Cerebral palsy refers to a group of conditions that affect control of movement and posture. Because of damage to areas of the brain that control movement, an affected child cannot move his or her muscles normally. While symptoms range from mild to severe, the condition does not get worse as the child gets older. With treatment, most children can significantly improve their abilities.
Many children with cerebral palsy have other problems that require treatment. These include mental retardation, learning disabilities, seizures, vision, hearing and speech problems.
How common is cerebral palsy?
Cerebral palsy usually is not diagnosed until a child is about 2 to 3 years of age. Approximately 2 to 3 children in 1,000 over the age of three have cerebral palsy. About 500,000 children and adults of all ages in this country have cerebral palsy.
What are the different types of cerebral palsy?
There are three major types of cerebral palsy, and some individuals may have symptoms of more than one type.
Spastic Cerebral Palsy
About 70-80% of affected individuals have spastic cerebral palsy, in which muscles are stiff, making movement difficult. When both legs are affected (spastic diplegia), a child may have difficulty walking because tight muscles in the hips and legs cause legs to turn inward and cross at the knees (called scissoring).
In other cases, only one side of the body is affected (spastic hemiplegia), often with the arm more severely affected than the leg.
Most severe is spastic quadriplegia, in which all four limbs and the trunk are affected, often along with the muscles controlling the mouth and tongue. Children with spastic quadriplegia often have mental retardation and other problems.
Athetoid or Dyskinetic Cerebral Palsy
About 10-20% of affected individuals have the athetoid form of cerebral palsy, which affects the entire body. It is characterized by fluctuations in muscle tone (varying from too tight to too loose), and sometimes is associated with uncontrolled movements, which can be slow and writhing or rapid and jerky.
Children often have trouble learning to control their bodies well enough to sit and walk. Because muscles of the face and tongue can be affected, there can also be difficulties with sucking, swallowing, and speech.
Ataxic Cerebral Palsy
About 5-10% of affected individuals have the ataxic form, which affects balance and coordination. They may walk with an unsteady gait with feet far apart, and have difficulty with motions that require precise coordination, such as writing.
What are the causes of cerebral palsy?
In about 70% of cases, cerebral palsy results from events occurring before birth that can disrupt normal development of the brain.
Contrary to common belief, lack of oxygen reaching the fetus during labor and delivery contributes to only a small minority of cases of cerebral palsy, according to a 2003 report by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP).
A small number of babies also develop brain injuries in the first months or years of life that can result in cerebral palsy. In many cases, the cause of cerebral palsy in a child is unknown.
Some of the known causes of cerebral palsy include:
- Infections during pregnancy – Certain infections in the mother, including rubella (German measles), cytomegalovirus (a usually mild viral infection) and toxoplasmosis (a usually mild parasitic infection) can cause brain damage and result in cerebral palsy. Recent studies suggest that maternal infections involving the placental membranes (chorioamnionitis) may contribute to cerebral palsy in full-term as well as preterm babies (those born before 37 completed weeks of pregnancy). A 2003 study at the University of California at San Francisco found that full-term babies were four times more ly to develop cerebral palsy if they were exposed to chorioamnionitis in the womb. Reproductive/urinary tract infections also may increase the risk of preterm delivery, another risk factor for cerebral palsy.
- Insufficient oxygen reaching the fetus – When the placenta is not functioning properly or it tears away from the wall of the uterus before delivery; the fetus may not receive sufficient oxygen.
- Prematurity – Premature babies who weigh less than 3 1/3 pounds are up to 30 times more ly to develop cerebral palsy than full-term babies. Many of these tiny babies suffer from bleeding in the brain, which can damage delicate brain tissue. They may also develop periventricular leukomalacia, which is destruction of nerves around the fluid-filled cavities (ventricles) in the brain.
- Asphyxia during labor and delivery – Until recently, it was widely believed that asphyxia (lack of oxygen) during a difficult delivery was the cause of most cases of cerebral palsy. The ACOG/AAP report shows that fewer than 10 percent of the types of brain injuries that can result in cerebral palsy are caused by asphyxia.
