Cerebral palsy (CP) refers to a group of disorders that affect muscle movement and coordination. In many cases, cerebral palsy also affects vision, hearing, and sensation.
The word “cerebral” means having to do with the brain. The word “palsy” means weakness or problems with body movement.
Cerebral palsy is the most common cause of motor disabilities in childhood. According to the Centers for Disease Control and Prevention (CDC), it affects
The symptoms of cerebral palsy vary from person to person and range from mild to severe. Some people with cerebral palsy may have difficulty walking and sitting. Other people with cerebral palsy can have trouble grasping objects.
The effects of the condition can become more or less obvious or limiting as a child grows and develops motor skills. They also vary depending on the part of the brain that was affected.
Some of the more common symptoms include:
- delays in reaching motor skill milestones, such as rolling over, sitting up alone, or crawling
- difficulty walking
- variations in muscle tone, such as being too floppy or too stiff
- spasticity, or stiff muscles and exaggerated reflexes
- ataxia, or a lack of muscle coordination
- tremors or involuntary movements
- delays in speech development and difficulty speaking
- excessive drooling and problems with swallowing
- favoring one side of the body, such as reaching with one hand
- neurological issues, such as seizures, intellectual disabilities, and blindness
Most children with cerebral palsy are born with it, but some may not show signs of it until months or years later. Symptoms usually appear
In most cases, the exact cause of cerebral palsy is unknown.
Atypical brain development or injury to the developing brain can cause cerebral palsy. The damage affects the part of the brain that controls body movement, coordination, and posture. This brain damage usually occurs before birth, but it can also happen during birth or the first years of life.
Other possible causes include:
- head injuries as a result of a car accident, fall, or child abuse
- intracranial hemorrhage, or bleeding into the brain
- brain infections, such as encephalitis and meningitis
- infections acquired in the womb, such as German measles (rubella) and herpes simplex
- asphyxia neonatorum, or a lack of oxygen to the brain during labor and delivery
- gene mutations that result in atypical brain development
- severe jaundice in the infant
Contact a doctor right away if you think your child may have cerebral palsy. Early diagnosis and treatment are very important.
Congenital cerebral palsy vs. acquired cerebral palsy
The vast majority of cerebral palsy cases —
85 to 90 percent, according to the CDC — are congenital. This means they result from brain damage or atypical brain development occurring before birth, during birth, or in the first month of life.
Cases that develop later in life are known as acquired cerebral palsy. Acquired cerebral palsy is associated with causes such as injury and infection.
Certain factors put babies at an increased risk for cerebral palsy. These include:
- premature birth
- low birth weight
- a low Apgar score, which is used to assess a baby’s physical health at birth
- breech birth, which occurs when a baby’s buttocks or feet come out first
- Rh incompatibility, which occurs when the pregnant parent’s blood Rh type is incompatible with their baby’s blood Rh type
- the pregnant parent’s exposure to toxic substances, such as illegal drugs, or medications that damage the fetus
- being a twin or triplet
There are four types of motor effects from cerebral palsy, depending on which areas of the brain are affected:
Many people have a combination, and the apparent effects can also change over a person’s lifetime as a child begins to grow and attempt to do new things, such as balance while walking.
Spastic cerebral palsy
Spastic cerebral palsy is the most common type of cerebral palsy, affecting
Many people with spastic cerebral palsy have walking abnormalities, such as unintentionally crossing their knees or making scissor-like movements with their legs. Muscle weakness and paralysis may also be present.
The symptoms can affect the entire body or just one side of the body.
Dyskinetic cerebral palsy
People with dyskinetic cerebral palsy have trouble controlling their body movements. The condition causes involuntary, unusual movements in the arms, legs, and hands. In some cases, dyskinetic cerebral palsy also affects the face and tongue.
The movements can be slow and writhing or rapid and jerky. The movements can make it difficult for the affected person to sit, walk, swallow, or talk.
Ataxic cerebral palsy
Ataxic cerebral palsy is the least common type of cerebral palsy. Ataxic cerebral palsy is characterized by voluntary muscle movements that often appear disorganized, clumsy, or jerky.
People with this form of cerebral palsy usually have trouble with balance and coordination. They may have difficulty walking and performing fine motor functions, such as grasping objects and writing.
Hypotonic cerebral palsy
Hypotonic cerebral palsy causes diminished muscle tone and overly relaxed muscles. The arms and legs move very easily and appear floppy, like those of a rag doll.
