests
• Gait lab analysis: This is to evaluate the walking pattern of the child.
• Magnetic resonance imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• Computed tomography scan (also called CAT scan or CT scan): A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
• Genetic studies: Diagnostic tests that evaluate for conditions that have a tendency to run in families.
• Metabolic tests: Diagnostic tests that evaluate the absence or lack of a specific enzyme (for example, amino acids, vitamins, carbohydrates) that are necessary to maintain the normal chemical function of the body.

Since cerebral palsy is a life-long condition that is not correctable, management includes focusing on preventing or minimizing deformities and maximizing the child's capabilities at home and in the community. Positive reinforcement will encourage the child to strengthen his/her self-esteem and promote as much independence as possible.

The full extent of the problems is usually not completely understood immediately after birth, but may be revealed as the child grows and develops.

When it comes to cerebral palsy, treatment is focused on helping your child achieve maximum independence. Your child's treatment plan will depend on the severity of his or her physical and mental challenges. Because no two children or CP patients are alike, an expert team of neurologists, neuropsychologists, orthopedists and occupational and physical therapists will work together with you and your child to design a program of care just for your child.

We focus on different kinds of therapy that can help your child achieve their maximum potential in growth and development. As soon as CP is diagnosed, your child can begin therapy for movement, learning, speech, hearing, and social and emotional development.

In addition, medication, surgery, or braces can help improve muscle function. Orthopedic surgery can help repair dislocated hips and scoliosis (curvature of the spine), which are common problems associated with CP. Severe muscle spasticity can sometimes be helped with medication taken by mouth or administered via a pump (the baclofen pump) implanted under the skin.

A variety of medical specialists might be needed to treat the different medical conditions. For example, a neurologist might be needed to treat seizures or a pulmonologist might be needed to treat breathing difficulties. Our team of specialists will work closely with you and your pediatrician to coordinate the care of your child. We also recommend downloading our free Health Care Notebook. It has everything you need to organize all your child's records, appointments, prescriptions and more, and help your coordinate care with family and caregivers.