- Blood Diseases – Rh disease, an incompatibility between the blood of the mother and her fetus, can cause severe jaundice and brain damage, resulting in cerebral palsy. Rh disease usually can be prevented by giving an Rh-negative woman an injection of a blood product called Rh immune globulin around the 28th week of pregnancy and again after the birth of an Rh-positive baby. Blood clotting disorders (thrombophilias) in either mother or baby also may increase the risk.
- Severe jaundice – Jaundice, yellowing of the skin and the whites of the eyes caused by the build-up of a pigment called bilirubin in the blood, occasionally becomes severe. Without treatment, severe jaundice can pose a risk of permanent brain damage resulting in athetoid cerebral palsy.
- Other birth defects – Babies with brain malformations, numerous genetic diseases and other physical birth defects are at increased risk of cerebral palsy.
- Acquired cerebral palsy– About 10 percent of children with cerebral palsy acquires it after birth due to brain injuries that occur during the first two years of life. The most common causes of such injuries are brain infections, such as meningitis, and head injuries.
How is cerebral palsy diagnosed?
Parents may become concerned about their baby’s or toddler’s development if the child is having problems learning to roll over, sit, crawl or walk. Parents always should discuss these concerns with their baby’s pediatrician.
Cerebral palsy is diagnosed mainly by evaluating how a baby or young child moves. The doctor will evaluate the child’s muscle tone, which can make them appear floppy. Others have increased muscle tone, which makes them appear stiff, or variable muscle tone (increased at times and low at other times).
The doctor will check the child’s reflexes and look to see if the baby has developed a preference for using his right or left hand.While most babies do not develop a hand preference (become right- or left-handed) until at least 12 months of age, some babies with cerebral palsy do so before six months of age. Another important sign of cerebral palsy is the persistence of certain reflexes, called primitive reflexes, which are normal in younger infants, but generally disappear by 6 to 12 months of age.
The doctor also will take a careful medical history, and attempt to rule out any other disorders that could be causing the symptoms.
Health care providers may also suggest brain imaging tests such as magnetic resonance imaging (MRI), computed tomography (CT scan) or ultrasound. These tests sometimes can help identify the cause of cerebral palsy.
Ultrasound often is recommended in preterm babies who are considered at risk of cerebral palsy to help diagnose brain abnormalities that are frequently associated with cerebral palsy (allowing therapy to begin early).
In some children with cerebral palsy, especially those who are mildly affected, brain imaging tests show no abnormalities, suggesting that microscopically small areas of brain damage can cause symptoms. About half of babies who are diagnosed with mild cerebral palsy appear to outgrow their symptoms.
How is cerebral palsy treated?
A team of health care professionals works with the child and family to identify the child’s needs and create an individualized treatment plan to help the child reach his or her maximum potential.
The team is generally coordinated by one health care professional and may include pediatricians, physical medicine and rehabilitation physicians, orthopedic surgeons, physical and occupational therapists, ophthalmologists, speech/language pathologists, social workers and psychologists.
The child usually will begin physical therapy soon after diagnosis. Therapy enhances motor skills (such as sitting and walking), improves muscle strength and helps prevent contractures (shortening of muscles that limit joint movement).Sometimes braces, splints or casts are used along with physical therapy to help prevent contractures and to improve function of the hands or legs. If contractures are severe, surgery may be recommended to lengthen affected muscles.
Drugs sometimes are recommended to ease spasticity or to reduce abnormal movement. Unfortunately, oral drug treatment is often not very helpful. Sometimes injection of drugs such as Botox (botulinum toxin) directly into spastic muscles is helpful, and the effects may last several months (allowing for more effective physical therapy during that time).
A new type of drug treatment is showing promise in children with moderate to severe spasticity. During a surgical procedure, a pump is implanted under the skin that continuously delivers the anti-spasmodic drug baclofen.
For some children with spasticity affecting both legs, a surgical technique called selective dorsal rhizotomy may permanently reduce spasticity and improve the ability to sit, stand and walk. In this procedure, doctors identify and cut some of the nerve fibers that are contributing most to spasticity.
