Cerebral Palsy

Cerebral palsy is the most common movement and motor disability of childhood, affecting the ability to move and maintain balance and posture. While there is no cure, treatments and supportive care can significantly improve the quality of life for those living with the condition.

Table of contents

• What is Cerebral Palsy?
• Types of Cerebral Palsy
• Signs and Symptoms
• Causes and Risk Factors
• Diagnosis
• Treatment and Management
• Living with Cerebral Palsy

What is Cerebral Palsy?

Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. The term “cerebral” refers to the brain, while “palsy” means weakness or problems with using the muscles^[1]. CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control their muscles^[1].

CP is the most common motor disability in childhood^[1]. It is a permanent, lifelong condition, but it does not worsen over time^[2]. The condition generally stays the same throughout a person’s life, though the exact symptoms can change as the person grows and develops^[1].

All people with CP have problems with movement and posture. However, the severity varies greatly from person to person. A person with severe CP might need to use special equipment to walk or might not be able to walk at all and might need lifelong care. A person with mild CP, on the other hand, might walk a little awkwardly but might not need any special help^[1].

Many people with CP also have related conditions. These can include intellectual disabilities, seizures, problems with vision, hearing, or speech, changes in the spine such as scoliosis (abnormal curvature of the spine), and joint problems^[1].

Types of Cerebral Palsy

Doctors classify CP according to the main type of movement disorder involved. Depending on which areas of the brain are affected, one or more movement disorders can occur^[1]. There are four main types of CP, each with distinct characteristics.

Spastic Cerebral Palsy

Spastic cerebral palsy is the most common type, affecting about 80% of people with CP^[1]. People with spastic CP have increased muscle tone, which means their muscles are stiff. As a result, their movements can be awkward^[1].

Spastic CP is usually described by which parts of the body are affected. Spastic diplegia mainly affects the legs, with the arms less affected or not affected at all. Tight hip and leg muscles cause the legs to pull together, turn inward, and cross at the knees, making walking difficult^[1]. Spastic hemiplegia affects only one side of the body, usually with the arm more affected than the leg^[1]. Spastic quadriplegia is the most severe form and affects all four limbs, the trunk, and the face. People with this form usually cannot walk and often have other developmental disabilities^[1].

Dyskinetic Cerebral Palsy

People with dyskinetic CP have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk^[1]. The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected, and the person has difficulty sucking, swallowing, and talking^[1]. Muscle tone can change from too tight to too loose, not only from day to day but even during a single day^[1].

Ataxic Cerebral Palsy

People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk and might have difficulty with quick movements or movements that need a lot of control, like writing^[1]. They may also have trouble controlling their hands or arms when reaching for something^[1].

Mixed Cerebral Palsy

Some people have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP^[1].

Signs and Symptoms

The symptoms of cerebral palsy can vary greatly from person to person. In some people, CP affects the whole body, while in others, symptoms might only affect one or two limbs or one side of the body^[2].

General symptoms include trouble with movement and coordination. Children with CP may have exaggerated reflexes. The arms, legs, and trunk may appear floppy, or they may have stiff muscles, known as spasticity^[2]. Symptoms can also include irregular posture, movements that can’t be controlled, and an unsteady walk^[2].

Infants with CP frequently have developmental delays and may be slower to learn to roll over, sit, crawl, or walk^[3]. Common early signs in babies include lack of muscle coordination when performing voluntary movements, stiff or tight muscles with exaggerated reflexes, weakness in one or more arms or legs, an unusual walking style, walking on the toes, stiff or floppy muscle tone, tremors or random involuntary movements, and delays in reaching movement milestones^[3].

Additional nonmovement symptoms may include head size differences such as an unusually small or large head, irritability, lack of interaction with people around them, and reduced muscle tone giving affected body parts a floppy appearance^[4].

CP may make it hard to swallow. It can also cause eye muscle imbalance, in which the eyes don’t focus on the same object. People with the condition might have reduced range of motion in their joints due to muscle stiffness^[2]. Some people with CP have difficulty with precise movements such as writing or buttoning a shirt^[1].

