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Facts About Cerebral Palsy

Cerebral Palsy Means Brain Weakness

Cerebral palsy (CP) means brain (cerebral) weakness (palsy). CP is caused by either abnormal brain development or damage to the developing brain before, during or after birth. This damage affects a person’s ability to control their muscles. Therefore, CP is a group of disorders that affect a person’s ability to move and maintain balance. In some children, there may be other disabilities as well.

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Symptoms

The symptoms of CP vary. Some people with CP may need special equipment to be able to walk. Others may not be able to walk at all. And still others may need lifelong care.

All people with CP have challenges with movement and posture. Many also have related conditions such as intellectual disability, seizures, vision, hearing or speech problems, and joint or spine issues. CP does not get worse over time, though the symptoms may change over a person’s lifetime.

Types of Cerebral Palsy

Using this as a guide, doctors classify four main types of CP:

Doctors classify CP according to the 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)
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Spastic Cerebral Palsy

The most common type of CP is spastic CP. It affects about 80% of people with CP. People with spastic CP have increased muscle tone so their muscles are stiff and their movements can be awkward. Spastic CP can also be further divided into what parts of the body are affected:

  • One Limb – Spastic monoplegia
    Affects only one limb usually an arm.
  • One Side of Body – Spastic hemiplegia/hemiparesis
    Affects only one side of a person’s body and usually the arm is more affected than the leg.
  • Mainly Legs – Spastic diplegia/diparesis
    Muscle stiffness is mainly in the legs. People with spastic diplegia often have difficulty walking because tight hip and leg muscles cause their legs to turn inward and cross at the knees.
  • Entire Body – Spastic quadriplegia/quadriparesis
    Spastic quadriplegia is the most severe form and affects the arms, legs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities including: intellectual disability, seizures, and issues with vision, speech, or hearing.

Dyskinetic Cerebral Palsy

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. This can make it difficult to sit or walk. The movements are uncontrollable and can be slow or rapid. 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 vary from too tight to too loose.

Ataxic Cerebral Palsy

People with ataxic CP have problems with balance and coordination. They might have a hard time controlling their hands or arms or may be unsteady when they walk.

Mixed Cerebral Palsy

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

Signs of Cerebral Palsy

The signs and symptoms of CP vary greatly because there are many different types and levels of disability. One major sign that a child might have CP is a delay reaching motor or movement milestones. For example, perhaps the child has difficulty rolling over, sitting, standing, or walking. Below are other possible signs of CP. (Please note that some children without CP may also have some of these signs.)

Signs of CP in a Baby Younger Than 6 Months of Age
  • Baby’s head lags when you pick them up.
  • Baby feels stiff.
  • Baby feels floppy.
  • When you pick him/her up, the baby’s legs get stiff and they cross or scissor.
Signs of CP in a Baby Older Than 6 Months of Age
  • Baby doesn’t roll over in either direction.
  • Baby cannot bring her hands together.
  • Baby has difficulty bringing her hands to her mouth.
  • Baby reaches out with only one hand while keeping the other fisted.
Signs of CP in a Baby Older Than 10 Months of Age
  • Baby crawls in a lopsided manner, pushing off with one hand and/or leg while dragging the opposite hand and/or leg
  • Baby scoots around on his buttocks or hops on his knees, but does not crawl on all fours.

Diagnosis of Cerebral Palsy

Diagnosing cerebral palsy (CP) early is important to the health of the child and the family. CP is generally diagnosed during the first or second year after birth. But if a child’s symptoms are mild, diagnosis may not occur until the child is a few years older. To diagnose CP usually involves three steps:

  • Developmental Monitoring
  • Developmental Screening
  • Developmental and Medical Evaluations

Developmental Monitoring

Developmental monitoring (also called developmental surveillance) involves tracking a child’s growth and development. During the office visits with your pediatrician, the doctor will examine the baby, watch to see how they move, and ask parents if they have any concerns about their child’s development. If the physician suspects that the child’s development is not happening as expected, then a developmental screening test will be suggested.

Developmental Screening

A developmental screening is a short test designed to see if the child has any specific developmental delays. Some developmental screening tests are interviews or questionnaires completed by parents. Others are tests that the doctor administers to the child. If the results of the screening test identifies any areas of concern, then the doctor will make referrals for developmental and medical evaluations and early interventions.

Developmental and Medical Evaluations

The goal of a developmental and medical evaluation is to diagnose the specific disability that affects a child. To evaluate movement or motor delays, the doctor will examine the child’s motor skills, muscle tone, posture, reflexes and will rule out other disorders that may cause similar problems. Because many children with CP also have other developmental conditions such as intellectual disability, seizures, and vision, hearing, or speech problems, the doctor will evaluate the child to identify if any of these disorders exist.

The developmental and medical evaluation can be performed by the primary care doctor or by a specialists such as: developmental pediatricians, neurodevelopment pediatricians, child neurologists, pediatric physiatrists, or pediatric rehabilitation doctors.

Clinical tests may also be performed to better understand the cause of a child’s CP. These tests may include: brain imaging tests, such as x-ray computed tomography (CT scan) or magnetic resonance imaging (MRI). An electroencephalogram (EEG), genetic testing, or metabolic testing, or any combination of these, may also be recommended.

Cerebral Palsy Treatments and Early Interventions

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 will work with the child and family to develop a plan to help the child reach their 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. Every child has their own specific needs. Before deciding on a treatment plan, parents should talk with the child’s doctor to understand all the risks and benefits.

Cerebral Palsy Prognosis

Mortality in Cerebral Palsy is extremely variable. Life expectancy is normal in most diplegic and hemiplegic children who receive appropriate medical care and have strong family support. However, some severely affected quadriplegics die of malnutrition, infections or respiratory problems before reaching adolescence. As these inspirational stories demonstrate, many children with CP enjoy full and productive lives.

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