Cerebral palsy is a disorder of muscle movement and coordination. It is caused by an injury to a child’s brain that occurs before birth or during infancy. It affects the part of the brain that controls body movement. People with cerebral palsy can have other problems such as seizures, decreased ability to learn, and problems hearing, seeing, and thinking. There is no cure for cerebral palsy, but early diagnosis and treatment can greatly improve quality of life.
Premature infants have a slightly higher risk for cerebral palsy. Causes for cerebral palsy in early infancy are:
- low oxygen levels (hypoxia)
- severe jaundice
- brain infections such as encephalitis, meningitis, and herpes simplex infections
- brain hemorrhage (bleeding into the brain)
- head injuries (due to accidents, a fall or child abuse)
- maternal infections such as rubella (German measles)
The types of cerebral palsy are:
- spastic: the most common type of cerebral palsy; reflexes are exaggerated and muscle movement is stiff
- dyskinetic: dyskinetic cerebral palsy is divided into two categories. Athetoid cerebral palsy which is marked by involuntary, slow, writhing movements and dystonic cerebral palsy where trunk movements are more affected than limb muscles, resulting in a twisted posture
- ataxic: voluntary muscle movements are not well coordinated
- hypotonic: muscle tone is decreased or floppy
- mixed: combinations of the symptoms listed above
Symptoms of cerebral palsy vary according to type, and range from mild to severe. Some of the more common symptoms include delayed milestones like controlling head, rolling over and sitting up. Some babies hold on to their infantile reflexes, like the startle reflex, that usually disappears after 6 months of age. Young children may develop a right or left “handedness” before 18 months. That could indicate a problem with not being able to use the other hand properly. Abnormal muscle tone is very common. Mental retardation and seizures are also seen in people with cerebral palsy.
Children with cerebral palsy may also have speech, hearing and vision difficulties as well as bladder and bowel problems.
Spastic Cerebral Palsy
In spastic cerebral palsy, muscles are very tight and may get worse with time. This tightness will cause a decrease in joint flexibility. People suffering from this symptom will have an abnormal walking posture. For example, knees may be touching or crossed, the arms may be tucked in at the sides, and there may be a scissors-like movement of the legs. Children may walk on their toes. Muscle weakness or paralysis may also be present. Symptoms can affect one side of the body, one arm, one leg, or both arms and both legs.
Other Types of Cerebral Palsy
Symptoms of other types of cerebral palsy may also include floppy muscle tone and lack of muscle coordination. Tremors or an unsteady gait are also common. People who have cerebral palsy may have difficulty with speech, chewing, and swallowing, drooling and irregular breathing.
Cerebral palsy is classified according to the Gross Motor Function Classification System (GMFCS). The GMFCS was developed by the World Health Organization (WHO) and the Surveillance of Cerebral Palsy in Europe (SCPE) as a universal standard for the determining the physical capabilities of a patient with cerebral palsy. GMFCS focuses on what the child is able to do rather than what his or her limitations are. GMFCS has five levels and is age specific. Emphasis is on the following capabilities:
- the ability to sit
- capability for movement and mobility
- charting independence
- use of adaptive technology
The GMFCS has five levels, which increase with decreasing mobility. The five levels of the GMFCS are:
- able to walk without limitations
- able to walk long distances, but cannot run or jump
- may need assistive devices such as braces when first learning to walk
- may need a wheel chair outside of the home
- able to sit with little support and is independent in standing
- able to “walk with adaptive assistance”
- walking indoors requires “hand held adaptive assistance”
- requires wheeled assistance outdoors
- limited self-mobility
- some support when sitting
- able to move independently with wheeled assistance
- head and trunk limitations are severe
- need for assistive technology and manual help is extensive
- may be able to control a motorized wheel chair
Cerebral palsy is diagnosed by taking a complete medical history (including prenatal history) and doing a physical exam. The exam includes a complete neurological evaluation. Additional testing can include: hearing and vision tests, intelligence testing, EEG (electroencephalogram to see if seizure activity is present in the brain), MRI and CAT scan of the head and blood tests.
Treatment is aimed at helping to improve limitations and complications. Treatment can include assistive aids, medications, surgery and other types of help. Examples of treatment are:
- hearing aids
- walking aids
Medications used to treat cerebral palsy are anticonvulsants and muscle relaxants such as Botox injections that reduce spasticity and drooling.
Surgery may be used to release joint contractures, place feeding tubes and control gastroesophageal reflux disease (where stomach fluids back up into the esophagus). Other surgeries can relieve pain and spasticity.
Other Types of Help
Other types of treatment for cerebral palsy include:
- speech therapy
- physical therapy
- occupational therapy (to learn how to modify tasks and adapt)
- social services consultations
- respite care for caregivers
There are many different complications of cerebral palsy. Some include impaired nutrition because of difficulty eating or swallowing. People with cerebral palsy may also develop pneumonia from breathing difficulties. Some can get conditions like osteoporosis, hip dislocations, arthritis, and scoliosis (an abnormal curvature of the spine). Many people with cerebral palsy, both children and adults, also suffer from the social stigma of the disease because they may not look like, move or speak like other people.
Scientific advances in the past 15 years have not decreased cases of cerebral palsy, but doctors have been able to prevent the condition through the rubella vaccine, research in blood typing, and by using phototherapy for the treatment of jaundice in newborns. The majority of medical problems that cause cerebral palsy may not be preventable; however, adequate prenatal care is crucial. See your doctor immediately if you see signs of cerebral palsy in your child. Early diagnosis and treatment is very important.
Cerebral palsy does not reduce life expectancy. The goal of treatment is to help patient’s function better and become independent, improving their quality of life.