Babies with this type of cerebral palsy have little control over their heads 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 or experience:
- difficulty speaking
- poor reflexes
- walking abnormalities
Mixed cerebral palsy
Some people have a combination of symptoms of the different types of cerebral palsy. This is called mixed cerebral palsy.
In most cases of mixed cerebral palsy, people experience symptoms of both spastic and dyskinetic cerebral palsy.
Cerebral palsy is classified according to the Gross Motor Function Classification System (GMFCS). Researchers at CanChild Centre for Childhood Disability Research developed the GMFCS as a universal standard for determining the physical capabilities of people with cerebral palsy.
The system focuses on:
- the ability to sit
- the capability for movement and mobility
- charting independence
- the use of adaptive technology
There are five levels of the GMFCS. Higher levels are associated with decreasing mobility.
Level 1 cerebral palsy
Level 1 cerebral palsy is characterized by being able to walk without limitations.
Level 2 cerebral palsy
A person with level 2 cerebral palsy can walk long distances without limitations, but they cannot run or jump.
They may need assistive devices, such as leg and arm braces, when first learning to walk. They may also need to use a wheelchair to get around outside of their home.
Level 3 cerebral palsy
A person with level 3 cerebral palsy 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 their home.
Level 4 cerebral palsy
A person with level 4 cerebral palsy can walk with the use of assistive devices.
They’re able to move independently in a wheelchair, and they need some support when sitting.
Level 5 cerebral palsy
A person with level 5 cerebral palsy 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 cerebral palsy by taking a complete medical history, performing a physical exam that includes a detailed neurological exam, and evaluating the symptoms.
The following additional testing may also be used:
- Electroencephalogram (EEG). An EEG is used to evaluate electrical activity in the brain. A doctor may order it when someone is showing signs of epilepsy, a primary cause of seizures. Learn more about epilepsy and seizures.
- MRI. An MRI uses powerful magnets and radio waves to produce detailed images of the brain. A healthcare professional may perform an MRI in order to identify brain irregularities or injuries.
- CT scan. A CT scan creates clear, cross-sectional images of the brain. It can also reveal brain damage.
- Ultrasound. A cranial ultrasound is a method of using high-frequency sound waves to get basic images of a young infant’s brain. It’s relatively quick and inexpensive. Learn more about ultrasounds.
- Blood tests. A healthcare professional may take and test a sample of blood in order to rule out other possible conditions, such as bleeding disorders.
If a doctor confirms a cerebral palsy diagnosis, they may refer you or your child to a specialist who can test for neurological issues that are often associated with the condition. These tests may detect:
- vision loss and impairment, such as blurred vision in one or both eyes
- speech delays
- intellectual disabilities
- movement disorders
People with cerebral palsy may have complications, including:
- communication difficulties, such as speech and language disorders
- spinal issues, such as scoliosis, lordosis (swayback) and kyphosis (hunchback)
- contractures, which occur when the muscles get locked into painful positions
- 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, or surgery.
Assistive aids include:
- hearing aids
- walking aids
- body braces
Muscle relaxants are commonly used to treat the symptoms of spasticity. Relaxing the muscles helps reduce pain from muscle spasms.
Your doctor might prescribe:
- dantrolene (Dantrium)
- diazepam (Valium)
- tizanidine (Zanaflex)
Your doctor might also suggest either local injections of botulinum toxin type A (Botox) or intrathecal baclofen therapy (Gablofen, Lioresal), where the drug is delivered through an implantable pump.
Orthopedic surgery may be used to relieve pain and improve mobility. It may also be needed to release tight muscles or correct bone irregularities 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 types of treatment for cerebral palsy include:
- speech therapy
- occupational therapy
- physical therapy
- recreational therapy
- counseling or psychotherapy
- social services consultations
Although experts are exploring stem cell therapy as a potential treatment for cerebral palsy, research is still in the early stages. It may be most effective at helping improve motor symptoms, according to a 2020 literature review.
The majority of conditions that cause cerebral palsy cannot always be prevented. However, if you’re pregnant or planning on becoming pregnant, you can take certain preventive measures to minimize complications.
It’s important to get vaccinated against conditions that can cause fetal brain damage, such as German measles (rubella).
It’s also crucial to receive adequate prenatal care. Attending regular appointments with your doctor or another professional during pregnancy can help prevent premature birth, low birth weight, and infections.
There’s no cure for cerebral palsy, but some of the effects can often be managed and many complications can be prevented or delayed. The specific type of treatment varies from person to person. Some people with cerebral palsy may not need very much assistance, while 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 cerebral palsy by helping them enhance their motor skills and ability to communicate.