Cerebral Palsy

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 or problems with brain development before birth. Some children with cerebral palsy also have learning, vision, hearing and language disorders. Although the specific brain injury or problem causing cerebral palsy does not worsen, the movement problems 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 low oxygen during labor and delivery once were thought to be common reasons for cerebral palsy, but now researchers believe that problems with labor and delivery cause very few of the cases. Other possible causes include: severe jaundice in newborns, infections in the mother during the pregnancy, genetic problems or other diseases that cause the brain to develop abnormally during pregnancy. Cerebral palsy can also occur after birth, such as when there is an infection of the brain or a head injury.

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 1 to 2 of every 1,000 live births, with the highest risk among premature, low-birth-weight infants (birth weight less than 1,500 grams), and in pregnancies complicated by infection or conditions that cause problems with the blood flow to the uterus or placenta.

Symptoms

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.
• Low muscle tone, or stiff muscles Low muscle tone (hypotonia) may show up as difficultly holding the head up or keeping the trunk of the body steady. The stiff muscles may first appear as "scissoring" of the legs in infancy.

Other symptoms depend on the type of cerebral palsy. They include:

• Spastic cerebral palsy This is the most common type of cerebral palsy (about 50%), 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. The person usually has these symptoms both when awake and asleep.
• Dyskinetic or athetoid cerebral palsy This less-common form (about 20%) 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) or writhing (athetosis) or can involve staying in an abnormal position (dystonia).
• Ataxic cerebral palsy This type of cerebral palsy also is uncommon and usually involves a brain injury in the part of the brain responsible for coordination (called the cerebellum). Characteristic symptoms include wobbling of the trunk, trouble keeping limbs steady and abnormal eye movements.
• 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 (in more than 50% of patients), a misalignment of the eye called strabismus (50%), epilepsy or seizures (30%), and disorders of vision or hearing (20%).

Diagnosis

Your child's doctor will review a detailed medical and developmental history and a history of the pregnancy and delivery, including medications taken by the mother, infections and fetal movement. A detailed family history, including the mother's history of miscarriage and whether relatives had similar conditions, also can help.

Your child's doctor will examine your child and may order vision and hearing tests. Additional tests may be done, such as brain imaging with ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI); a test of 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).

Expected Duration

Cerebral palsy generally is a long-lasting (chronic) condition, but it does not get worse. 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 change into increased muscle tone (hypertonia) in later childhood.

Prevention

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

Treatment

Comprehensive treatment of cerebral palsy requires a team of specialists 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. Some may have surgical procedures, such as tendon releases or bone surgery (especially on hips and spine). Some also need treatment to reduce spasticity, which may include medications taken by mouth, injections into the muscle or surgery. For children with dyskinetic cerebral palsy, medications are sometimes used to help their movement problems.

Some people with severe cerebral palsy are unable to eat and breathe without aspirating (breathing in things that normally should not go into the lungs). These people 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).

When To Call A Professional

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

Prognosis

The outlook for people with cerebral palsy depends on 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. With support and treatment, though, many people with cerebral palsy can live healthy, happy lives.

Additional Info

United Cerebral Palsy

1660 L St. NW

Suite 700

Washington, DC 20036

Phone: 202-776-0406

Toll-Free: 1-800-872-5827

TTY: 202-973-7197

Fax: 202-776-0414

Email: webmaster@ucp.org

http://www.ucpa.org/