This procedure usually is done when a child is between 2 and 7 years of age. According to UCP, this procedure is usually recommended only for children with severe leg spasticity who have not responded well to other treatments.
Occupational therapists work with the child on skills required for daily living, including feeding and dressing.
Children with speech problems work with a speech therapist or, in more severe cases, learn to use a computerized voice synthesizer that can speak for them.Computers have become an important tool for children and adults with cerebral palsy in terms of therapy, education, recreation and employment.
Some children with cerebral palsy may benefit from the many mechanical aids available today, including walkers, positioning devices (to allow a child with abnormal posture to stand correctly), customized wheelchairs, specially adapted scooters and tricycles.
Can cerebral palsy be prevented?
In many cases, the cause of cerebral palsy is not known, so there is nothing that can be done to prevent it. In spite of improvements in the care of pregnant women and sick babies, the number of babies with cerebral palsy seems to be increasing. This is due, in part, to the survival of an increasing number of very premature babies, who are at high risk of cerebral palsy.
However, some causes of cerebral palsy have been identified, and cases of cerebral palsy that result from them often can be prevented.
Rh disease and congenital rubella syndrome used to be important causes of cerebral palsy. Now Rh disease usually can be prevented when an Rh-negative pregnant woman receives appropriate care.
Women can be tested for immunity to rubella before pregnancy and be vaccinated if they are not immune.
Babies with severe jaundice can be treated with special lights (phototherapy).
Head injuries in babies, a significant cause of cerebral palsy in the early months of life, often can be prevented when babies ride in car seats properly positioned in the back seat of the car.
Routine vaccination of babies (with the Hib vaccine) prevents many cases of meningitis, another cause of brain damage in the early months.
A woman can help reduce her risk of preterm delivery when she seeks early monitoring (ideally starting with a pre-pregnancy visit) and regular prenatal care and avoids cigarettes, alcohol and illicit drugs.
Where is more information available?
Additional information is available from:
United Cerebral Palsy1660 L Street, N.W., Suite 700Washington, DC 20036-5602Phone: (800) 872-5827Last Updated: 07/2015
Symptoms, Diagnosis, Causes, and Treatment
Discovering that your child has cerebral palsy is life-changing. It may feel a devastating blow, but there is hope. Learn more about this condition for practical solutions for your child and to find out that children with this condition can live long, healthy, and satisfying lives.
As you become more educated about cerebral palsy and discover the many treatment and therapy options, it will become clear that there is hope for your child. Even with permanent disabilities, it is possible to live fully.
What is Cerebral Palsy?
Cerebral palsy (CP) is the most common motor and movement disability of childhood. It is a neurological condition with brain damage as the underlying cause. The damage may occur while the baby is still in utero, during labor and delivery, or shortly after birth.
As an umbrella term, cerebral palsy actually refers to a group of symptoms and disorders. There are many possible symptoms, types of disabilities, and complications under the umbrella. They are all related but each child will have a unique and individual experience of cerebral palsy.
The condition affects over 500,000 people in the U.S. There is no cure, but treatments and therapies can make a big difference.
Cerebral palsy can trigger or contribute to other medical conditions as well:
- Speech problems
- Learning disabilities
- Cognitive impairments
- Problems with hearing and vision
- Emotional and behavioral challenges
- Spinal deformities
- Joint problems
Types of Cerebral Palsy
There are a four types of cerebral palsy:
Spastic Cerebral Palsy
Spastic cerebral palsy accounts for 75 percent of all people with CP. It causes increased muscle tone, known as spasticity.
Typical symptoms include:
- Delayed developmental milestones for moving.
- Abnormal movements.
- Movement inhibition.
- Stiff and spastic muscles.
- Difficulties controlling muscle movement.
- Difficulties moving from one position to another.
Spastic quadriplegia impacts a child’s upper and lower limbs and body, severely restricting mobility. Many children also have seizures, have difficulty with hearing and speech, as well as associated learning disabilities.