Causes and Risk Factors

CP is caused by abnormal development or damage to the developing brain. This damage affects a person’s ability to control their muscles^[1]. The areas of the brain involved in muscle movement may not develop as expected in the womb, or the damage may result from injury to the brain before, during, or after birth^[3].

The symptoms of cerebral palsy are caused by problems in brain development that may include damage to the brain’s white matter, interruption of brain growth caused by gene changes, bleeding in the brain, or a lack of oxygen^[3].

When this development or damage happens before birth, it is called congenital CP. Most CP is congenital, and its causes may include changes in genes, brain malformations, infections or fevers in the pregnant parent, and injuries to the developing baby^[8]. CP can also happen during or after birth. CP that happens more than 28 days after birth is called acquired CP^[8]. Acquired causes can include brain damage in the first few months or years of life, infections such as meningitis or encephalitis, problems with blood flow to the brain, and head injuries from accidents or falls^[8].

Certain medical conditions or events can increase a baby’s risk of developing congenital cerebral palsy. These risk factors include being born too small, being born too early, being born a twin or other multiple birth, infections during pregnancy, health problems in the pregnant parent such as thyroid disorders and seizures, severe newborn jaundice, having complications during birth, and exposure to toxic chemicals during pregnancy^[8].

In many cases, the exact cause of CP is unknown^[8]. Damage before birth makes up about 80% of the causes^[4].

Diagnosis

Diagnosing CP involves several steps and usually occurs over time. Symptoms of cerebral palsy can become more apparent as a child grows. A diagnosis might not be made until a few months to a year after birth^[9]. If symptoms are mild, diagnosis may be delayed longer^[9].

The diagnostic process includes developmental monitoring, which means tracking a child’s growth and development over time. If there are concerns about a child’s development, they should have a developmental screening test as soon as possible^[8]. Developmental screening involves giving a child a short test to check if they are learning basic skills when they should^[8].

If cerebral palsy is suspected, a healthcare professional evaluates the child’s symptoms, reviews the medical history, conducts a physical exam, and monitors growth and development during appointments^[9]. The child may be referred to specialists trained in treating children with brain and nervous system conditions, including pediatric neurologists, pediatric physical medicine and rehabilitation specialists, and child development specialists^[9].

A series of tests may be needed to make a diagnosis and rule out other possible causes. Brain imaging tests can reveal areas of damage or irregular brain development^[9]. Magnetic resonance imaging (MRI) uses radio waves and a magnetic field to produce detailed images of the brain and can often identify changes in the brain^[9]. A cranial ultrasound can be performed during infancy and uses high-frequency sound waves to produce images of the brain^[9].

If a child is suspected of having seizures, an electroencephalogram (EEG) may be used to evaluate the condition further. In an EEG test, a series of electrodes are attached to the scalp to measure electrical activity in the brain^[9].

Treatment and Management

There is no cure for cerebral palsy, but treatment can improve the lives of those who have the condition^[1]. Treatments are available to help people with CP be as active and independent as possible^[13]. The type of treatments needed depends on the type and severity of CP, co-occurring conditions, level of impairment, and location of movement problems^[12].

Children and adults with CP are cared for by a team of healthcare professionals who work together to create a care and support plan^[13]. This plan is continually reassessed as the person’s needs change^[13].

Therapy Services

Physical therapy is one of the most important treatments for cerebral palsy. It involves exercises to help maintain and improve movement^[13]. The main goals are to encourage movement, increase strength, and stop muscles from becoming weak or losing their range of motion^[13]. A physical therapist may also advise on walking aids and arm or leg braces to support the limbs^[13].

Occupational therapy helps with daily tasks like eating, dressing, writing, and using a computer. Therapists work on improving fine motor skills and may use special tools to make tasks easier^[13]. This therapy can be very useful in boosting independence, especially as children get older^[13].

Speech and language therapy can help people who have trouble communicating. A speech and language therapist can provide exercises to practice speech or teach alternative methods of communication such as sign language or using pictures^[13]. For those who have trouble swallowing, therapists offer exercises to help with eating and drinking safely^[13].

