What is Cerebral Palsy
Cerebral palsy (CP) is a disorder which affects movement, muscle tone, and balance. It is caused by damage that affects the brain during development, usually as a pre-birth occurrence. Symptoms of CP usually appear during infancy or toddlerhood and most cases are diagnosed by the age of three.
Cerebral palsy affects about 750,000 children and adults and is the most common motor disability affecting children. CP does not always affect cognitive skills but about half of all children with the disorder do have cognitive impairment and require some sort of additional care. Cerebral palsy is not contagious and though there is no cure, most children who develop CP have a life-expectancy that is near normal.
What Causes Cerebral Palsy?
Cerebral palsy is caused by damage which occurs while the immature brain is developing. In most cases, brain injury occurs before birth but it can also be caused by accident, infection or other trauma which occurs during early childhood. Specific causes include:
- Maternal health conditions or infections may affect a developing fetus
- Genetic mutations which lead to abnormal brain development or growth
- The fetal stroke which causes a disruption in blood supply to developing brain
- Infant infections which cause brain swelling or inflammation
- Traumatic head injury during infancy from vehicular accident or fall or due to abuse
- Lack of oxygen during delivery, much less common than previously thought
Risk Factors for Cerebral Palsy
Certain conditions may increase the risk for development of cerebral palsy in infants or children. These include:
Maternal health conditions which occur during pregnancy can result in CP.
- Infections like chickenpox, herpes, syphilis, measles, Zika, cytomegalovirus and toxoplasmosis.
- Exposure to toxins such as mercury or insecticides
- Medical complications including thyroid problems, seizure disorders, and intellectual disabilities
Infant illnesses in a newborn can result in CP.
- Bacterial meningitis produces swelling and inflammation in protective tissue around the brain and spinal cord due to bacterial infection
- Viral encephalitis produces swelling and inflammation of the brain and surrounding area due to viral infection
- Severe jaundice or untreated jaundice results in yellowed skin due to toxins which are not cleared by newborn’s liver and can cause neurological damage
Other risk factors related to pregnancy and birth which may increase the risk for CP.
- Complicated labor and delivery which results in vascular or respiratory problems and may decrease oxygen supply to the brain
- Breech (feet first) birth position can increase the difficulty of delivery and result in extended time in the birth canal
- Low birth weight of less than 5.5 pounds carries a higher risk of CP, risk decreases with increasing weight.
- Premature birth at less than 37 weeks has a higher rate of CP, earlier births show greater risk.
- Multiple birth (twin, triplet or greater) babies have a higher risk, even greater if one of the babies dies during gestation or delivery.
- Rh blood type mismatch or incompatibility between mother and infant may result in the mother’s immune system producing antibodies to “attack” infant blood cells which will limit oxygen supply.
Symptoms of Cerebral Palsy
Cerebral palsy is generally considered a motor condition but may also affect other areas of the brain. In most cases, symptoms of CP will not be apparent at birth or immediately after birth but will begin to appear over time. Commonly, the disorder becomes apparent when infants begin to miss developmental milestones such as rolling over, sitting up and crawling.
Cerebral palsy can affect only one area of the body such as a single limb or a much larger portion such as all limbs. Cerebral palsy is not progressive and will not worsen with age, but the disorder may become more apparent as the child grows and develops.
Signs of cerebral palsy include:
- Muscular rigidity (stiff muscles)
- Muscular spasticity (exaggerated movements)
- Ataxia (lack of coordination)
- Athetosis (slow movements)
- Lack of muscle tone (limp or floppy muscles)
- Delay in motor skill milestone (rolling over, sitting up, etc)
- Fine motor skill difficulty
- Difficulty swallowing, drooling
- Involuntary movements
- Paralysis of one side of the body
- Intestinal or urinary problems
In some cases, children with cerebral palsy may also show developmental or cognitive symptoms such as slow growth, speech delay, learning disabilities or other conditions.
Diagnosing Cerebral Palsy
Early diagnosis of cerebral palsy allows for early intervention and better treatment which may improve the child’s quality of life. Most cases are diagnosed during infancy and early childhood before the child is three years of age. In some cases, physicians are reluctant to make an official diagnostic decision before the child is five when they consider there may be other issues with a developing brain.
The diagnosis procedure will likely take place over a period of time and will consider growth, developmental milestones, body function, muscle development, and motor skills. The primary care physician may refer the child to a specialist such as a neurologist who may order CT or MRI scans or other tests to rule out other potential causes before giving a CP diagnosis.
Types of Cerebral Palsy
Cerebral palsy is usually classified by severity level and type of symptom it causes. Types include:
- Spastic – causes stiffness of muscles and mixed mobility issues. The most common type of CP.
- Hypertonic – rigid limbs with high muscle tone
- Hypotonic – limp limbs with low muscle tone or strength
- Athetoid – causes slow or sporadic movements which are involuntary.
- Ataxic – problems with balance and depth perception
- Mixed – a combination of other types
Treatments for CP vary by type of symptom and severity.
Treatments for Cerebral Palsy
Cerebral palsy is a permanent condition which cannot be cured, however, intervention and treatment can help to improve prognosis and increase the quality of life for children and as they grow into adults.
Treatments may involve medication but will also involve various types of therapy depending on the child’s needs. In some cases, surgical intervention may be recommended and many children will benefit from mental health or social work services to address concerns like depression and self-esteem issues.
Treatment plans are developed on an individual basis and will likely involve a team of healthcare professionals. Treatments may include:
- Botulinum toxin (Botox) – for spasticity which is localized to one area of the body
- Muscle relaxants (diazepam, dantrolene, baclofen) – for generalized spasticity
- Medications to reduce drooling may also be used such as trihexyphenidyl, scopolamine or glycopyrrolate along with other medications for conditions such as seizure disorder or intestinal problems.
Consultation with occupational therapists may provide tools for mobility or function such as walkers, canes, and other assistant devices.
May be recommended to increase social skills and provide exposure to fun or engaging activities like horseback riding and adapted sports programs.
Specific training exercises to increase mobility, flexibility, and balance. Exercises will likely be done both at a therapy center and at home but may also include specific treatment settings like a pool.
May help improve the ability to speak clearly and improve communication skills. May also address other oral muscle-related issues such as swallowing or tongue movements.
In severe cases, orthopedic surgery may be needed to correct joint position or lengthen muscles or tendons which have contracted over time and help to reduce pain and improve mobility.
In some extreme cases, intense pain may be an issue which has not resolved through other methods. Surgery to sever certain nerves in affected muscles may be required to resolve pain but will likely result in numbness of the area and is used as a last resort.
As a child nears adolescence, he or she may benefit from talk therapy or group therapy to address concerns about self-esteem, appearance, and depression which may occur due to CP.
About half of the children with CP will have some cognitive effects and may benefit from educational assistance such as tutoring or work with the special education professionals at schools.
Cerebral palsy is the most common motor disability in children and affects about 750,000 children and adults. It is more common in boys and African American children but also affects girls and children of other ethnicities. Early intervention is essential to improve prognosis and increase the quality of life for children and further as they grow into adults.
Parents or caregivers of children who may have developed cerebral palsy after a birth injury may wish to consult with a legal expert. In some cases, compensation may be available to help with medical costs and other financial concerns.