Cerebral palsy (CP) refers to a group of disorders that affect muscle movement and coordination. In many cases, vision, hearing, and sensation are also affected.
The word “cerebral” means having to do with the brain. The word “palsy” means weakness or problems with body movement.
CP is the most common cause of motor disabilities in childhood. According to the Centers for Disease Control and Prevention (CDC), it affects at least 1.5 to 4 out of every 1,000 children worldwide.
The symptoms of CP vary from person-to-person and range from mild to severe. Some people with CP may have difficulty walking and sitting. Other people with CP can have trouble grasping objects.
The symptoms can become more severe or less severe over time. They also vary depending on the part of the brain that was affected.
Some of the more common signs include:
- delays in reaching motor skill milestones, such as rolling over, sitting up alone, or crawling
- variations in muscle tone, such as being too floppy or too stiff
- delays in speech development and difficulty speaking
- spasticity, or stiff muscles and exaggerated reflexes
- ataxia, or a lack of muscle coordination
- tremors or involuntary movements
- excessive drooling and problems with swallowing
- difficulty walking
- favoring one side of the body, such as reaching with one hand
- neurological problems, such as seizures, intellectual disabilities, and blindness
Most children are born with CP, but they may not show signs of a disorder until months or years later. Symptoms usually appear before a child reaches age 3 or 4.
Call your doctor if you suspect your child has CP. Early diagnosis and treatment are very important.
Abnormal brain development or injury to the developing brain can cause CP. The damage affects the part of the brain that controls body movement, coordination, and posture.
The brain damage usually occurs before birth, but it can also happen during birth or the first years of life. In most cases, the exact cause of CP isn’t known. Some of the possible causes include:
- asphyxia neonatorum, or a lack of oxygen to the brain during labor and delivery
- gene mutations that result in abnormal brain development
- severe jaundice in the infant
- maternal infections, such German measles and herpes simplex
- brain infections, such as encephalitis and meningitis
- intracranial hemorrhage, or bleeding into the brain
- head injuries as a result of a car accident, a fall, or child abuse
Certain factors put babies at an increased risk for CP. These include:
- premature birth
- low birth weight
- being a twin or triplet
- a low Apgar score, which is used to assess the physical health of babies at birth
- breech birth, which occurs when your baby’s buttocks or feet come out first
- Rh incompatibility, which occurs when a mother’s blood Rh type is incompatible with her baby’s blood Rh type
- maternal exposure to toxic substances, such as methylmercury, while pregnant
There are different types of CP that affect various parts of the brain. Each type causes specific movement disorders. The types of CP are:
Spastic cerebral palsy
Spastic CP is the most common type of CP, affecting approximately 80 percent of people with CP. It causes stiff muscles and exaggerated reflexes, making it difficult to walk.
Many people with spastic CP have walking abnormalities, such as crossing their knees or making scissorlike movements with their legs while walking. Muscle weakness and paralysismay also be present.
The symptoms can affect the entire body or just one side of the body.
Dyskinetic cerebral palsy
People with dyskinetic CP have trouble controlling their body movements. The disorder causes involuntary, abnormal movements in the arms, legs, and hands.
In some cases, the face and tongue are also affected. The movements can be slow and writhing or rapid and jerky. They can make it difficult for the affected person to walk, sit, swallow, or talk.
Hypotonic cerebral palsy
Hypotonic CP causes diminished muscle tone and overly relaxed muscles. The arms and legs move very easily and appear floppy, like a rag doll.
Babies with this type of CP have little control over their head and may have trouble breathing. As they grow older, they may struggle to sit up straight as a result of their weakened muscles. They can also have difficulty speaking, poor reflexes, and walking abnormalities.
Ataxic cerebral palsy
Ataxic CP is the least common type of CP. Ataxic CP is characterized by voluntary muscle movements that often appear disorganized, clumsy, or jerky.
People with this form of CP usually have problems with balance and coordination. They may have difficulty walking and performing fine motor functions, such as grasping objects and writing.
Mixed cerebral palsy
Some people have a combination of symptoms from the different types of CP. This is called mixed CP.
In most cases of mixed CP, people experience a mix of spastic and dyskinetic CP.
Cerebral palsy is classified according to the Gross Motor Function Classification System (GMFCS). The World Health Organization (WHO) and the Surveillance of Cerebral Palsy in Europe developed the GMFCS as a universal standard for determining the physical capabilities of people with CP.