Spastic diplegia only affects the lower half of the body. Many of these children can still walk with some impairments. These children often need assistive devices for mobility. Other symptoms include delayed milestones, fatigue, seizures, “flexed knees,” and a crouched gait.
Spastic hemiplegia affects one side of the body only, usually the arm more than the leg. A child can adapt, and most are able to walk.Dyskinetic Cerebral Palsy
Dyskinetic cerebral palsy (also known as dystonic and athetoid) is the second most common type of CP. Symptoms include:
- Dystonia – repetitive, twisting motions.
- Athetosis – writhing movements.
- Chorea – unpredictable movements.
- Poor posture.
- Painful movements.
- Difficulty swallowing or talking.
Ataxic Cerebral Palsy
Ataxic cerebral palsy is least common. It causes poor balance, limited coordination, tremors, and shaky movements that are difficult to control.
Mixed Cerebral Palsy
Mixed cerebral palsy causes symptoms characteristic of two or three of the other types. Spastic-dyskinetic cerebral palsy is the most common type of mixed CP.
What If I Notice Symptoms of Cerebral Palsy in My Child?
Consult your child’s pediatrician if you notice unusual symptoms. Even if you aren’t sure they are caused by cerebral palsy, take your concerns about a child’s symptoms or development to a pediatrician. Early intervention is critical when helping children with cerebral palsy.
What Causes Cerebral Palsy?
Brain damage is the cause of CP, but there are many underlying causes of brain damage. The exact cause of cerebral palsy brain damage can’t always be determined. Possible causes are:
- Poor brain development in the womb.
- Maternal infections or medical conditions.
- Disruption of blood flow to the developing brain.
- Genetic conditions.
- Ingestion of toxins or drugs during pregnancy.
A difficult childbirth or a mistake made by a medical professional during delivery may cause brain damage. Premature babies are at greater risk because of complications.
Can Medical Negligence Cause Cerebral Palsy?
Yes, medical negligence can cause brain damage during pregnancy or childbirth. Mistakes that deprive a baby of oxygen during birth, for instance, can lead to damage that causes cerebral palsy. Improper use of medical tools can also cause physical damage to a baby’s brain.
A doctor may also be at fault for failing to act. A delayed decision to perform a Cesarean section for instance, could lead to damage. Not appropriately monitoring the health of the fetus, or failing to detect and treat infections or medical conditions of a woman during pregnancy can also be negligent.
Will My Child Be Intellectually Impaired?
Cerebral palsy does not necessarily cause intellectual impairment. In fact, most children with CP have average or above average intelligence. Many adults living with cerebral palsy are doctors, attorneys, teachers, and other professions. Some children, however, will develop a cognitive impairment due to the brain injury.
How is Cerebral Palsy Diagnosed?
When mild, cerebral palsy may not be diagnosed until a child is walking and talking. Your pediatrician can make a diagnosis or recommend a specialist if you suspect your child has any issues with motor development, muscle tone, or coordination and balance.
If there are factors that put your child at risk for CP, such as birth complications, you may get a diagnosis in the first few months of life. With known risk factors, parents and doctors should closely monitor for early signs of CP.
When diagnosing cerebral palsy, doctors look for spastic movements, abnormal muscle movements, delayed development, and poor coordination.
No single, easy test for cerebral palsy exists. It takes time and multiple tests and observations to get an accurate diagnosis and to rule out other conditions.
Can Cerebral Palsy Be Prevented?
In many cases there is no way cerebral palsy can be prevented. But there are always steps you can take to help lower your risk of having a baby born with the brain damage that can cause it:
- Before pregnancy, eat well and have any pre-existing medical problems under control.
- While pregnant, continue with these healthy habits and take recommended pre-natal vitamins.
- See your obstetrician for regular checkups throughout pregnancy.
- Get screened for potential complications.
Unfortunately, there is no easy way to predict when an infant will suffer brain damage due to negligence. The best you can do is choose your doctors carefully and advocate for your own healthcare and that of your child. If you have an infant or toddler at home, baby proof rooms to prevent falls or accidents that can lead to brain injury.
