What Is It?

Cerebral palsy is the name given to a large group of motor (body movement) disorders that begin early in life and result from brain injuries that are non-progressive (do not worsen over time). Some children with cerebral palsy also have learning, vision, hearing and language disorders. Brain injuries that produce cerebral palsy can happen before, during or after birth. Although the specific brain injury causing cerebral palsy does not worsen, the movement problems produced by the injury can vary over time.

In most cases of cerebral palsy, the exact cause is unknown. Some possibilities include developmental abnormalities of the brain, brain injury to the fetus caused by low oxygen levels (asphyxia) or poor circulation, infection, and trauma. Injury and asphyxia during labor and delivery once were thought to be common reasons for cerebral palsy. However, some current research suggests that cerebral palsy is caused by problems that happen earlier in the pregnancy and then result in a difficult delivery.

There are four basic types of cerebral palsy:

• Spastic — stiff, difficult movement
• Dyskinetic or athetoid — involuntary and uncontrolled movement
• Ataxic — poor coordination and balance
• Mixed — combination of these types

Cerebral palsy is the most common movement disorder of childhood. It occurs in approximately one to two out of every 1,000 live births, with the highest risk among premature, low-birth-weight infants (birth weight less than 1,500 grams) and multiple-gestation pregnancies (twins, triplets, etc.).

Early symptoms of cerebral palsy include:

• Difficulty feeding — Having a hard time with the coordination of sucking and swallowing



• Delays in the appearance of normal motor milestones — Not doing things that would be expected by a certain age. For example, not having good head control by 3 months, rolling over by 4 to 5 months, sitting without support by 6 months, and walking by 12 to 14 months.



• Exaggeration or persistence of primitive reflexes — A reflex is an involuntary response to a stimulus. Newborns have certain protective reflexes that normally disappear as they get older. An example is the Moro reflex, in which the infant extends both arms in response to stimulation or a change in head position. The reflex disappears gradually and should be gone by age 3 months to 5 months.



• Low muscle tone — Having a period of low muscle tone (hypotonia) early in life. This occurs before other problems in muscle tone and movement become apparent.

In addition to these early symptoms, other symptoms can also be seen, according to the particular subtype. Symptoms of specific types of cerebral palsy include:

• Spastic cerebral palsy — This is the most common type of cerebral palsy, in which the affected limbs are spastic, meaning they are stiff and resist being stretched. The arms and legs also have brisk “deep-tendon reflexes” (involuntary muscle contractions in response to a stimulus). For example, when the patellar tendon in the knee is tapped with a small hammer, the lower leg kicks forward strongly. These symptoms usually are present whether the person is awake or asleep.
  
  Spastic cerebral palsy is categorized further according to which limbs are affected. Hemiplegia is the impairment of both the arm and leg on the same side of the body. In quadriplegia, all four limbs are impaired equally. Diplegia is the impairment of all four limbs, with legs affected more than arms. Double or bilateral hemiplegia is the impairment of all four limbs, with arms affected more than legs.



• Dyskinetic or athetoid cerebral palsy — This less-common form of cerebral palsy is characterized by involuntary movements of the face, trunk and limbs that often interfere with speaking and feeding. Symptoms may worsen during times of emotional stress and typically go away during sleep. Movements can be rapid and jerky (chorea), writhing (athetosis) or can involve the maintenance of an abnormal position (dystonia).



• Ataxic cerebral palsy — This type of cerebral palsy also is uncommon and usually involves a brain injury in the the part of the brain responsible for coordination (cerebellum). Characteristic symptoms include wobbling of the trunk (titubation), trouble keeping limbs steady (dysmetria) and abnormal eye movements (nystagmus).



• Mixed — A combination of symptoms from at least two of the above subtypes.

All forms of cerebral palsy can have associated problems, including mental retardation (more than 50 percent of patients), a misalignment of the eye called strabismus (50 percent), epilepsy or seizures (30 percent), and disorders of vision or hearing (20 percent).

A doctor may suspect that your child has cerebral palsy because of a history of difficulties at birth, feeding problems, poor growth, low muscle tone or developmental delays. He or she will review a detailed medical and developmental history, and a history of the pregnancy and delivery, including medications taken by the mother during fetal development, infections and fetal movement. A detailed family history, including the mother’s history of miscarriage and relatives with similar conditions also can help.

Your child’s doctor will perform a thorough physical examination and may order vision and hearing testing. Additional studies may be considered such as brain imaging with ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI), brain activity using electroencephalogram (EEG), or blood or urine tests.

To help make a specific diagnosis and choose an appropriate therapy plan, the doctor may consult with other specialists, such as a neurologist, an orthopedic surgeon, or an ear, nose, and throat doctor (otolaryngologist).

Cerebral palsy generally is a long-lasting (chronic), but not worsening (non-progressive), condition. Some children are affected severely and have lifelong difficulties. Others may have mild symptoms of cerebral palsy as infants, but later develop more normal muscle tone and motor skills. Although these children may continue to have abnormal deep-tendon reflexes, they may not experience significant movement problems in their daily lives.

In some cases, cerebral palsy symptoms change over time. For example, decreased muscle tone (hypotonia) in infancy can evolve into increased muscle tone (hypertonia) in later childhood.

To help prevent cerebral palsy, doctors encourage pregnant women to follow a program of regular prenatal care beginning as early as possible during the pregnancy. However, for most cases of cerebral palsy, the cause is not known. Despite significant improvements in obstetric and neonatal care in recent years, the incidence of cerebral palsy has not decreased. Ultimately, more research into the causes of cerebral palsy is necessary to prevent these disorders.

Comprehensive treatment of cerebral palsy requires a multidisciplinary team approach to help maximize and coordinate movement, minimize discomfort and pain and prevent long-term complications. This team may include a neurologist, an orthopedist, and physical, speech, and occupational therapists. In addition, social workers can provide support to families and help to identify private and community resources. Most children with cerebral palsy benefit from early and regular physical and occupational therapy. Some children need braces and supports to help them stand and walk; surgical procedures, such as tendon releases or bone surgery (especially on hips and spine); and treatments to reduce spasticity.

Spasticity can prevent a child from developing necessary motor skills and it also can be extremely painful. Several medications are available to reduce spasticity, including some given by mouth, through a pump into the spinal fluid or injected directly into the muscle. A difficult surgical procedure involving selected nerves sometimes can relieve spasticity. Treatment of dyskinetic cerebral palsy is intended to decrease the specific abnormal movement and different medications can be tried, depending on the type of movement problems.

Some patients with severe cerebral palsy are unable to eat and breathe without aspirating (breathing in things that normally should not go into the lungs). These patients may need to be fed using a tube inserted through the skin into the stomach (gastrostomy) or may need to breathe through a small surgical opening in the neck (tracheostomy).

Contact your doctor if your child has abnormal muscle tone, muscle weakness, or abnormal body movements, or is not reaching normal developmental milestones at the expected ages.

The prognosis in patients with cerebral palsy varies with the severity of the cerebral palsy. Some children have only mild problems in muscle tone and no problems with daily activities, while others are unable to purposefully move any part of their body. In people with severe cerebral palsy, motor problems often lead to medical complications, including frequent and serious infections, severe breathing problems, feeding intolerance and skin breakdown. These medical complications can lead to frequent hospitalizations and a shortened life expectancy.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.