The system focuses on:
- the ability to sit
- the capability for movement and mobility
- charting independence
- the use of adaptive technology
The five levels of the GMFCS increase with decreasing mobility:
Level 1 cerebral palsy
Level 1 CP is characterized by being able to walk without limitations.
Level 2 cerebral palsy
A person with level 2 CP can walk long distances without limitations, but they can’t run or jump.
They may need assistive devices, such as leg and arm braces, when first learning to walk. They also may need to use a wheelchair to get around outside of their home.
Level 3 cerebral palsy
A person with level 3 CP can sit with little support and stand without any support.
They need handheld assistive devices, such as a walker or cane, while walking indoors. They also need a wheelchair to get around outside of the home.
Level 4 cerebral palsy
A person with level 4 CP can walk with the use of assistive devices.
They’re able to move independently in a wheelchair, and they need some support when they’re sitting.
Level 5 cerebral palsy
A person with level 5 CP needs support to maintain their head and neck position.
They need support to sit and stand, and they may be able to control a motorized wheelchair.
A doctor will diagnose CP by taking a complete medical history, performing a physical exam that includes a detailed neurological exam, and evaluating the symptoms. Additional testing can also be performed:
- An electroencephalogram (EEG) is used to evaluate the electrical activity in the brain. It may be ordered when someone is showing signs of epilepsy, which causes seizures.
- An MRI scan uses powerful magnets and radio waves to produce detailed images of the brain. It can identify any abnormalities or injuries in the brain.
- A CT scan creates clear, cross-sectional images of the brain. It can also reveal any brain damage.
- A cranial ultrasound is a relatively quick and inexpensive method of using high-frequency sound waves to get basic images of the brain in young infants.
- A sample of blood may be taken and tested to rule out other possible conditions, such as bleeding disorders.
If your doctor confirms CP, they may refer you to a specialist who can test for neurological problems that are often associated with the disorder. These tests may detect:
- vision loss and impairment, such as blurred vision in one or both eyes
- deafness
- speech delays
- intellectual disabilities
- movement disorders
People with CP may have other problems, such as:
- communication difficulties, including speech and language disorders
- drooling
- spinal deformity such as scoliosis (curvature), lordosis (saddle back) and kyphosis(humpback)
- osteoarthritis
- contractures, which occur when the muscles get locked in painful positions
- incontinence
- osteopenia, or poor bone density that can make bones easily breakable
- dental problems
The goal of treatment is to improve limitations and prevent complications. Treatment may include assistive aids, medications, and surgery.
Assistive aids
Assistive aids include:
- eyeglasses
- hearing aids
- walking aids
- body braces
- wheelchairs
Medications
Oral anticonvulsants and muscle relaxants are commonly used as first-line treatments for CP. Your doctor might prescribe:
- diazepam (Valium)
- dantrolene (Dantrium)
- baclofen
- tizanidine (Zanaflex)
Your doctor might also suggest local injections of botulinum toxin type A (Botox) or intrathecal baclofen therapy, where the drug is delivered by an implantable pump.
Surgery
Orthopedic surgery may be used to relieve pain and improve mobility. It may also be needed to release tight muscles or to correct bone abnormalities caused by spasticity.
Selective dorsal rhizotomy (SDR) might be recommended as a last resort to reduce chronic pain or spasticity. It involves cutting nerves near the base of the spinal column.
Other treatment
Other types of treatment for CP include:
- speech therapy
- physical therapy
- occupational therapy
- recreational therapy
- counseling or psychotherapy
- social services consultations
Although stem cell therapy is being explored as a potential treatment for CP, research is still in the early stages.
The majority of problems that cause CP can’t always be prevented. However, if you’re pregnantor planning on becoming pregnant, you can take certain preventive measures to minimize complications.
It’s important to get vaccinated against diseases that can cause fetal brain damage, such as rubella. It’s also crucial to receive adequate prenatal care. Attending regular appointments with your doctor during pregnancy can help prevent premature birth, low birth weight, and infections.
There’s no cure for CP, but the condition can often be treated and managed effectively. The specific type of treatment varies from person to person. Some people with CP may not need very much assistance, and others might need extensive, long-term care for their symptoms.
Regardless of the severity of the condition, treatment can improve the lives of those with CP. The following can help many people enhance their motor skills and ability to communicate:
- assistive aids
- medications
- therapy
- surgery
