Saturday, August 13, 2022

What is Cerebral Palsy? Types, Cause, Symptoms, Treatments

Cerebral palsy (CP) is a group of disorders that affect muscle movement and coordination. Learn about Cerebral Palsy types, causes, symptoms, treatments and risk factors.

All people with CP have problems with movement and posture. 

There may be problems with intellectual disability, sensationvisionhearing, and speaking. 

Cerebral palsy affects over 500,000 people in the U.S. There is no cure, but treatments and therapies can make a big difference.

In this detailed article, you’ll also discover how it’s diagnosed and classified, whether it can be prevented, and what the long-term outlook is for people with CP.

What is Cerebral Palsy? Types, Cause, Symptoms, treatment

Cerebral palsy
US Navy 081028-N-3173B-027 Cmdr. John King assesses the reflexes of a Cerebral Palsy patient at the Arima District Health Facility as part of the humanitarian-civic assistance mission Continuing Promise (CP) 2008.jpg
A child with cerebral palsy being assessed by a physician
Specialty
  • Pediatrics
  • Neurology
  • Physiatry
Symptoms
Complications
Usual onset Early childhood
Duration Lifelong
Causes Often unknown
Risk factors
  • Brain damage during infancy
  • Preterm birth
  • Being a twin
  • Certain infections during pregnancy
  • Difficult delivery
Diagnostic method Based on child’s development
Treatment
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Conductive education
  • External braces
  • Orthopedic surgery
Medication
Frequency 2.1 per 1,000[source]

What is Cerebral Palsy?

Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. CP is the most common motor disability in childhood.

Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles. CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles.

Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children of their age. 

Other symptoms include seizures and problems with thinking or reasoning, which each occur in about one-third of people with CP. While symptoms may get more noticeable over the first few years of life, underlying problems do not worsen over time.

Cerebral palsy is the most common movement disorder in children. It occurs in about 2.1 per 1,000 live births. Cerebral palsy has been documented throughout history, with the first known descriptions occurring in the work of Hippocrates in the 5th century BCE.

Extensive study of the condition began in the 19th century by William John Little, after whom spastic diplegia was called “Little’s disease”. William Osler first named it “cerebral palsy” from the German zerebrale Kinderlähmung (cerebral child-paralysis). 

A number of potential treatments are being examined, including stem cell therapy. However, more research is required to determine if it is effective and safe.

Types of Cerebral Palsy

Doctors classify CP according to the main type of movement disorder involved. Depending on which areas of the brain are affected, one or more of the following movement disorders can occur:

  • Stiff muscles (spasticity)
  • Uncontrollable movements (dyskinesia)
  • Poor balance and coordination (ataxia)

Cerebral Palsy Types

There are four main types of CP:

Spastic Cerebral Palsy

The most common type of CP is spastic CP. Spastic CP affects about 80% of people with CP.

People with spastic CP have increased muscle tone. This means their muscles are stiff and, as a result, their movements can be awkward. Spastic CP usually is described by what parts of the body are affected:

  • Spastic diplegia/diparesis―In this type of CP, muscle stiffness is mainly in the legs, with the arms less affected or not affected at all. People with spastic diplegia might have difficulty walking because tight hip and leg muscles cause their legs to pull together, turn inward, and cross at the knees (also known as scissoring).
  • Spastic hemiplegia/hemiparesis―This type of CP affects only one side of a person’s body; usually the arm is more affected than the leg.
  • Spastic quadriplegia/quadriparesis―Spastic quadriplegia is the most severe form of spastic CP and affects all four limbs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.

Dyskinetic Cerebral Palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies)

People with dyskinetic CP have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk. The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected and the person has a hard time sucking, swallowing, and talking. A person with dyskinetic CP has muscle tone that can change (varying from too tight to too loose) not only from day to day, but even during a single day.

Ataxic Cerebral Palsy

People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something.

Mixed Cerebral Palsy

Some people have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.

Cerebral Palsy Causes and Risk Factors

CP is caused by abnormal development of the brain or damage to the developing brain that affects a child’s ability to control his or her muscles. There are several possible causes of the abnormal development or damage.

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People used to think that CP was mainly caused by lack of oxygen during the birth process. Now, scientists think that this causes only a small number of CP cases.

The abnormal development of the brain or damage that leads to CP can happen before birth, during birth, within a month after birth, or during the first years of a child’s life, while the brain is still developing.

