Cerebral palsy

Cerebral palsy (CP) is a term used to describe a group of nervous system (neurological) disorders characterized by impaired body movement and muscle coordination. CP can be caused by injury to or abnormal development of the brain during pregnancy, birth or the first two to three years of life.

Motor skills are controlled primarily by structures in the middle regions of the brain, including the frontal motor cortex, basal ganglia, thalamus, cerebellum and brainstem. Damage to or impaired development of any of these structures can lead to problems with normal motor functions, movement and posture.

CP is most often present at birth and may go unnoticed until there are signs of developmental delays. Babies may appear normal at birth. However, as they age, parents may notice developmental delays (e.g., failure to sit up, roll over, crawl or walk at the normal stages) and signs of poor coordination or stiff or tight muscles.

CP is not progressive, meaning it does not worsen with time. However, a child’s symptoms can become more pronounced over time and the developmental disabilities may become more obvious. In addition, secondary symptoms such as muscle spasms may become better, worsen or remain the same over time.

Children with CP often have other disorders related to brain injury or cerebral dysfunction. These can include mental retardation, behavioral or emotional disorders, seizures and visual and speech impairments. The severity of these disorders can affect the child’s treatment and/or progress in physical, occupational and speech therapy. Generally, the earlier that therapy and other treatment begins, the better the child’s opportunity to overcome or adapt to disabilities.

According to the United Cerebral Palsy Foundation, there are between 1.5 and 2 million children and adults with CP in the United States. Some 10,000 infants and babies are diagnosed with the disorder each year. Another 1,200 to 1,500 preschool aged children are diagnosed with CP annually.

Researchers continue to investigate the causes of CP. They are focusing on the roles of early brain development, genetic defects and abnormalities in the development of the condition. Other research areas include the influence of traumatic events during gestation (e.g., fetal stroke), and evaluating therapeutic methods to develop the most effective therapy.

Cerebral palsy (CP) is used to describe several different neurological disorders involving body movement and motor skills. The condition may manifest in different types of movement or muscle abnormalities (palsies), depending on the area of the brain affected by the disorder.

The four major types of CP are:

• Spastic (or pyramidal). Muscles are stiff, permanently contracted and unable to relax. Infants with spastic CP may also have periods of poor muscle tone (hypotonia). Spastic CP is the most common form, affecting 70 to 80 percent of patients with the disorder, according to the United Cerebral Palsy Foundation (UCPF). The spasticity (stiffness) and/or weakness (paresis or plegia) can affect both legs (spastic diplegia or paraplegia), the arms and legs (spastic quadriplegia), the left side of the body (left hemi-paresis), the right side (right hemi-paresis), one extremity (monoplegia) or both arms and one leg (triplegia).
• Athetoid (or dyskinetic). According to the UCPF, this form of CP affects an estimated 10 to 20 percent of patients. It is characterized by uncontrolled, slow, writhing movements typically affecting the hands, feet, arms, legs or face and tongue muscles. Patients with athetoid CP may drool or grimace. They may also have difficulty coordinating the facial muscles needed for speech (dysarthria).
• Ataxic. A rare form of CP that affects 5 to 10 percent of patients, according to the UCPF. Poor coordination, tremor, an unsteady walk with a wide gait and difficulty executing precise movements such as writing or buttoning a shirt are common characteristics.
• Mixed. Some people have a combination of the three major types of CP in varying degrees. The most common mix is spastic and athetoid disorders, but other combinations are possible.

Scientists do not completely understand what causes most cases of cerebral palsy (CP). There may be a number of factors contributing to the disorder, but researchers believe that abnormal brain development during pregnancy (prenatal) may be responsible in most cases. A small number of cases are believed to be due to injury to the brain before, during or after birth (perinatal).

There are several factors generally recognized to increase the risk of a fetus, newborn or young child developing CP.

Signs and symptoms may be mild to severe and will vary depending on the type of cerebral palsy (CP) a child has. Generally, the patient will have problems coordinating muscle and body movements and posture. Children with severe cases of CP may also have other problems such as seizures and mental retardation.

