Cerebral Palsy

Overview

Cerebral palsy (CP) describes a group of conditions that impact movement and muscle coordination/control. It is caused by damage to motor areas in the brain which typically happens during pregnancy as the fetus is developing before/during/shortly after birth or during the first three years of a child's life. The damage impairs the brain's ability to effectively control movement and posture. Cerebral palsy is not progressive and does not generally get worse with time. There is no cure for cerebral palsy although in many cases it can be effectively managed.

Causes

Because cerebral palsy is a group of disorders there is no one single cause. It can be present at birth (congenital cerebral palsy) or occur during the first few years of a child's life (acquired cerebral palsy).

Congenital cerebral palsy is more common although it may not be detected for months following birth. In most cases the cause is much more difficult to determine. Scientists have however identified some specific events that happen during pregnancy or around the time of birth which may result in congenital cerebral palsy including:
  • German measles rubella cytomegalovirus or toxoplasmosis during pregnancy
  • Placental and other maternal infections
  • Jaundice
  • Rh incompatibility
  • A severe shortage of oxygen to the brain during labour and/or delivery
  • Stroke in the fetus or newborn baby

Some of the common causes of acquired cerebral palsy include:

  • Head injury often due to a car accident a fall or child abuse
  • Brain infections including bacterial meningitis or viral encephalitis

Symptoms

The signs of cerebral palsy are usually apparent before a child reaches three years of age. It is often parents who first notice that their child is not reaching normal developmental milestones. Early indicators include:
  • Your child is slow learning to roll over
  • Your child is slow learning to sit
  • Your child is slow learning to crawl
  • Your child is slow to begin smiling
  • Your child is slow to begin walking

Children with cerebral palsy may also exhibit abnormal muscle tone. Decreased muscle tone (hypotonia) causes the child to appear limp and relaxed perhaps even floppy. If muscle tone is increased (hypertonia) your child may seem rigid or stiff. In some cases a baby may first exhibit hypotonia which then progresses to become hypertonia after the first two or three months of life.

Contact your family doctor if you are concerned about your child's development -he or she can help to distinguish between normal variations in development and a developmental disorder.

Your physician will examine your child for the symptoms described above including slow development increased/decreased muscle tone and unusual posture. In addition he or she will test your infant's reflexes and look for early signs of hand preference.

Certain reflexes such as the Moro reflex are typical in babies six months of age and younger. However babies with CP maintain this reflex for unusually long periods of time. The Moro reflex is just one reflex that your physician can check.

Your physician will also check to see if your infant tends to use one hand over the other. Infants under one year of age do not generally show a preference for their right or left hand. However infants with spastic hemiplegia (see definition below) may develop a preference at an earlier age because the side of their body that is not affected is stronger and more useful.

Other steps your doctor may take to diagnose cerebral palsy include:

  • Ruling out other disorders which cause movement problems (genetic diseases muscle diseases metabolic disorders and/or tumors in the nervous system)
  • Requesting a CT scan to reveal underdeveloped areas of the brain or other physical problems (such as abnormal cysts)
  • Magnetic resonance imaging (MRI) which provides more detailed pictures than a CT scan of abnormal areas near bone
  • Ultrasonography which although less precise than CT and MRI scans is effective at detecting cysts and abnormal structures in the brain
  • Your physician may also want to check your child for conditions linked to cerebral palsy including vision or hearing problems seizure disorders and mental impairment. It is important to identify conditions that accompany cerebral palsy so that they can be specifically addressed as part of an overall treatment program.

Types of cerebral palsy

Cerebral palsy is classified in four broad movement disorder categories:

- Spastic cerebral palsy - this form of cerebral palsy is characterized by muscles that are permanently tight and stiff. When used they become overactive and result in clumsy and/or blocked movements. The level of spasticity can be mild or severe and it can change over time. Spasticity can be helped by therapy surgery drugs and/or adaptive equipment.

- Athetoid cerebral palsy - uncontrolled slow writhing movements are common characteristics of this form of cerebral palsy. The hands feet arms and/or legs are usually affected by these abnormal movements. In some cases grimacing or drooling occurs if the face and/or tongue muscles are involved. Periods of extreme emotional stress can cause movements to increase. Some people with cerebral palsy also have difficulty coordinating the muscles required to speak (known as dysarthria).

- Ataxic cerebral palsy - balance and depth perception are affected with this rare form of cerebral palsy. People with ataxic cerebral palsy are not steady when they walk and place their feet unusually far apart. Coordination is poor and they find it difficult to perform precise movements such as buttoning a shirt or writing. People with ataxic cerebral palsy may also have intention tremor. It occurs when a voluntary movement (such as reaching for a book) is initiated causing the body part being used to shake and progressively worsen as the individual gets closer to reaching the desired object.

- Combined classifications - Some people have more than one type of cerebral palsy. The most common grouping includes both spasticity and athetoid movements however other combinations are also possible.

Cerebral palsy is also classified by the number of limbs involved:

  • Monoplegia - one limb usually an arm is affected
  • Triplegia - involves three limbs usually both arms and a leg
  • Hemiplegia - one side of the body is affected; the arm is usually more involved than the leg
  • Diplegia - involves all four limbs with both legs more severely affected than the arms
  • Quadriplegia - involves all four limbs

The classifications involving movement disorder and limbs involved are usually combined. So for example a person with spastic cerebral palsy involving all four limbs would be diagnosed as having "spastic quadriplegia".

Treatment

There is no standard therapy that works for all people with cerebral palsy. Instead a customized management program is developed to ensure that the child meets his or her full potential. Doctors therapists educators nurses social workers and/or other professionals may become involved to help the child and their family. Specific treatments may include any/all of the following:

  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Behavioural therapy
  • Drug therapy (to control seizures and muscle spasms)
  • Specialized braces
  • Mechanical aids (may include customized shoes communication devices etc.)
  • Surgery

Generally speaking the earlier treatment begins the better chance a child has of overcoming developmental disabilities or learning new ways to accomplish difficult tasks. As the child matures and becomes an adult additional support services may be required.

It is important to remember that each person with cerebral palsy is affected in a different way. The intensity of this condition varies from person to person as do their associated limitations and abilities. Many people with cerebral palsy go to school have jobs get married raise families and live independent lives.