What is Cerebral Palsy?
Cerebral palsy (CP) is a term that covers multiple disorders that impact physical movement, maintaining balance, and posture. Cerebral means the disease affects the brain, and palsy means being affected by paralysis that often presents with involuntary tremors. CP is the leading cause of motor disability in young children as a result of a brain injury (or abnormal brain development) during fetal development or after birth, affecting about half a million children and adults each year.
Signs and Symptoms
CP is a complex diagnosis that ranges in severity and differs between every case, so signs and symptoms vary. In general, some of the symptoms can include:
Typically, symptoms don’t worsen with age since the brain disorder causing CP doesn’t change over time. Symptoms can also be related to neurological problems, including difficulty seeing and hearing, intellectual disabilities, seizures, psychiatric conditions, urinary incontinence, or seizures.
- Issues with muscle tone, ranging from stiff to floppy
- Spasticity (increased tone in muscle resulting in exaggerated reflexes) causing contracture, which stop bone growth or makes bones bend and cause joint deformities, dislocation, or partial dislocation
- Poor coordination and trouble with movement
- Excessive or underdeveloped reflexes
- Problems with maintaining posture and balance
- Tremors and involuntary movement
- Delays in motor skills milestones as part of development
- Favoring one side of the body with movement (such as only reaching with one hand)
- Difficulty walking (seen as walking on toes, crouched over, a gait with knees crossing, or a wide or asymmetrical gait)
- Oral motor function problems – excessive drooling or trouble swallowing or eating
- Delays in speech development
- Problems with precise motions, such as using writing or eating utensils
- Lung disease and breathing disorders
Typically, symptoms don’t worsen with age since the brain disorder causing CP doesn’t change over time. Symptoms can also be related to neurological problems, including difficulty seeing and hearing, intellectual disabilities, seizures, psychiatric conditions, urinary incontinence, or seizures.
Causes and Risk Factors
The exact cause of CP isn’t known, only that there is an abnormality or disruption in brain development typically before the child is born. There are certain factors that cause problems with brain development including gene mutations, maternal infections, fetal stroke (when the blood supply to the brain is disrupted), infant infections after birth, traumatic head injury, or a lack of oxygen to the brain during labor and delivery.
Since maternal infections can cause issues to a developing fetus brain, certain infections are cause for concern when developed while pregnant, including rubella (measles), chickenpox, herpes, toxoplasmosis, and syphilis.
During birth, certain medical conditions or complications can increase risk of a child developing CP. A baby who is in breech position at the start of labor rather than head first, complications during labor and delivery (such as the baby having vascular or respiratory problems), low birth weight (under 5.5 pounds), delivering multiple babies (particularly if one or more dies), premature birth, or Rh blood type incompatibility between the mother and baby – this means the mother’s immune system might develop antibodies to attack and kill the baby’s blood cells, causing possible brain damage.
Once the baby is born, certain illnesses can cause damage to the brain – including bacterial meningitis (causing inflammation to the membranes around the brain and spinal cord), viral encephalitis (also causing inflammation), and jaundice that is severe or untreated since it means byproducts of blood cells aren’t being adequately filtered from the bloodstream.
Since maternal infections can cause issues to a developing fetus brain, certain infections are cause for concern when developed while pregnant, including rubella (measles), chickenpox, herpes, toxoplasmosis, and syphilis.
During birth, certain medical conditions or complications can increase risk of a child developing CP. A baby who is in breech position at the start of labor rather than head first, complications during labor and delivery (such as the baby having vascular or respiratory problems), low birth weight (under 5.5 pounds), delivering multiple babies (particularly if one or more dies), premature birth, or Rh blood type incompatibility between the mother and baby – this means the mother’s immune system might develop antibodies to attack and kill the baby’s blood cells, causing possible brain damage.
Once the baby is born, certain illnesses can cause damage to the brain – including bacterial meningitis (causing inflammation to the membranes around the brain and spinal cord), viral encephalitis (also causing inflammation), and jaundice that is severe or untreated since it means byproducts of blood cells aren’t being adequately filtered from the bloodstream.
Diagnosis
CP is typically first noticed when a parent or caregiver realizes their child has delays in development, especially for hitting specific physical milestones such as rolling over, crawling, or walking. A child could also have seizures, episodes where the child doesn’t seem to be aware of their surroundings, poor coordination, difficulty swallowing, or eye muscle imbalance.
Once a child with suspected CP is brought to a doctor, they will perform a physical evaluation, gather a patient history, then may refer the patient to a pediatric neurologist. Other tests may be ordered to rule out other diagnoses.
