What is cerebral palsy?
Cerebral palsy (CP) is a group of permanent disorders related to the development of movement and posture. It occurs as a result of non-progressive disturbances that occurred in the developing fetal or infant brain. CP may result from several problems, such as lack of oxygen to the brain, genetic conditions, infections, brain hemorrhage, severe cases of jaundice and injury to the head.
What causes cerebral palsy?
Many cases of CP have unknown causes. The disorder occurs when there is abnormal development or damage to areas in the brain that control motor function. It occurs in approximately three out of every 1,000 live births. Risk factors for CP include the following:
- Blood clotting disorders
- Very low birthweight (especially in babies weighing less than 3.3 lbs.)
- Chemical or substance abuse during pregnancy
- Bleeding in the brain
- Complications of labor and delivery (rarer than people believe, it only appears to be the cause in 5 to 10 percent of cases.)
What are the symptoms of cerebral palsy?
The following are the most common symptoms of CP. However, each child may experience symptoms differently. Your child may have muscle weakness, poor motor control or increased muscle tone (tight muscles, also known as spasticity) of the arms or legs. The full extent of the condition is not completely understood immediately after birth, but may be revealed as your child grows and develops.
There are different ways to classify cerebral palsy:
- By muscle tone. Spastic, dystonic, athetotic (involuntary, purposeless and rigid movement) and/or mixed
- By part of the body involved. Diplegic (arms or legs), hemiplegic (affecting one half or side of the body) or quadriplegic (all four limbs)
- By motor function. Using the Gross Motor Classification System (GMFCS)
Children with CP may have additional problems, such as:
- Vision, hearing or speech disorders
- Learning disabilities
- Intellectual disability
- Respiratory deficits
- Swallow and feeding disorders
- Musculoskeletal disorders: scoliosis (curvature of the spine), hip dysplasia (abnormal development of the hip joints) and contractures (loss of joint flexibility)
- Chronic pain
- Sleep disorders
Babies with CP are often slow to reach developmental milestones, such as learning to roll over, sit, crawl or walk. They may also have certain reflexes present that normally disappear in early infancy. The symptoms of CP may resemble other conditions. Always consult your child's doctor for a diagnosis.
How is cerebral palsy diagnosed?
The diagnosis of CP is made between 12 and 24 months of age. The diagnosis is based on:
- Your child’s prenatal and birth history
- Your child’s developmental history
- Examination of your child that includes neurological exam and assessment of motor function
Treatment of cerebral palsy
Specific treatment for cerebral palsy will be determined by your child's doctor based on:
- Your child's age, overall health and medical history
- The extent of the disease
- The type of CP
- Your child's tolerance for specific medications, procedures or therapies
- Expectations for the course of the disease
- Your opinion or preference
Your child is best treated with an interdisciplinary team that may include the following health care providers:
- Pediatrician/family practitioner
- Orthopaedic surgeon
- Physical medicine and rehabilitation specialist
- Developmental pediatrician
- Physical therapist
- Occupational therapist
- Speech language pathologist
- Vision therapist
- Durable medical equipment (DME) provider
Management of CP includes nonsurgical and surgical options. Nonsurgical interventions may include:
- Positioning aids (used to help the child sit, lie or stand)
- Assistive devices for walking, participation in self-care or communication
- Braces to prevent deformity and to provide support or protection and/or assist with function
- Medications to help control muscle tone; the medications may be given by mouth or as an injection
Surgical interventions may be used to manage the following conditions:
- Orthopaedic problems that may include managing curvatures of the spine, hip positioning and joint contractures
Long-term outlook for the child with cerebral palsy
Since CP is a lifelong condition that is not correctable, management includes focusing on preventing or minimizing deformities and maximizing your child's capabilities at home and in the community. Positive reinforcement will encourage your child to strengthen his or her self-esteem and promote as much independence as possible.