Health Information

Cerebral Palsy

(CP)

Definition

Cerebral palsy (CP) is a group of chronic disorders that affect the ability to control movement. It appears in the first few years of life. Generally, the nerve damage does not worsen over time, but the muscle, joint, and skeletal effects can get worse without treatment.

Causes

CP occurs due to damage to areas of the brain that direct movement. This damage interferes with the brain's ability to control movement and posture. Other areas of the brain controlling thinking, speech, vision, or hearing may also be involved. CP may develop before, during, or after birth.
Causes include:
  • Stroke or bleeding occurs in the baby's brain during development or after birth
  • Child sustains a head injury or brain infection
  • There are abnormalities of the umbilical cord or placenta, or the placenta separates too early from the wall of the uterus
  • Child does not get enough oxygen during or after birth
  • Child has meningitis, encephalitis, seizures, or head injury
  • Child has genetic/metabolic abnormalities
  • Brain tissue that may not develop correctly during pregnancy—growing fetus may experience a lack of oxygen or nutrients
  • Mother has rubella, toxoplasmosis, or cytomegalovirus while pregnant
  • Mother and child's blood types are not compatible causing severe jaundice

Risk Factors

Factors that increase the risk of CP include:
  • Premature birth
  • Low birth weight
  • Complicated or premature delivery
  • Multiple births, such as twins or triplets
  • Breech birth
  • In vitro fertilization (IVF)—in part due to multiple births associated with IVF
  • Infection or blood clotting problems during pregnancy
  • Vaginal bleeding during pregnancy
  • Family history of CP in parent or sibling
  • Seizures or intellectual disability in the expectant mother
  • Cord prolapse
  • Low Apgar score—a rating of the child's condition just after birth
  • Vaginal or urinary tract infection during pregnancy
  • High birth weight
  • Type 1 diabetes in the expectant mother
  • Small head
  • Seizures

Symptoms

Symptoms of CP vary widely. They may include difficulty with fine motor tasks like writing or using scissors, difficulty maintaining balance or walking, difficulty hearing or speaking, muscle tightness, and involuntary movements . The symptoms differ from person to person and may change over time.
CP first shows up in children aged three years or younger. Symptoms vary depending on what areas of the brain are affected. The problems can involve 1 side of the body (hemiplegia), the upper or lower body (diplegia), or both the upper and lower body on both sides (quadraplegia). Occasionally the face and neck are involved.
Disabilities can be mild to severe and vary from side to side and top to bottom. Although symptoms may change or progress slightly as the child grows older, the child's condition is unlikely to worsen significantly, especially with treatment.
Symptoms include:
  • Late to turn over, sit up, smile, or walk
  • Trouble writing, buttoning a button, or other fine motor activities
  • Difficulty walking or standing
  • Tight, spastic muscles
  • Weak muscles
  • Poor balance
  • Speech problems
  • Tremors
  • Unintentional body movements
  • Difficulty swallowing
  • Drooling
Some people with CP suffer from other medical disorders as well, including:
  • Seizures
  • Intellectual disability
  • Learning disabilities
  • Vision or hearing problems
  • Failure-to-thrive
  • Decreased ability to feel pain or identify items by touch
  • Problems with bowel and bladder control
  • Breathing problems if food or water has accidentally entered the lungs
  • Skin breakdown
  • Low bone density and fractures

Diagnosis

Doctors diagnose CP by testing motor skills and reflexes, looking into medical history, and using a variety of specialized tests.
You may have your brain's electrical activity tested. This can be done with an Electroencephalogram (EEG).
You may have pictures taken of structures inside your head. This can be done with:
MRI Scan
MRI of the Brain
Copyright © Nucleus Medical Media, Inc.

Treatment

There is no treatment to cure CP. The brain damage cannot be corrected. Therapy aims to help the child reach his or her full potential. Children with CP grow to adulthood and may be able to work and live independently.

Medication

Drugs help control muscle spasms and seizures, and prevent bone loss.
Medications may help:
Different seizure medications can be used depending on the type of seizure

Surgery

Certain operations may improve the ability to sit, stand, and walk. These may include tendon transfers or lengthening, joint loosening, bone straightening, and nerve surgery.

