What Is It?
Cerebral palsy is the name given to a large group of disorders that affect muscles and movement. These disorders begin early in life and result from brain injuries or problems with brain development before birth. Although the specific brain injury or problem causing cerebral palsy does not worsen, the movement problems can vary over time.
Cerebral palsy is caused by damage to the parts of the brain that control muscles and movement. There are many possible ways that the brain can be damaged, including problems during pregnancy, infection, stroke, genetic problems, lack of oxygen, severe jaundice or diseases that cause the brain to develop abnormally.
Cerebral palsy can also occur after birth, such as when there is an infection of the brain or a head injury.
There are four basic types of cerebral palsy:
Spastic — Stiff, difficult movement
Dyskinetic or athetoid — Involuntary and uncontrolled movement
Ataxic — Poor coordination and balance
Mixed — Combination of these types
According to the United Cerebral Palsy Association, 8,000 infants and 1,200 to 1,500 preschoolers are diagnosed with cerebral palsy every year.
The symptoms of cerebral palsy may be mild, like some clumsiness, or more serious, like not being able to move at all. Every child with cerebral palsy is different.
Early symptoms of cerebral palsy may include:
Difficulty feeding — Children with cerebral palsy may have trouble coordinating sucking and swallowing.
Delays in the appearance of normal motor milestones — For example, children with cerebral palsy may not sit, crawl or walk at the age they would normally be expected to.
Floppiness or stiffness — Some children with cerebral palsy have low muscle tone, making it hard for them to do things like hold their head up or sit straight. Others have increased muscle tone, making their arms and legs stiff. The stiff muscles may first appear as "scissoring" of the legs in infancy.
Trouble coordinating movements — Children with cerebral palsy may seem very clumsy, or have difficulty getting their arms and legs to do what they want them to.
Other symptoms depend on the type of cerebral palsy. They include:
Spastic cerebral palsy — This is the most common type of cerebral palsy, in which the affected limbs are spastic, meaning they are stiff and resist being stretched or bent. The person usually has these symptoms both when awake and asleep.
Dyskinetic or athetoid cerebral palsy — This less-common form of cerebral palsy is characterized by involuntary movements of the face, trunk and limbs that often interfere with speaking and feeding. Symptoms may worsen during times of emotional stress and typically go away during sleep. Movements can be rapid and jerky (chorea) or writhing (athetosis) or can involve staying in an abnormal position (dystonia).
Ataxic cerebral palsy — This type of cerebral palsy also is uncommon and usually involves a brain injury in the part of the brain responsible for coordination (called the cerebellum). Characteristic symptoms include wobbling of the trunk, trouble keeping limbs steady and abnormal eye movements.
Mixed — A combination of symptoms from at least two of the above subtypes.
All forms of cerebral palsy can have associated problems, including:
Seizures and other disorders of the nervous system
Vision or hearing problems
Your child's doctor will review a detailed medical and developmental history and a history of the pregnancy and delivery, including medications taken by the mother, infections and fetal movement. A detailed family history, including the mother's history of miscarriage and whether relatives had similar conditions, also can help.
Your child's doctor will examine your child and may order vision and hearing tests. Additional tests may be done, such as brain imaging with ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI); a test of brain activity using electroencephalogram (EEG); or blood or urine tests.
To help make a specific diagnosis and choose an appropriate therapy plan, the doctor may consult with other specialists, such as a neurologist; an orthopedic surgeon; or an ear, nose and throat doctor (otolaryngologist).
Cerebral palsy generally is a long-lasting (chronic) condition, but it does not get worse. Some children are affected severely and have lifelong difficulties. Others may have mild symptoms of cerebral palsy as infants, but later develop more normal muscle tone and motor skills. Although these children may continue to have abnormal deep tendon reflexes, they may not experience significant movement problems in their daily lives.
In some cases, cerebral palsy symptoms change over time. For example, decreased muscle tone (hypotonia) in infancy can change into increased muscle tone (hypertonia) in later childhood.
To help prevent cerebral palsy, doctors encourage pregnant women to get regular prenatal care beginning as early as possible during the pregnancy. However, since the cause of most cases of cerebral palsy is not known, it is difficult to prevent. Despite significant improvements in obstetric and neonatal care in recent years, the incidence of cerebral palsy has not decreased. More research into the causes of cerebral palsy is necessary to prevent these disorders.
Comprehensive treatment of cerebral palsy requires a team of specialists to help maximize and coordinate movement, minimize discomfort and pain, and prevent long-term complications. This team may include a neurologist, an orthopedist, other specialists, as well as physical, speech and occupational therapists. In addition, social workers can provide support to families and help to identify private and community resources. Most children with cerebral palsy benefit from early and regular physical and occupational therapy. Some children need braces and supports to help them stand and walk. Some may have surgical procedures, such as tendon releases or bone surgery (especially on hips and spine). Some also need treatment to reduce spasticity, which may include medications taken by mouth, injections into the muscle or surgery. For children with dyskinetic cerebral palsy, medications are sometimes used to help their movement problems.
Some people with severe cerebral palsy are unable to eat and breathe without aspirating (breathing in things that normally should not go into the lungs). These people may need to be fed using a tube inserted through the skin into the stomach (gastrostomy) or may need to breathe through a small surgical opening in the neck (tracheostomy).
When To Call a Professional
Contact your doctor if your child has abnormal muscle tone, muscle weakness, abnormal body movements or is not reaching normal developmental milestones at the expected ages.
The outlook for people with cerebral palsy depends on the severity of the cerebral palsy. Some children have only mild problems in muscle tone and no problems with daily activities, while others are unable to purposefully move any part of their body. In people with severe cerebral palsy, motor problems often lead to medical complications, including frequent and serious infections, severe breathing problems, feeding intolerance, and skin breakdown. These medical complications can lead to frequent hospitalizations and a shortened life expectancy. With support and treatment, though, many people with cerebral palsy can live healthy, happy lives.
United Cerebral Palsy
1660 L St. NW
Washington, DC 20036