Cerebral palsy

What is it?

Cerebral palsy the name for a group of movement disorders caused by an injury to the brain either during pregnancy, during birth, shortly after birth, or before age 5. Children with cerebral palsy have difficulty coordinating muscle movement because nerve cells in the motor control centers of the brain are damaged and can’t signal the appropriate muscles. Cerebral palsy is not a disease and symptoms do not steadily worsen as the child gets older. For this reason, it is also called static encephalopathy. Static means it stays the same; encephalopathy refers to a disorder of the brain.

Who gets it?

Cerebral palsy affects 2 to 6 of every 1,000 infants born in the United States each year, making it the most common handicapping disorder. It is 10 times more common in premature infants. It is also more likely to occur in full term, but very small infants.

What causes it?

Cerebral palsy is not an inherited disorder; it is caused by injury to the brain. In many cases, doctors are unable to determine what causes the brain injury. However, known causes that affect the brain of the fetus or newborn include a poor supply of oxygen to the brain during development or during delivery; premature birth; difficult labor or traumatic delivery; early separation of the placenta or umbilical cord damage; mother and baby having different blood types; and extremely high bilirubin levels that are untreated. Cerebral palsy can be caused during pregnancy if the mother develops an infection, such as rubella or HIV; abuses drugs or alcohol; contracts the herpes virus; develops toxoplasmosis from exposure to cat feces or undercooked meat; is anemic; or suffers physical trauma that affects the infant. During the first five years of life, cerebral palsy can be caused by an infection that affects the brain, such as meningitis or encephalitis; severe convulsions; head trauma; severe dehydration, and exposure to toxins. However, approximately 90 percent of all cases of cerebral palsy are caused by brain injury during the prenatal period (before labor begins).

What are the symptoms?

The symptoms of cerebral palsy are usually not noticeable at birth. However, as children with cerebral palsy develop they do not meet normal developmental milestones, such as sitting unsupported or crawling, within predictable times because the muscles do not function normally. The symptoms of cerebral palsy range from mild clumsiness to severe contortions of the arms and legs. Cerebral palsy is classified into five main types, depending upon the nature of the movement disorder and the pattern of the limbs involved. 

Cerebral palsy classification:

1. Spastic. Symptoms include stiff, weak muscles; abnormal posture; and poor fine motor control.
2. Athetoid. Symptoms include spontaneous, slow muscle movements.
3. Hypotonic. Symptoms include floppy muscles.
4. Ataxic. Symptoms include poor coordination and balance, with shaky movements.
5. Dystonic. Two of the above types, usually spastic and athetoid, are mixed. This type occurs in many children.

The pattern of the limbs involved is classified as hemiplegia, which affects the arm and leg on only one side of the body; diplegia, which affects mainly both legs; and quadriplegia, which affects both arms and both legs. So, a child could have spastic diplegia, or ataxic hemiplegia.

Some children with cerebral palsy may also have seizures; speech, vision, and hearing problems; learning disabilities; and attention deficit and/or hyperactivity disorder (ADD/ADHD). Two thirds of all cases have some degree of mental retardation. These conditions are not necessarily a component of cerebral palsy, but result from the effect of brain abnormalities on other areas of brain function. Some symptoms of cerebral palsy can cause additional complications. For example, spastic muscle movement can cause orthopedic problems, such as hip dislocation, curvature of the spine, or shortened muscles (contractures). Drooling, cavities, and gum disease are more common in people with cerebral palsy because of tightness in the mouth and jaw and difficulty with coordination. Constipation is also common.

How is it diagnosed?

Cerebral palsy is usually difficult to detect during early infancy. If your doctor notices problems with muscle development, spasticity, or poor coordination, he or she will carefully monitor your child’s development. While there is no laboratory test to identify cerebral palsy, your doctor may order studies such as computed tomography (CT) or magnetic resonance imaging (MRI) of the brain, blood tests, and tests that involve electrical stimulation of the muscles to rule out any other disorders with symptoms similar to cerebral palsy. 

What is the treatment?

There is currently no cure for cerebral palsy. The goal of treatment is to make your child as independent as possible. Physical therapy will help keep muscles stretched and improve balance and muscle control, Orthopedic surgery may be necessary for the child to be able to walk with the aid of braces or crutches. Surgery may also be needed to correct vision problems. Hearing problems are treated with hearing aids. Speech therapy may help make your child easier to understand and improve eating problems.

Children with severe speech difficulties can be taught to use computers and picture boards to communicate. Children with seizures can take anticonvulsant drugs, which can also help with spastic muscle movements. Spasticity can also be treated with muscle relaxing drugs. One such drug, baclofen, can be delivered at regular intervals through a pump implanted under the skin. Many children with cerebral palsy are able to attend regular schools, which can also help encourage independence.

Occupational therapy is also an important component of treatment that helps children with cerebral palsy become self-sufficient adults. Because the symptoms of cerebral palsy can cause behavioral and emotional problems, many children benefit from counseling or behavior therapy. Massage therapy may also provide relief to children and adults with painful muscle contractions. Good nutrition, regular visits to the medical specialists involved in your child’s treatment, and understanding are important components of successful treatment. While cerebral palsy is not fatal, it can affect a person’s lifespan in more severe cases. However, most children with cerebral palsy live into adulthood.