Tests specifically for diagnosing CP include an MRI of the child’s brain, or a cranial ultrasound, which is faster than an MRI and uses sound waves to create images of the brain. This works as a preliminary assessment of the brain to check for abnormalities. An EEG (electroencephalogram) may be used for a child experiencing seizures to find out if the child has epilepsy, which is one of the signs of CP. An EEG records the electrical signals in the brain to see if there are changes in brain wave patterns.
Once a child with suspected CP is brought to a doctor, they will perform a physical evaluation, gather a patient history, then may refer the patient to a pediatric neurologist. Other tests may be ordered to rule out other diagnoses.
Tests specifically for diagnosing CP include an MRI of the child’s brain, or a cranial ultrasound, which is faster than an MRI and uses sound waves to create images of the brain. This works as a preliminary assessment of the brain to check for abnormalities. An EEG (electroencephalogram) may be used for a child experiencing seizures to find out if the child has epilepsy, which is one of the signs of CP. An EEG records the electrical signals in the brain to see if there are changes in brain wave patterns.
Treatment
Patients diagnosed with CP will require long-term care with a medical team throughout their lives since there is no cure for the disease. Treatment for CP focuses on improving quality of life. A CP patient’s care team could consist of a neurologist, orthopedic surgeon (to help with bone and muscle problems), physical therapist for improving strength and coordination, and further specialists and therapists to help with the other symptoms of CP (speech and communication, mental health, daily cognitive/physical skills, development, education).
Medications can be prescribed to alleviate the tightness of muscles to improve physical function or treat pain. The medications can be prescribed based on how CP is affecting the child’s body – whether it affects specific muscles (isolated) or the whole body (generalized).
Botox injections can be given directly to the muscle for isolated issues, but if the whole body is affected, oral muscle relaxants may be prescribed to help loosen stiff muscles. Since there’s a dependency risk with muscle relaxants, they usually aren’t prescribed for long-term use.
In certain cases, surgery is used to loosen tight muscles or correct bone deformation that is caused by spasticity to put them back in the correct position. Some procedures can lengthen muscles and tendons that are too short, lessening pain and making mobility easier. When CP is severe and other treatments have not made improvements, surgeons can sever nerves causing spastic muscles (selective dorsal rhizotomy) which relaxes the muscle, but can result in numbness.
Medications can be prescribed to alleviate the tightness of muscles to improve physical function or treat pain. The medications can be prescribed based on how CP is affecting the child’s body – whether it affects specific muscles (isolated) or the whole body (generalized).
Botox injections can be given directly to the muscle for isolated issues, but if the whole body is affected, oral muscle relaxants may be prescribed to help loosen stiff muscles. Since there’s a dependency risk with muscle relaxants, they usually aren’t prescribed for long-term use.
In certain cases, surgery is used to loosen tight muscles or correct bone deformation that is caused by spasticity to put them back in the correct position. Some procedures can lengthen muscles and tendons that are too short, lessening pain and making mobility easier. When CP is severe and other treatments have not made improvements, surgeons can sever nerves causing spastic muscles (selective dorsal rhizotomy) which relaxes the muscle, but can result in numbness.
Life Expectancy
Since CP is a disorder that will not become worse over time, a child diagnosed with CP can grow up to lead an independent and productive life as long as symptoms are appropriately managed. Those with enough professional caregivers and support can live well into adulthood.
CP presents in many levels of severity, so it’s hard to estimate the lifespan for any one patient. It relies on the severity of symptoms and the success of treatment methods. The National Institutes of Health published one study estimating that the most severe cases of CP have a 25% chance of living to age 30 – cases that are less severe can live a lot longer.
CP presents in many levels of severity, so it’s hard to estimate the lifespan for any one patient. It relies on the severity of symptoms and the success of treatment methods. The National Institutes of Health published one study estimating that the most severe cases of CP have a 25% chance of living to age 30 – cases that are less severe can live a lot longer.
Sources & More Information
Centers for disease Control and Prevention, “Basics About Cerebral Palsy” https://www.cdc.gov/ncbddd/cp/facts.html
Cerebral Palsy Group, “Cerebral Palsy – The Complete Guide” https://cerebralpalsygroup.com/cerebral-palsy/
Mayo Clinic, “Cerebral palsy” https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999
Cerebral Palsy Group, “Cerebral Palsy – The Complete Guide” https://cerebralpalsygroup.com/cerebral-palsy/
Mayo Clinic, “Cerebral palsy” https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999