Some children born with CP may appear normal at birth. The motor skills and muscle control problems associated with the disorder may not become evident until the child is toddler age. However, signs that a child has CP usually appear by 18 months of age.

As the child gets older, physical disabilities tend to become more obvious.

To diagnose cerebral palsy (CP), a pediatrician or pediatric neurologist will perform a complete physical examination and medical history, paying attention to prenatal development, birth and the mother’s health status during the pregnancy. A neurological examination will also be used to diagnose the condition.

During well-baby checkups (these occur at 2, 4, 6, 9 and 12 months of age), the physician performs a visual examination of the baby and checks the ability to move the neck, hands, feet, arms and legs. The physician also rotates the baby’s legs to check for hip dislocation. In addition, the physician will check several basic responses and reflexes, such as a startle response, to assess the baby’s development.

The checkups will also focus on assessing the child’s motor, speech and language and neurological (nervous system) development. The physician will focus on basic skills such as rolling over, sitting up and standing as well as the use of sounds and words.

During the examination at 12 months, the physician will inspect a child’s feet and observe the child’s gait to make sure the bones in the legs and feet are normal. The physician will assess the child’s basic motor movements, such as grasping and clapping, to determine if there are any difficulties. The physician will discuss the child’s communication skills with the parent, including the child’s ability to understand and whether or not the child is speaking. In addition, the physician will examine the child’s ears for any signs of infection and mouth for the presence of teeth.

The physician will also evaluate the child’s ability to visually track or follow objects (e.g., vision test) and generally assess the child’s hearing.

In addition to the medical history, neurological and physical examination, the physician may also order diagnostic tests for the child. These may include:

During the mother’s pregnancy, the treating physician routinely performs a number of diagnostic tests to monitor fetal development. These tests can be early warning signals of risk factors for CP. The tests may include:

There is no cure for cerebral palsy (CP), but there are several treatment options designed to improve symptoms, the child’s quality of life, physical abilities and independence. Some children with CP may require minimal physical therapy whereas others may need surgery and extensive physical therapy as well as medications to control symptoms such as seizures. The type and duration of treatment will depend on the type and severity of the motor skill dysfunction.

The child’s team of physicians and specialists may include the pediatrician and pediatric neurologist as well as an orthopedic surgeon, various physical, speech and occupational therapists, nurses, school psychologists, social workers, nutritionists and mental health professionals. Caregivers are also an integral part of any successful treatment plan.

Common treatment options for CP may include:

Primary prevention methods for cerebral palsy (CP) focus on insuring a healthy pregnancy for the woman. This may include:

For CP that develops in the first few years of a child’s life, prevention can focus on safeguarding the home against accidental drowning (by putting fencing around backyard swimming pools) and falls (by putting child safety equipment such as toddler gates to block the top of staircases). Use of car safety seats and infant carriers when transporting children in vehicles has been shown in numerous highway safety studies to prevent serious head trauma and injury during traffic accidents.

In addition, wearing helmets while biking, skating or participating in recreational sports activities may also prevent serious head injuries. Enrolling infants and toddlers in swimming classes can also be effective prevention measures.

Having a child or loved one with cerebral palsy (CP) can present various psychological, social, financial and emotional challenges for the individual, family and caregivers. There is no cure for CP but the vast majority of children with the disorder live into adulthood (past 20 years of age). With surgery and physical therapy, people with mild to moderate CP can lead relatively normal and independent lives, gaining employment and driving cars. For severe cases, patients may require a lifetime of round-the-clock care.

Homes and cars may have to be customized with special equipment (e.g., wheelchairs and wheelchair lifts, ramps and handrails in hallways, stairways and bathrooms). The impact on the family life may be significant as well, especially if one parent has to stop working in order to care for the child.

Parents and family members of children with CP are often urged to seek family and individual and/or group counseling to help them cope with caregiving responsibilities. Many experience guilt associated with blaming themselves for the child’s condition. The child will also need counseling to help adapt to life as a person with disabilities who may be unable to do what other children do.