What Are the Treatment Options for Cerebral Palsy?
Currently, there is no cure for cerebral palsy, but it will also not get worse with time. A variety of treatment options can improve symptoms and quality of life for babies and children. Many interventions can be started immediately after a diagnosis is given.
Medications help control spastic movements, seizures, and relieve pain. Some of the drugs used for cerebral palsy symptoms are:
- Baclofen or other muscle relaxants
- Stool softeners/laxatives
- Sleep aids
Surgery is a critical part of treatment for many children with CP. Surgical procedures may improve mobility or manage pain. Common procedures include tendon or muscle release, the repair of hip dislocations, and scoliosis surgery.
Therapy helps children and babies with cerebral palsy in a variety of ways. Therapy can improve physical, mental, social, and learning deficits. If started early, therapies for cerebral palsy can reduce impairment and lessen the risk of developing other associated conditions.
Common types of therapy used to help children with cerebral palsy are:
- Horse and animal
- Bowel program
Is Cerebral Palsy Fatal?
Many children diagnosed with cerebral palsy have the same life expectancy as other kids. Life expectancy was once shorter, but better detection and therapies have improved many health conditions for these children.
While CP does not shorten life expectancy, it does generally require early intervention and good medical care for the best outcomes. This is especially true for those with severe forms of the disorder.
Some of the conditions associated with cerebral palsy can be life-threatening if not treated. These include breathing and swallowing difficulties (which can cause pneumonia or malnutrition), seizures, chronic nutritional deficiencies, or life-threatening pressure infections.
What Conditions are Associated with Cerebral Palsy?
A number of conditions are associated with cerebral palsy. Many kids with CP have at least one co-existing condition:
- Hearing deficits
- Vision impairment
- Cognitive disability
- Behavioral, emotional issues
- Feeding problems and nutritional deficiencies
- Gastric reflux
- Joint problems
- Sleep disorders
What is the Prognosis for Cerebral Palsy?
The prognosis for cerebral palsy depends on individual factors, but except in severe cases it is possible for most to have a normal life. Many children with cerebral palsy have average or above average intelligence and are mobile with or without assistance.
Most kids can go to school with their peers. They may need adaptive equipment to assist with communication, hearing or vision, or for physical needs and mobility.Some children have mild CP, and aside from muscle spasms and tightness, may be able to participate in school and other activities to the same degree as any other child.
Children with more severe forms of cerebral palsy may have multiple associated conditions. These conditions are typically what cause ongoing medical problems that can affect quality of life and longevity.
What Do I Do If I Can’t Afford My Child’s Care?
The care required for a child with special needs can be costly. According to the Morbidity and Mortality Weekly Report (MMWR), the average cost is $921,000. This doesn’t include out-of-pocket expenses or lost wages. If you find yourself struggling, there are several options to try.
Kids with motor dysfunctions may qualify for cash assistance from the government. This falls under section 111.000 of the Social Security disability insurance program. Those approved for cash assistance from the Social Security Administration (SSA) usually also qualify for full medical insurance at little to no charge.
You may also qualify for free or reduced child care under the Americans With Disabilities Act (ADA) or educational assistance under The Individuals with Disabilities Act of 2004.
If your child’s cerebral palsy was caused by medical negligence, you have the option to file for compensation from the responsible party through legal action.
How Do I Know if My Child’s Disorder Was Caused by Medical Negligence?
Medical negligence occurs when a doctor or another healthcare professional causes preventable harm to a patient by failing to provide an accepted standard of care. Incidents in which negligence may have caused CP include but are not limited to:
- A doctor failing to diagnose a maternal condition that led to brain injuries.
- A doctor, nurse, or other healthcare professional failing to monitor and treat maternal or fetal distress.
- Improper use of tools to assist in the birthing process.
- The doctor failing to schedule emergency C-section when indicated by fetal distress.
- A doctor failing to detect and treat infant hypoxia, jaundice or infection, leading to brain damage.