CP related to abnormal development of the brain or damage that occurred before or during birth is called congenital CP. The majority of CP (85%–90%) is congenital. In many cases, the specific cause is not known.

A small percentage of CP is caused by abnormal development of the brain or damage that occurs more than 28 days after birth. This is called acquired CP, and usually is associated with an infection (such as meningitis) or head injury.

Preterm birth

Between 40% and 50% of all children who develop cerebral palsy were born prematurely. Most of these cases (75-90%) are believed due to issues that occur around the time of birth, often just after birth. 

Multiple-birth infants are also more likely than single-birth infants to have CP. They are also more likely to be born with a low birth weight.

Term infants

In babies that are born at term risk factors include problems with the placenta, birth defects, low birth weight, breathing meconium into the lungs, a delivery requiring either the use of instruments or an emergency Caesarean section, birth asphyxia, seizures just after birth, respiratory distress syndrome, low blood sugar, and infections in the baby.

Cerebral Palsy Autosomal recessive
Autosomal recessive inheritance pattern.

Genetics

About 2% of all CP cases are expected to be inherited, with glutamate decarboxylase-1 being one of the possible enzymes involved. Most inherited cases are autosomal recessive.

There is a small percentage of CP cases caused by brain damages that stemmed from the prenatal period, which is estimated to be less than 5% of CP cases overall. Due to that fact CP is not commonly considered a genetic disease. Moreover, there is no one reason why some CP cases come from prenatal brain damages and it’s not known if are those cases have to occur per the genetic issues.

Early childhood

After birth, other causes include toxins, severe jaundice, lead poisoning, physical brain injury, stroke, abusive head trauma, incidents involving hypoxia to the brain (such as near drowning), and encephalitis  or meningitis.

Others

Infections in the mother, even those not easily detected, can triple the risk of the child developing cerebral palsy. Infections of the fetal membranes known as chorioamnionitis increases the risk.

Intrauterine and neonatal insults (many of which are infectious) increase the risk.

Rh blood type incompatibility can cause the mother’s immune system to attack the baby’s red blood cells.

Malnourishment can cause cerebral palsy, such as feeding a baby a vegan diet with an inadequate level of protein.

It has been hypothesised that some cases of cerebral palsy are caused by the death in very early pregnancy of an identical twin.

Cerebral Palsy Symptoms Early Signs

The signs of CP vary greatly because there are many different types and levels of disability. The main sign that a child might have CP is a delay reaching motor or movement milestones (such as rolling over, sitting, standing, or walking). Following are some other signs of possible CP. It is important to note that some children without CP also might have some of these signs.

In a Baby Younger Than 6 Months of Age

  • His head lags when you pick him up while he’s lying on his back
  • He feels stiff
  • He feels floppy
  • When held cradled in your arms, he seems to overextend his back and neck, constantly acting as if he is pushing away from you
  • When you pick him up, his legs get stiff and they cross or scissor

In a Baby Older Than 6 Months of Age

  • She doesn’t roll over in either direction
  • She cannot bring her hands together
  • She has difficulty bringing her hands to her mouth
  • She reaches out with only one hand while keeping the other fisted

In a Baby Older Than 10 Months of Age

  • He crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg
  • He scoots around on his buttocks or hops on his knees, but does not crawl on all fours

Skeleton

For bones to attain their normal shape and size, they require the stresses from normal musculature. People with cerebral palsy are at risk of low bone mineral density.

The shafts of the bones are often thin (gracile), and become thinner during growth. When compared to these thin shafts (diaphyses), the centres (metaphyses) often appear quite enlarged (ballooning).

Growth spurts during puberty can make walking more difficult for people with CP.

Eating

Due to sensory and motor impairments, those with CP may have difficulty preparing food, holding utensils, or chewing and swallowing. An infant with CP may not be able to suck, swallow or chew. Gastro-oesophageal reflux is common in children with CP. Children with CP may have too little or too much sensitivity around and in the mouth.

Children with severe cerebral palsy, particularly with oropharyngeal issues, are at risk of undernutrition. Triceps skin fold tests have been found to be a very reliable indicator of malnutrition in children with cerebral palsy.

Language

Speech and language disorders are common in people with cerebral palsy. The incidence of dysarthria is estimated to range from 31% to 88%, and around a quarter of people with CP are non-verbal.

Speech problems are associated with poor respiratory  control,  laryngeal and velopharyngeal dysfunction, and oral articulation disorders that are due to restricted movement in the oral-facial muscles.

