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OVERVIEW

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, which can cause them to make unusual muscle movements. Babies who have CP may take longer than usual to start rolling over, sitting up, crawling, smiling or walking. 

CP can be mild or severe. A child who has mild CP may have awkward movements but they may require little or no assistance. A child who has severe CP may not be able to walk, may have trouble speaking and may require lifelong care and assistance.

What are different types of CP?

There are 3 types of CP:

• Spastic CP is the most common form of CP. 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 is the least common form of CP. Ataxic CP affects balance, coordination, and depth perception..

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

What are the symptoms of CP?

Children with CP show a wide variety of symptoms.  The symptoms of CP usually do not get worse over time. Symptoms 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.

CAUSES & RISK FACTORS

What causes CP?

CP is caused by abnormal brain development or brain injury.  The brain damage that causes CP can occur before the child is born, 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 to move and exactly when to move. Children who have 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, such as rubella or chickenpox, in the pregnant mother can increase the risk of brain damage in the developing baby and cause CP. Sometimes, a baby’s brain does not develop properly while in the womb, which can also lead to CP.

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

Children who have meningitis or viral encephalitis can also lead to CP. Meningitis causes inflammation of the membranes surrounding the brain and spinal cord. Viral encephalitis causes inflammation of the brain.

CP has also been associated with 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 for CP

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
• Severe jaundice in newborns
• Infections in the baby after birth, such as bacterial meningitis
• Head injuries after birth

DIAGNOSIS & TESTS

How can my healthcare provider tell if my child has CP?

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

PREVENTION

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.
• Attending all prenatal appointments. Tell your healthcare provider 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 their 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.

TREATMENT

What are the treatment options?

There is no cure for CP. If your child has CP, your healthcare provider will help you create a treatment plan that may include:

• Physical therapy: Exercise and muscle training will help your child with balance, flexibility, coordination and strength. Physical therapy can also help your child learn to use 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 type of therapy teaches your child how to help take care of their self. 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 healthcare provider may prescribe muscle relaxants to ease muscle stiffness. If your child has seizures, your healthcare provider may also suggest an anticonvulsant medicine.
• Surgery: Your healthcare provider may recommend surgery if your child’s muscles or tendons are very stiff and limit the range of motion in the arms and legs.

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 conditions. These include computers, software, voice synthesizers, and picture books to help with communication.