Malpractice cases are complicated. There has to be enough evidence just to start a case. Specific guidelines set by state laws have to be met first.
Additionally, you’ll need to demonstrate that injuries did indeed come from the negligence of a healthcare provider. But, if the case is valid, a successful lawsuit can help you take care of your child for life.
What is the United Cerebral Palsy?
United Cerebral Palsy (UCP) is a non-profit organization that helps people with cerebral palsy. Assistance from UCP comes from over 80 national affiliates and includes help with transportation, housing, recreational activities, traveling, health awareness, assistive technologies, advocacy in education, and more.
According to the official UCP site, “UCP educates, advocates and provides support services to ensure a life without limits for people with a spectrum of disabilities. UCP works to advance the independence, productivity and full citizenship of people with disabilities through an affiliate network that has helped millions.”
Is There a Cure For Cerebral Palsy?
No, cerebral palsy cannot be cured, but it is also not progressive. Scientists and researchers are conducting ongoing studies to try to find a cure and better ways to prevent CP. Promising studies include those involving stem cells, which may be used to replacing damaged cells with healthy ones in the brain.
While there is no cure, parents can give their child the best possible start with good, early care. It is also important to file a lawsuit to get compensation and to hold a negligent healthcare worker responsible. A successful case will help provide for the costs of a child’s care.
How Is Cerebral Palsy Diagnosed?
Babies who are born early or who have health problems that put them at risk for cerebral palsy are watched for signs of the condition. Doctors look for:
- developmental delays, not reaching for toys by 4 months or sitting up by 7 months
- problems with motor skills, being unable to crawl, walk, or move arms and legs in the usual way
- uncoordinated movements
- muscle tone that is too tight or too lose
- infant reflexes ( the palmar grasp, or “hands in fists” reflex) that stay beyond the age at which they're usually gone
What Problems Does CP Cause?
There is a range of physical and cognitive (the ability to learn and understand) disabilities when it comes to CP. Some kids have a lot of trouble with movement or learning, while others don't.
It depends on how much the brain was damaged. For example, the damage can be partial, affecting only the part of the brain that controls walking.
Or it can affect a larger area, the parts that control walking and talking.
Brain damage that causes CP also can affect other brain functions and lead to problems :
- visual impairment or blindness
- hearing loss
- food aspiration (the sucking of food or fluid into the lungs)
- gastroesophageal reflux (spitting up)
- speech problems and/or drooling
- tooth decay
- sleep disorders
- osteoporosis (weak, brittle bones)
- behavior problems
- learning disabilities
Seizures, speech and communication problems, and learning problems are more common among kids with CP. Many have problems that can need ongoing therapy and assistive devices braces or wheelchairs.
How Is Cerebral Palsy Treated?
There's no cure for cerebral palsy. But resources and therapies can help kids grow and develop to their greatest potential.
As soon as CP is diagnosed, a child can begin therapy for movement and other areas that need help, such as learning, speech, hearing, and social and emotional development.
Medicine helps kids who have a lot of muscle pain and stiffness. They can take medicine by mouth or get it through a pump (the baclofen pump) placed under the skin.Surgery can help fix dislocated hips and scoliosis (curved spine), which are common in kids with CP. Leg braces help with walking.
Kids can improve their bone health by eating diets high in calcium, vitamin D, and phosphorus. These nutrients help keep bones strong. Doctors, dietitians, and speech-language therapists can work with families to make sure kids get enough of the right nutrients and suggest changes to their diets or mealtime routines, if needed.
What Else Should I Know?
Kids with CP often need to see many different medical specialists for care. That team may include doctors and surgeons, nurses, therapists, psychologists, educators, and social workers.
Even if many medical specialists are needed, it's still important to have a primary care doctor or a CP specialist. This doctor will take care of your child's routine health care and also help you coordinate care with other doctors.
Where Can Caregivers Get Help?
Taking care of a child with cerebral palsy can feel overwhelming at times. Not only do kids with CP need a lot of attention at home, they also need to go to many medical appointments and therapies. Don't be afraid to say yes when someone asks, “Can I help?” Your family and friends really do want to be there for you.