Pain and sleep

Pain is common and may result from the inherent deficits associated with the condition, along with the numerous procedures children typically face. When children with cerebral palsy are in pain, they experience worse muscle spasms. 

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Pain is associated with tight or shortened muscles, abnormal posture, stiff joints, unsuitable orthosis, etc. Hip migration or dislocation is a recognizable source of pain in CP children and especially in the adolescent population.

Nevertheless, the adequate scoring and scaling of pain in CP children remains challenging. Pain in CP has a number of different causes, and different pains respond to different treatments.

Associated disorders

Associated disorders include intellectual disabilities, seizures, muscle contractures, abnormal gait, osteoporosis, communication disorders, malnutrition, sleep disorders, and mental health disorders, such as depression and anxiety. 

In addition to these, functional gastrointestinal abnormalities contributing to bowel obstruction, vomiting, and constipation may also arise. Adults with cerebral palsy may have ischemic heart diseasecerebrovascular disease, cancer, and trauma more often.

Cerebral Palsy – Screening and Diagnosis

Diagnosing CP at an early age is important to the well-being of children and their families. Diagnosing CP can take several steps:

Developmental Monitoring

Developmental monitoring (also called surveillance) means tracking a child’s growth and development over time. If any concerns about the child’s development are raised during monitoring, then a developmental screening test should be given as soon as possible.

Developmental Screening

During developmental screening a short test is given to see if the child has specific developmental delays, such as motor or movement delays. If the results of the screening test are cause for concern, then the doctor will make referrals for developmental and medical evaluations.

Developmental and Medical Evaluations

The goal of a developmental evaluation is to diagnose the specific type of disorder that affects a child.

Your doctor might also order a series of tests to make a diagnosis and rule out other possible causes.

Brain scans

Brain-imaging technologies can reveal areas of damage or abnormal development in the brain. These tests might include the following:

  • MRI. An MRI uses radio waves and a magnetic field to produce detailed 3D or cross-sectional images of the brain. An MRI can often identify lesions or abnormalities in your child’s brain. This test is painless, but it’s noisy and can take up to an hour to complete. Your child will likely receive a sedative or light general anesthesia beforehand.
  • Cranial ultrasound. This can be performed during infancy. A cranial ultrasound uses high-frequency sound waves to produce images of the brain. An ultrasound doesn’t produce a detailed image, but it may be used because it’s quick and it can provide a valuable preliminary assessment of the brain.

Electroencephalogram (EEG)

If your child is suspected of having seizures, an EEG can evaluate the condition further. Seizures can develop in a child with epilepsy. In an EEG test, a series of electrodes are attached to your child’s scalp. The EEG records the electrical activity of your child’s brain. It’s common for there to be changes in normal brain wave patterns in epilepsy.

Laboratory tests

Tests of the blood, urine or skin might be used to screen for genetic or metabolic problems.

Additional tests

If your child is diagnosed with cerebral palsy, you’ll likely be referred to specialists to test your child for other conditions often associated with the disorder. These tests can identify problems with:

  • Vision
  • Hearing
  • Speech
  • Intellect
  • Development
  • Movement
  • Other medical conditions

The type of cerebral palsy is determined by the main movement disorder experienced, but several movement disorders can occur together. The most common type of cerebral palsy is spastic cerebral palsy, which includes stiff muscles and exaggerated reflexes. Other types of cerebral palsy include movement disorders involving poor balance and coordination (ataxic) and difficulty controlling voluntary muscles (dyskinetic).

After making the diagnosis of cerebral palsy, your doctor may use a rating scale tool, such as the Gross Motor Function Classification System, to determine function and severity of mobility, posture and balance. This information can help in selecting treatments.

Cerebral Palsy Treatment

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.

Treatments and Intervention Services

There is no cure for CP, but treatment can improve the lives of those who have the condition. It is important to begin a treatment program as early as possible.

After a CP diagnosis is made, a team of health professionals works with the child and family to develop a plan to help the child reach his or her full potential. Common treatments include medicines; surgery; braces; and physical, occupational, and speech therapy. No single treatment is the best one for all children with CP. Before deciding on a treatment plan, it is important to talk with the child’s doctor to understand all the risks and benefits.

Visit the NINDS Cerebral Palsy Information Page to learn more about treatments for CP external icon

Intervention Services

Both early intervention and school-aged services are available through our nation’s special education law—the Individuals with Disabilities Education Act (IDEA). Part C of IDEA deals with early intervention services (birth through 36 months of age), while Part B applies to services for school-aged children (3 through 21 years of age). Even if your child has not been diagnosed with CP, he or she may be eligible for IDEA services.