Medications

Medicines can help relieve several symptoms of cerebral palsy. Medications for muscle stiffness include tablets or liquids such as diazepam or baclofen^[13]. Baclofen can sometimes be given using a small pump inserted under the skin, which allows the medicine to reach the area inside the spine^[13]. Botulinum toxin injections can relax certain muscles or groups of muscles for a few months at a time^[13].

Other medications may be prescribed for sleeping difficulties, seizures, constipation, pain, or drooling^[13]. Each person with CP may need different medications, and the healthcare team will work to find the best ones^[13].

Assistive Devices

Devices like wheelchairs, walkers, and communication boards help with mobility, posture, and speech. Orthotics are special braces or splints that support joints, reduce pain, and help with walking^[13]. Positioning aids can help a child sit, lie down, or stand properly^[15].

Surgery

In some cases, surgery may be needed to correct tight muscles, joint problems, or bone issues^[13]. Orthopedic surgery can help improve mobility, alignment, and function, making it easier to move and do daily activities^[13]. One type of surgery, called selective dorsal rhizotomy (SDR), is done on the spine to help reduce spasticity in the legs^[15].

Early Intervention Services

For babies and toddlers up to age 3, early intervention services offer free therapy to help children reach developmental milestones. These services can include physical therapy, occupational therapy, speech therapy, hearing loss services, health and nutrition support, and assistive technology devices^[14]. Early intervention services can start even before a CP diagnosis is made^[14].

For school-aged children ages 3 to 22 years, services are available through the Individuals with Disabilities Education Act (IDEA). These services can continue at home or in school settings^[14].

Living with Cerebral Palsy

People with cerebral palsy can live active, fulfilling lives with the right care and support. They can participate in daily activities, pursue education, and enjoy a range of hobbies^[25]. Medical and technological advances mean that people with this condition are living longer, fuller lives^[4].

Mobility is commonly affected by CP, and the extent varies by individual. Early evaluation and intervention can help improve mobility^[17]. As children grow, mobility issues become more apparent, allowing families and healthcare teams to plan strategies to minimize limitations. This may mean obtaining wheelchairs, walkers, canes, or other support devices^[17].

Communication can be a challenge for some people with CP. Speech therapy conducted by a licensed speech pathologist is recommended for all children with cerebral palsy to provide resources for current and future communication needs^[17]. For those who cannot talk, assistive equipment such as communication boards with pictures, letters, and words, or other devices, can make communication easier^[17].

Some children with CP, especially those with significant mobility limitations, need assistance with meals and snacks. A speech pathologist can teach the best techniques for helping during mealtime^[17]. Children with cerebral palsy benefit from a high-quality diet with many fruits, vegetables, and other healthy foods^[17].

Sleep can be a challenge for children with pain and movement issues. Good quality sleep is essential for success in all areas of life^[17]. Strategies to improve sleep may be needed.

Staying active and maintaining physical fitness are important for people with CP. Exercise can help improve mobility limitations, movement, and overall health^[18]. Similar to physical therapy, exercise can help improve symptoms such as lack of coordination, voluntary movements, and muscle tone^[18].

It is important to focus on strengths rather than limitations. CP can make some activities harder, but focusing on abilities helps build confidence^[25]. With therapy and perseverance, many people with CP improve their abilities and lead fulfilling lives^[25].

Taking care of mental health is also important. CP can sometimes feel frustrating or isolating. Talking to a counselor or therapist can help with stress, anxiety, or depression^[25]. Support from family, friends, and support groups can make a big difference. Support groups help people connect with others who have similar experiences^[25].

For children, inclusion in school is important. Many schools have programs to support students with disabilities, including therapy services and assistive devices^[25]. Working with educational teams helps ensure that children have the tools and support they need to succeed^[25].

The condition does not automatically cause intellectual disability. Having CP doesn’t automatically cause someone to have difficulties with thinking or learning, though some people with CP do have related conditions^[4].