To feel less alone and to connect with others who are facing the same challenges, find a local or online support group. You also can get information and support from CP organizations, such as:
- Cerebral Palsy Foundation
- United Cerebral Palsy
Staying strong and healthy is not only good for you, but also for your child and your whole family.
Living with cerebral palsy is different for every child. To help your child move and learn as much as possible, work closely with your care team to develop a treatment plan. Then, as your child grows and his or her needs change, adjust the plan as necessary.
These guides can help as you plan for each stage of childhood and early adulthood:
Cerebral Palsy: Symptoms, Causes, Types, and Treatments
Cerebral palsy (CP) refers to a group of disorders that affect muscle movement and coordination. In many cases, vision, hearing, and sensation are also affected.
The word “cerebral” means having to do with the brain. The word “palsy” means weakness or problems with body movement.
CP is the most common cause of motor disabilities in childhood. According to the Centers for Disease Control and Prevention (CDC), it affects at least 1.5 to 4 every 1,000 children worldwide.
The symptoms of CP vary from person-to-person and range from mild to severe. Some people with CP may have difficulty walking and sitting. Other people with CP can have trouble grasping objects.
The symptoms can become more severe or less severe over time. They also vary depending on the part of the brain that was affected.
Some of the more common signs include:
- delays in reaching motor skill milestones, such as rolling over, sitting up alone, or crawling
- variations in muscle tone, such as being too floppy or too stiff
- delays in speech development and difficulty speaking
- spasticity, or stiff muscles and exaggerated reflexes
- ataxia, or a lack of muscle coordination
- tremors or involuntary movements
- excessive drooling and problems with swallowing
- difficulty walking
- favoring one side of the body, such as reaching with one hand
- neurological problems, such as seizures, intellectual disabilities, and blindness
Most children are born with CP, but they may not show signs of a disorder until months or years later. Symptoms usually appear before a child reaches age 3 or 4.
Call your doctor if you suspect your child has CP. Early diagnosis and treatment are very important.
Abnormal brain development or injury to the developing brain can cause CP. The damage affects the part of the brain that controls body movement, coordination, and posture.
The brain damage usually occurs before birth, but it can also happen during birth or the first years of life. In most cases, the exact cause of CP isn’t known. Some of the possible causes include:
There are different types of CP that affect various parts of the brain. Each type causes specific movement disorders. The types of CP are:
Spastic cerebral palsy
Spastic CP is the most common type of CP, affecting approximately 80 percent of people with CP. It causes stiff muscles and exaggerated reflexes, making it difficult to walk.
Many people with spastic CP have walking abnormalities, such as crossing their knees or making scissor movements with their legs while walking. Muscle weakness and paralysis may also be present.
The symptoms can affect the entire body or just one side of the body.
Dyskinetic cerebral palsy
People with dyskinetic CP have trouble controlling their body movements. The disorder causes involuntary, abnormal movements in the arms, legs, and hands.
In some cases, the face and tongue are also affected. The movements can be slow and writhing or rapid and jerky. They can make it difficult for the affected person to walk, sit, swallow, or talk.
Hypotonic cerebral palsy
Hypotonic CP causes diminished muscle tone and overly relaxed muscles. The arms and legs move very easily and appear floppy, a rag doll.
Babies with this type of CP have little control over their head and may have trouble breathing. As they grow older, they may struggle to sit up straight as a result of their weakened muscles. They can also have difficulty speaking, poor reflexes, and walking abnormalities.
Ataxic cerebral palsy
Ataxic CP is the least common type of CP. Ataxic CP is characterized by voluntary muscle movements that often appear disorganized, clumsy, or jerky.
People with this form of CP usually have problems with balance and coordination. They may have difficulty walking and performing fine motor functions, such as grasping objects and writing.
Mixed cerebral palsy
Some people have a combination of symptoms from the different types of CP. This is called mixed CP.
In most cases of mixed CP, people experience a mix of spastic and dyskinetic CP.
