Cerebral palsy is a group of disorders involving movement, learning, hearing, seeing, and thinking that occur due to problems with brain development.
Spastic paralysis; Paralysis - spastic
Causes, incidence, and risk factors:
Cerebral palsy is caused by injuries or abnormalities of the brain. Most of these problems occur as the baby grows in the womb, but they can happen at any time during the first 2 years of life, while the baby's brain is still developing.
In some people with cerebral palsy, parts of the brain are injured due to low levels of oxygen (hypoxia ) in the area. It is not known why this occurs.
Trauma and low oxygen levels during birth (birth asphyxia) is an uncommon cause of cerebral palsy.
Premature infants have a slightly higher risk of developing cerebral palsy. Cerebral palsy may also occur during early infancy as a result of several conditions, including:
Types of cerebral palsy include:
- Spastic cerebral palsy is the most common type.
- Dyskinetic (athetoid) cerebral palsy involves abnormal movements (twisting, jerking, or other movements).
- Ataxic cerebral palsy involves tremors, unsteady gait , loss of coordination , and abnormal movements.
- Hypotonic cerebral palsy involves floppy muscles, especially at rest, and increased range of motion in the joints.
- Mixed cerebral palsy involves any combination of symptoms.
Injury to the largest part of the brain (cerebrum) can lead to the loss of nerve functions in different areas. Many children with this condition have increased muscle tone (spasticity ). Spasticity may affect:
- One arm or leg
- One side of the body (spastic hemiplegia)
- Both legs (spastic diplegia)
- Both arms and legs (spastic quadriplegia)
Symptoms are usually seen before age 2. In severe cases, they may appear as early as 3 months.
Symptoms may include:
Signs and tests:
A doctor's examination may reveal:
- Abnormal walk (gait), with a tendency to tuck the arms in toward the sides, make "scissors" movements of the legs, and walk on the toes
- Abnormal slow, writhing movements that get worse with stress and don't occur during sleep
- Delayed development of motor skills (reaching, sitting rolling, crawling, walking)
- Infant reflexes (such as sucking and startle) that continue past the age where they usually disappear
- Joint contractures
- Muscle contractions
- Muscles that do not stretch (spasticity)
- Muscle tremors
- Muscle weakness
The following tests may be performed:
There is no cure for cerebral palsy. The goal of treatment is to help the person be as independent as possible.
Treatment requires a team approach, including:
- A primary care doctor
- A social worker
- Occupational, physical, and speech therapists
- Other specialists
Treatment is based on the person's symptoms and the need to prevent complications.
Self and home care include:
- Getting enough food and nutrition
- Keeping the home safe
- Performing exercises recommended by the health care providers
- Practicing proper bowel care (stool softeners, fluids, fiber, laxatives, regular bowel habits)
- Protecting the joints from injury
Putting the child in regular schools is recommended, unless physical disabilities or mental development makes this impossible. Special education or schooling may help.
Many adults are able to live in the community, either independently or with different levels of help. In severe cases, the person will need to be placed in an institution.
The following may help with communication and learning:
- Hearing aids
- Muscle and bone braces
- Walking aids
Physical therapy, occupational therapy, orthopedic help, or other treatments may also be needed.
Medications may include:
- Anticonvulsants to prevent or reduce the frequency of seizures
- Botulinum toxin to help with spasticity and drooling
- Muscle relaxants (baclofen) to reduce tremors and spasticity
Surgery may be needed in some cases to:
- Control gastroesophageal reflux
- Cut certain nerves from the spinal cord to help with pain and spasticity
- Place feeding tubes
- Release joint contractures
Stress and burnout among parents and other caregivers of cerebral palsy patients is common, and should be monitored.
Cerebral palsy is a lifelong disorder. Long-term care may be required. The disorder does not affect expected length of life. The extent of disability varies.
- Bone thinning
- Bowel obstruction
- Hip dislocation and arthritis in the hip joint
- Injuries from falls
- Joint contractures
- Pneumonia caused by choking
- Poor nutrition
- Reduced communication skills (sometimes)
- Reduced intellect (sometimes)
- Seizures (in about half of patients)
- Social stigma
Calling your health care provider:
Call your health care provider if symptoms of cerebral palsy develop, especially if you know that an injury occurred during birth or early infancy.
Getting the proper prenatal care may reduce the risk of some rare causes of cerebral palsy. However, dramatic improvements in care over the last 15 years have not reduced the rate of cerebral palsy. In most cases, the injury causing the disorder may not be preventable.
Pregnant mothers with certain medical conditions may need to be followed in a high-risk prenatal clinic.
Krigger KW. Cerebral palsy: an overview. Am Fam Physician. 2006;73:91-100.
Johnston MV. Encephalopathies. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 598.
Whelan MA. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2004;63:1985-1986.