Cerebral Palsy

What is cerebral palsy?

Cerebral palsy (CP) is a group of neurological (brain) disorders. These disorders affect body movement and muscle coordination. It usually appears in infancy or early childhood, as the brain develops. Children with CP may have stiff or weak muscles. This can cause them to make unusual muscle movements. It may take a baby with CP longer than usual to start rolling over, sitting up, crawling, or walking.

CP can be mild or severe. A child with mild CP may have awkward movements but require little or no assistance. A child with severe CP may not be able to walk. He or she may have trouble speaking and may require lifelong care and assistance.

There are 3 general types of CP:

• Spastic CP is the most common form. It causes the muscles to stiffen and makes movement difficult. It can affect just one side of the body, only the legs, or the whole body. This depends on the type of spastic CP and the severity.
• Dyskinetic CP causes uncontrolled body movements. These can be slow or fast and jerky. It affects the entire body.
• Ataxic CP affects balance, coordination, and depth perception. It is the least common form of CP.

Some children will show signs of more than one type of CP. This is referred to as mixed CP.

Many children with CP have other conditions as well. Some of the most common include:

• Intellectual disability or learning difficulties
• Seizures
• Delayed growth and development
• Spinal deformities
• Vision or hearing loss
• Speech disorders
• Infections and long-term illnesses

Symptoms of CP

Children with CP show a wide variety of symptoms. The symptoms usually do not get worse over time. They may include:

• Stiff muscles or muscles that are too floppy
• Uncontrolled movements
• Lack of coordination
• Difficulty walking (for example, one foot or leg may drag)
• Difficulty with fine motor control (for example, difficulty with writing or buttoning a shirt)
• Difficulty speaking, swallowing, or eating
• Excessive drooling
• Seizures

Signs of CP usually show up in the first few months of a baby’s life. They often are signs of developmental delay. This means they don’t reach developmental milestones in the typical time. These milestones include learning to roll over, sit, crawl, or walk.

What causes CP?

CP is caused by abnormal brain development or brain injury. The brain damage can occur before the child is born. It can also occur during birth or in the first few years of life. In most cases, CP is present at birth.

Normally, the brain sends out messages telling the body exactly how and when to move. Children with CP have damage to the part of the brain that sends out these messages. This affects the way a child who has CP talks, walks, and moves.

Certain infections in the pregnant mother can increase the risk of brain damage in the developing baby and cause CP. These infections include rubella or chickenpox. Sometimes, a baby’s brain does not develop properly in the womb. This can also lead to CP. Doctors don’t know for sure why this happens. In some cases it can be associated with the mother’s exposure to certain toxic substances.

A difficult labor or delivery can cause CP. This can happen if there is a lack of oxygen to the baby’s brain during birth. Severe jaundice that is left untreated in newborns can also result in CP.

Meningitis or viral encephalitis in children can lead to CP. Meningitis causes inflammation of the membranes surrounding the brain and spinal cord. Viral encephalitis causes inflammation of the brain.

CP can also be caused by brain injuries during the first few months or years of life. These could be from an accident or from being shaken.

In many cases, the cause of a child’s CP is never found.

Risk factors

Some things can increase the risk of a baby developing CP. Risk factors include:

• Infection, such as rubella, in a pregnant mother
• Problems with blood circulation in the brain before birth
• Abnormal brain development
• Premature birth or low birth weight
• Babies in a feet-first (breech) position at the beginning of labor
• Difficult labor and delivery or delivery of multiple babies
• Exposure to toxic substances in a pregnant mother
• Severe jaundice in newborns
• Infections in the baby after birth, such as bacterial meningitis
• Head injuries after birth

How is CP diagnosed?

CP is often diagnosed in the first two years of a child’s life. Your doctor will look at your child’s muscles, posture, and reflexes. They will ask you about your child’s physical development. They may monitor your child over time, tracking their growth and development. They may also order special tests, such as a CT scan or an MRI. These can help the doctor see if there is any damage to the brain. These tests can also help your doctor determine if your child’s symptoms are the result of a different disorder.

Children with milder symptoms may not be diagnosed until they are 4 or 5.

Can CP be prevented or avoided?

Some cases of CP cannot be prevented. They are the result of complications that happen during pregnancy or birth that could not be foreseen.

The best way to prevent CP is to take measures to lower the risk factors. You can do this by:

• Maintaining your physical health during your pregnancy. This includes eating a healthy diet, exercising, and getting plenty of rest.
• Taking folic acid. It has been shown to prevent premature birth, which is associated with CP. It also helps with neurological development.
• Attending all prenatal doctor appointments. Tell your doctor if anything doesn’t feel right.
• Avoiding unhealthy habits. This includes drinking alcohol, smoking, or using drugs.
• Watching for jaundice after the baby is born. Untreated jaundice (yellow skin) could lead to CP.
• Keeping your baby current on vaccinations. Some preventable illnesses, such as rubella (German measles), can cause CP.
• Avoiding potential injury or accidents. Always fasten your child securely into his or her car seat when traveling in the car. Don’t ever shake your baby. This can cause brain injury that could result in CP. Make sure anyone who watches your baby is trustworthy and won’t shake or harm your baby.

CP treatment

There is no cure for CP. If your child has CP, your doctor will help you create a treatment plan. Treatment should improve his or her skills. The plan may include:

• Physical therapy: Exercise and muscle training will help your child with balance, flexibility, coordination, and strength. It can help your child learn to use assistive devices. These could include crutches, braces, splints, or a wheelchair if necessary.
• Speech therapy: A speech therapist can help your child with speaking or sign language, swallowing, and eating.
• Occupational therapy: This teaches your child how to help take care of themselves. It can help teach your child to perform daily activities at home or school. It also helps your child learn or improve fine motor skills, such as writing.
• Medicines: Your doctor may prescribe muscle relaxants to ease muscle stiffness. If your child has seizures, your doctor may suggest an anticonvulsant.
• Surgery: Your child’s muscles or tendons could be very stiff. This limits the range of motion in the arms or legs. In these cases, your doctor may recommend surgery.

Living with CP

Many people with CP are in treatment for most of their lives. Some use other methods to help manage their disease. Orthotic devices help stabilize movement. These could include braces, wedges, special chairs, rolling walkers, or powered scooters. Many assistive devices have been developed to help people with CP and other disabling diseases. These include computers, software, voice synthesizers, and picture books to help with communication.

Many parents explore complementary and alternative medicine (CAM) for their children. Although the FDA hasn’t approved these therapies, some parents have reported positive results. Some alternative therapies include:

• Hyperbaric oxygen therapy
• Electrical stimulation
• Specialized learning strategies
• Stem cell therapy 

Questions to ask your doctor

• Where can I get help and support in my community?
• Will my child be able to attend school?
• What kind of special equipment do I need in my home?
• Will my child learn how to speak?
• Will my child ever be able to walk without help?
• Will my child ever be able to live independently?

Resources

Centers for Disease Control and Prevention: Cerebral Palsy

National Institute of Neurological Disorders and Stroke: Cerebral Palsy: Hope Through Research

U.S. National Library of Medicine: Cerebral Palsy