Cerebral palsy, or CP, is a chronic neurological disorder that impairs body movement, coordination, and balance. The condition appears in infancy or early childhood, with most cases diagnosed by the time a child turns three. It is the most common motor disability in childhood, and around 764,000 children and adults are currently living with CP in the U.S.
Cerebral palsy does not always cause impaired cognitive ability. However, as many as 50% of all children living with CP have some level of cognitive impairment requiring additional levels of care.
Cerebral palsy is not life-threatening or contagious. Although there is currently no cure for the disorder, there are many treatments that can improve a patient’s motor capabilities and quality of life. With the exception of severe cases, most children with CP live long lives.
Cerebral Palsy Causes and Risk Factors
Cerebral palsy is caused by a non-progressive brain injury or malformation that occurs while the brain is developing. Most cases of CP result before a child is born, but in some instances, a young child can develop the condition as a result of brain damage from an accident or an infection that inhibits proper blood flow.
Specific Cerebral Palsy Causes
|Genetic mutations: Certain gene mutations can affect brain development and lead to CP|
|Maternal health: Some infections during pregnancy can cause the unborn baby to develop CP. These include measles, chickenpox, herpes, syphilis, and Zika, among others.|
|Fetal or pediatric stroke: If an unborn baby or young child experiences a stroke, this can disrupt blood flow and impact the developing brain.|
|Infection: Some childhood infections can lead to issues in the brain that impact development.|
|Brain injury: Traumatic injury to the head during a fall or car accident can inhibit brain development. Shaken baby syndrome is also responsible for some cases of CP.|
|Lack of oxygen to the brain: If oxygen is cut off (asphyxia) for any prolonged period during labor, a child can develop cerebral palsy. But this is rare, accounting for only about 10% of cases.|
|Premature birth: Premature babies have a higher risk of being diagnosed with cerebral palsy than babies carried to full term. Babies that are twins or triplets are more likely to be born with CP than single birth children.|
Symptoms and Diagnosis of Cerebral Palsy
Symptoms of cerebral palsy vary. At its core, the condition causes physical impairment and difficulty with motor skills. With the exception of severe cases, most children will not show symptoms immediately after birth, meaning CP is usually diagnosed in early childhood. The most obvious sign of CP is issues with developmental milestones, such as sitting up and crawling.
In general, patients with CP can find it difficult to move their arms, legs, or face. Depending on the individual, they may experience issues with one limb, a combination of limbs, or all their limbs. The brain disorder is consistent and will not worsen with age.
Specific symptoms of cerebral palsy include:
- Stiff muscles with exaggerated reflexes (spasticity) or stiff muscles with normal reflexes (rigidity)
- Lack of coordination (ataxia)
- Slow movements (athetosis)
- Delays in motor skill development, like sitting up or crawling
- Favoring one side of the body over the other
- Difficulty walking
- Difficulty with fine motor skills, like picking up objects
- Drooling or difficulty swallowing
- Varying muscle tones, from too stiff to too floppy
If your child shows any symptoms of CP or other developmental issues, it is important to speak to a doctor as soon as possible. An early diagnosis can lead to better treatment and intervention programs that can improve quality of life.
Diagnosing Cerebral Palsy
There is no single test to diagnose cerebral palsy, so confirming the disorder takes time. Most cases are diagnosed between the ages of 18 months and two years. Some doctors and specialists will not make an absolute decision until full the brain is fully developed between the ages of three and five.
Doctors diagnose CP by taking into account the full developmental status of the child, and considering where he or she stands with developmental milestones and average growth charts. The doctor will test various body functions, examining reflexes, muscle tone, coordination, fine and gross motor skills, posture, balance, and oral motor function.
After being assessed by his or her primary pediatrician, the child may be referred to a specialist for further tests. Neurologists can use CT scans and MRIs to analyze the brain and rule out other conditions before determining if the child has CP.
Types of Cerebral Palsy
Doctors will often classify CP by severity level, identified as mild, moderate, or severe. This is determined by the amount of assistance and treatment the patient will need. Doctors also classify cerebral palsy by the symptoms it causes. These types include:
- Spastic: The most common form of the disorder, this type will cause stiffness of muscles and difficulty with mobility.
- Athetoid: Patients who experience athetoid CP show involuntary and sporadic movements.
- Ataxic: This form of CP leads to issues with depth perception and balance.
- Mixed: Some patients experience multiple forms of the disorder, such as a combination of spastic and athetoid CP.
In addition to classifying the condition and its severity, the doctor will determine how CP affects the child’s muscle tone. Hypotonia CP describes patients with low muscle tone and loss of strength, while hypertonia CP describes high muscle tone and rigid limbs.
Treatment for CP varies by type, so these classifications are important for ensuring the child gets the treatment they need.
Treatments for Cerebral Palsy
Cerebral palsy is a chronic condition and cannot be cured. Although there is currently no cure, there are many ways to treat the disorder and improve the patient’s prognosis and quality of life.
Once a child is diagnosed with cerebral palsy, a team of doctors will prepare a treatment plan. Typically, a number of specialists contribute to the care of a CP patient, including a pediatrician, pediatric neurologist, physical therapist, orthopedic surgeon, speech-language therapist, developmental therapist, mental health specialist, and social worker. This is determined on a case by case basis.
Treatments vary based on specific symptoms, but can include a combination of therapies and medications, such as:
Cerebral Palsy Treatments
|Isolated spasticity medication: If spasticity is localized to one area of the body, doctors may recommend Botox injections every three months to treat the muscle.||Occupational therapy: Therapists will identify and provide specialized equipment, such as walkers and canes, to help improve independent mobility.|
|Generalized spasticity medication: In the case that the whole body is impacted by spasticity, doctors may prescribe oral muscle relaxants including diazepam, dantrolene, and baclofen.||Recreational therapy: Many doctors also recommend recreational therapies to improve mobility and give patients an opportunity to engage in fun group activities. These include therapeutic horseback riding, and adapted soccer, tennis, and basketball.|
|Physical therapy: Specific exercise and training can help improve muscle flexibility, mobility, and balance. Certified physical therapists can provide specialized treatments and exercises for the patient to perform at home.||Speech therapy: A common symptom of cerebral palsy is speech-related difficulty. Speech therapists can help improve a child’s ability to speak clearly and communicate with others, while also addressing difficulty with oral muscles.|
|Orthopedic surgery: In more extreme cases, surgery may be necessary to correct positions of joints in the limbs, or to lengthen muscles and tendons that shorten through abnormal contractions. These operations can improve mobility and lessen pain.||Severing nerves: In cases of intense pain, when other therapies have failed, an operation to cut nerves in spastic muscles may be used. While this helps to deal with painful symptoms, it can also create numbness in the area treated.|
Cerebral Palsy Statistics
Cerebral palsy is one of the most common disabilities in children, with about three in every 1,000 children diagnosed with the condition. In the U.S., there are currently around 500,000 children under the age of 18 living with CP. Cerebral palsy is seen more often in boys than in girls, and tends to affect African Americans more than white or Hispanic children.
Spastic CP is the most common type of the disorder, affecting as many as three quarters of all patients. This has been relatively consistent over the past few decades.
Recent studies indicate that over half of all patients with CP are able to walk independently, and another 12% can walk with the use of a mobility device like crutches or a cane. With proper treatment and therapies, cerebral palsy can be effectively managed, so it’s important to speak to a doctor to learn about your options if your child is showing symptoms of CP.