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Learn more about IDEA Services

What’s the long-term outlook for people with cerebral palsy?

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.(source)

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

9 Famous People With Cerebral Palsy

Cerebral palsy is a group of disorders that affect a person’s ability to move and maintain balance and posture, but that hasn’t kept these nine people from achieving great things.(source)

  1. Josh Blue, Comedian
  2. Abbey Nicole Curran, Pageant Winner and Founder
  3. Dan Keplinger, Artist and Speaker
  4. Geri Jewell, Comedian, Actress, Author, and Speaker
  5. Christy Brown, Painter, Poet, and Author
  6. RJ Mitte, Actor, Producer, Model, and Activist
  7. Bonner Paddock, Athlete and Advocate
  8. Jhamak Ghimire, Writer
  9. Maysoon Zayid, Comedian and Activist

If You’re Concerned

If you think your child is not meeting movement milestones or might have CP, contact your doctor or nurse and share your concerns.

If you or your doctor is still concerned, ask for a referral to a specialist who can do a more in-depth evaluation of your child and assist in making a diagnosis.

At the same time, call your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

  • If your child is not yet 3 years old, contact your local early intervention system.
    You can find the right contact information for your state by calling the Early Childhood Technical Assistance Center (ECTA) at 919-962-2001 or visit the Early Childhood Technical Assistance Centerexternal icon.
  • If your child is 3 years of age or older, contact your local public school system.
    Even if your child is not yet old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.
    If you’re not sure who to contact, you can call the Early Childhood Technical Assistance Center (ECTA) at 919-962-2001 or visit the Early Childhood Technical Assistance Centerexternal icon.

References

American Academy of Pediatrics. Caring for your baby and young child: Birth to age five. 5th ed. Shelov SP, editor. Elk Grove Village (IL): Bantam Books; 2009.

American Academy of Pediatrics Healthy Children / Cerebral Palsy
http://www.healthychildren.org/English/health-issues/conditions/developmental-disabilities/pages/Cerebral-Palsy.aspxexternal icon

American Association on Intellectual and Developmental Disabilities
https://aaidd.org/homeexternal icon

Honeycutt A, Dunlap L, Chen H, Homsi G. Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment: United States, 2003. MMWR Morb mital Wkly Rep. 2004;53(3): 57-59.
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5303a4.htm

Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Pediatrics, July 2006.
http://pediatrics.aappublications.org/content/118/1/405.full.pdf pdf icon[PDF – 930 KB]external icon

March of Dimes. Cerebral Palsy.
http://www.marchofdimes.org/baby/cerebral-palsy.aspxexternal icon

My Child Without Limits
http://www.mychildwithoutlimits.org/?page=homeexternal icon

National Institute of Neurological Disorders and Stroke. Cerebral Palsy: Hope Through Research. NIH Publication Number 10-159, updated 5/6/10.
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Cerebral-Palsy-Hope-Through-Researchexternal icon

Pellegrino, Louis. Cerebral Palsy, in Batshaw ML, Pellegrino L, Roizen NJ (eds.), Children with Disabilities, 6th Edition, Baltimore, MD, Paul H Brookes Publishing Company, 2007, pp 387-408.

UCP
http://www.ucp.org

Cerebral Palsy FAQs

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Can Cerebral Palsy Be Cured?

There is no cure for cerebral palsy, but it will also not get worse with time. This is not a progressive disease, and early therapies and treatments can reduce symptoms and disabilities while also improving mobility.

Can Cerebral Palsy Be Prevented?

There is no foolproof way to prevent CP, but there are steps you can take to lower the risk.

What is the main cause of cerebral palsy?

Cerebral palsy is caused by damage or abnormal development in the parts of the brain that control movement.

Does cerebral palsy affect IQ?

People with Cerebral Palsy have limited mobility or coordination of their arms and or legs. Although permanent, CP is fortunately non-progressive, meaning it does not worsen over time. Cerebral Palsy does not on its own affect a person’s intelligence.

How lon can live someone with cerebral palsy?

Generally, children born with cerebral palsy can expect to live between 30 and 70 years on average.

Does cerebral palsy get worse with age?

Cerebral palsy is not a progressive disease. It does not get worse with age. However, the co-occurring or associated conditions that many people with cerebral palsy have can get worse.

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