Cerebral palsy is classified according to the Gross Motor Function Classification System (GMFCS). The World Health Organization (WHO) and the Surveillance of Cerebral Palsy in Europe developed the GMFCS as a universal standard for determining the physical capabilities of people with CP.
The system focuses on:
- the ability to sit
- the capability for movement and mobility
- charting independence
- the use of adaptive technology
The five levels of the GMFCS increase with decreasing mobility:
Level 1 cerebral palsy
Level 1 CP is characterized by being able to walk without limitations.
Level 2 cerebral palsy
A person with level 2 CP can walk long distances without limitations, but they can’t run or jump.
They may need assistive devices, such as leg and arm braces, when first learning to walk. They also may need to use a wheelchair to get around outside of their home.
Level 3 cerebral palsy
A person with level 3 CP can sit with little support and stand without any support.
They need handheld assistive devices, such as a walker or cane, while walking indoors. They also need a wheelchair to get around outside of the home.
Level 4 cerebral palsy
A person with level 4 CP can walk with the use of assistive devices.
They’re able to move independently in a wheelchair, and they need some support when they’re sitting.
Level 5 cerebral palsy
A person with level 5 CP needs support to maintain their head and neck position.
They need support to sit and stand, and they may be able to control a motorized wheelchair.
A doctor will diagnose CP by taking a complete medical history, performing a physical exam that includes a detailed neurological exam, and evaluating the symptoms. Additional testing can also be performed:
- An electroencephalogram (EEG) is used to evaluate the electrical activity in the brain. It may be ordered when someone is showing signs of epilepsy, which causes seizures.
- An MRI scan uses powerful magnets and radio waves to produce detailed images of the brain. It can identify any abnormalities or injuries in the brain.
- A CT scan creates clear, cross-sectional images of the brain. It can also reveal any brain damage.
- A cranial ultrasound is a relatively quick and inexpensive method of using high-frequency sound waves to get basic images of the brain in young infants.
- A sample of blood may be taken and tested to rule out other possible conditions, such as bleeding disorders.
If your doctor confirms CP, they may refer you to a specialist who can test for neurological problems that are often associated with the disorder. These tests may detect:
- vision loss and impairment, such as blurred vision in one or both eyes
- speech delays
- intellectual disabilities
- movement disorders
The goal of treatment is to improve limitations and prevent complications. Treatment may include assistive aids, medications, and surgery.
Assistive aids include:
- hearing aids
- walking aids
- body braces
Oral anticonvulsants and muscle relaxants are commonly used as first-line treatments for CP. Your doctor might prescribe:
- diazepam (Valium)
- dantrolene (Dantrium)
- tizanidine (Zanaflex)
Your doctor might also suggest local injections of botulinum toxin type A (Botox) or intrathecal baclofen therapy, where the drug is delivered by an implantable pump.
Orthopedic surgery may be used to relieve pain and improve mobility. It may also be needed to release tight muscles or to correct bone abnormalities caused by spasticity.
Selective dorsal rhizotomy (SDR) might be recommended as a last resort to reduce chronic pain or spasticity. It involves cutting nerves near the base of the spinal column.
Other types of treatment for CP include:
- speech therapy
- physical therapy
- occupational therapy
- recreational therapy
- counseling or psychotherapy
- social services consultations
Although stem cell therapy is being explored as a potential treatment for CP, research is still in the early stages.
The majority of problems that cause CP can’t always be prevented. However, if you’re pregnant or planning on becoming pregnant, you can take certain preventive measures to minimize complications.
It’s important to get vaccinated against diseases that can cause fetal brain damage, such as rubella. It’s also crucial to receive adequate prenatal care. Attending regular appointments with your doctor during pregnancy can help prevent premature birth, low birth weight, and infections.There’s no cure for CP, but the condition can often be treated and managed effectively. The specific type of treatment varies from person to person. Some people with CP may not need very much assistance, and others might need extensive, long-term care for their symptoms.
Regardless of the severity of the condition, treatment can improve the lives of those with CP. The following can help many people enhance their motor skills and ability to communicate:
- assistive aids