Physical Aids

Braces and splints help reduce muscle contraction, keep limbs in correct alignment, and prevent deformities. Positioning devices enable better posture. Walkers, special scooters, and wheelchairs make it easier to move around.

Special Education

Programs designed to meet the child's special needs may improve learning. Some children do well attending regular schools with special services. Vocational training can help prepare young adults for jobs.

Rehabilitation Services

Speech, physical, and occupational therapies may improve the ability to speak, move, walk, and perform activities of daily living. Physical therapy helps strengthen muscles and improve fitness. Children can learn different ways to complete difficult tasks.

Family Services

Professional support helps a patient and family cope with CP. Counselors help parents learn how to modify behaviors. Caring for a child with CP can be stressful. Some families find support groups helpful.

Other Treatment

Therapeutic electrical stimulation might help increase muscle strength and range of motion.

Prevention

Several of the causes of CP that have been identified through research are preventable or treatable:
  • Before getting pregnant, receive a vaccination for rubella.
  • Seek out early prenatal care.
  • Receive testing for blood-type problems when pregnant. Get treatment if tests reveal incompatible blood types.
  • Do not smoke , drink alcohol, or use drugs while pregnant.
  • Put the baby in a child safety seat when in the car.
  • Insist that the child wear a helmet when riding a bicycle.
  • Seek help if you have, or want to, hurt the child.
  • Keep poisons away from your child.
  • Closely supervise bathing.
  • Get your child immunized at the recommended time.
  • If your baby becomes sick, call the doctor right away.
  • For infants with brain injury at birth, hypothermia to lower body temperature can reduce the risk of tissue injury and of long-term problems.

RESOURCES

MyChild http://www.cerebralpalsy.org

United Cerebral Palsy http://www.ucp.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Ontario Federation for Cerebral Palsy http://www.ofcp.ca

References

Ashwal S, Russman BS, Blasco PA, et al. 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;62(6):851-863.

Cerebral palsy (CP). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 7, 2014. Accessed September 9, 2014.

Cerebral palsy (CP). Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities website. Available at: http://www.cdc.gov/ncbddd/cp/index.html. Updated July 14, 2014. Accessed September 9, 2014.

Cerebral palsy: hope through research. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/cerebral%5Fpalsy/detail%5Fcerebral%5Fpalsy.htm. Updated July 21, 2014. Accessed September 9, 2014.

Hazneci B, Tan AK, Guncikan MN, Dincer K, Kalyon TA. Comparison of the efficacies of botulinum toxin A and Johnstone pressure splints against hip adductor spasticity among patients with cerebral palsy: a randomized trial. Mil Med. 2006;171(7):653-656.

Johnson SL, Blair E, Stanley FJ. Obstetric malpractice litigation and cerebral palsy in term infants. J Forensic Leg Med. 2011;18(3):97-100.

Nolan KW, Cole LL, Liptak GS. Use of botulinum toxin type A in children with cerebral palsy. Phys Ther. 2006;86(4):573-584.

Park ES, Park CI, Chang HC, Park CW, Lee DS. The effect of botulinum toxin type A injection into the gastrocnemius muscle on sit-to-stand transfer in children with spastic diplegic cerebral palsy. Clin Rehabil. 2006;20(8):668-674.

Steinbok P. Selection of treatment modalities in children with spastic cerebral palsy. Neurosurg Focus. 2006;21(2):e4.

10/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mergler S, Evenhuis HM, Boot AM, et al. Epidemiology of low bone mineral density and fractures in children with severe cerebral palsy: a systematic review. Dev Med Child Neurol. 2009;51(10):773-778.

2/4/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Delgado MR, Hirtz D, Aisen M, et al. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2010;74:336-343.

7/30/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: United States Food and Drug Administration. FDA approves drug for chronic drooling in children. United States Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm220444.htm. Published July 28, 2010. Accessed September 9, 2014.

8/11/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Azzopardi D, Strohm B, et al. Effects of hypothermia for perinatal asphyxia on childhood outcomes. N Engl J Med. 2014;371(2):140-149.

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