Cerebral Palsy is the most common of all childhood disabilities, affecting approximately three live births out of every thousand in the United States. To truly understand how widespread the condition is among children and adults in the United States - or in a particular community - it helps to understand the difference between incidence and prevalence. Cerebral palsy (CP) is a group of conditions caused by damage to the brain that affects a person's ability to move and control their muscles.
While CP affects a person for their entire life, the damage to the brain that causes CP occurs before birth, or in the first few months after.
There can be many causes for the brain damage that leads to CP, but for most babies that develop the condition, doctors are not able to identify a particular cause.
Risk factors that have been associated with an increased chance of a child developing cerebral palsy include:
Males are slightly more likely to develop CP than females. Babies from a multiple pregnancy (twins, triplets or more babies) are also more likely to be born prematurely, or have a low birth weight and therefore at a higher risk of developing CP.
While the genetic basis of CP is not strong, there may be some traits, such as prematurity, that have a genetic link and so increase the risk of developing CP.
The part of the body's nervous system that includes the brain and the spinal cord.
Substances in foods that are necessary for the body to function and grow. They include macronutrients, which provide energy and micronutrients, which are substances needed in small amounts such as vitamins, minerals and trace elements.
The organ that forms within the uterus of a pregnant woman to provide the fetus with nourishment from the blood supply of the mother.
The process by which blood changes from a liquid to a semi-solid state, usually to seal off any sites of bleeding. This is also known as coagulation.
A newborn baby's weight at birth that is less than 2.5kg.
The kind of symptoms someone with CP experiences depends on which part of the brain is damaged.
Cerebral palsy can cause damage in different parts of the brain, which results in diverse symptoms.
There are four main types of CP:
This is by far the most common form of CP and is caused by damage to the motor cortex, the main area at the top of the brain that is responsible for controlling body movements.
For body movements to occur smoothly, different muscle groups have to work together in the correct sequence, with some contracting while others relax. In spastic CP, muscles tend to be stiff and tight and the muscle groups do not receive messages from the brain in the correct sequence, making it difficult to move smoothly.
People with spastic CP tend to:
Dyskinetic CP is much less common. It occurs because of damage to an area of the brain called the basal ganglia, which regulates messages between the motor cortex and the spinal cord, helping to control voluntary movements.
People with dyskinetic CP can have three kinds of movement disorders:
Ataxic CP is the least common form of CP. It occurs as a result of damage to the cerebellum, an area at the base of the brain that helps to control balance.
People with ataxic CP tend to have difficulties maintaining their balance. They may also make shaky or tremor-like movements and have trouble with speech and swallowing, in addition to controlling eye movements.
With combined or mixed CP, a person is affected by more than one of the CP types described above.
A connecting surface or tissue between two bones.
The clear watery fluid secreted into the mouth by salivary glands, which aids chewing, swallowing and digestion.
A bundle of nerve tissue that runs from the brain through the spinal column and connects the brain to the body, transmitting sensory and motor signals.
Unintentional trembling in one or more parts of the body.
Cerebral palsy affects each person differently. Symptoms can range from mild to severe and may affect many different parts of the body.
While the damage that causes CP generally happens before or shortly after birth, it may take quite some time for symptoms to become apparent.
Signs of cerebral palsy can include:
CP can affect development, which means that infants and small children with the condition may not be able to perform actions expected for children of their age. These developmental milestones can include actions such as sitting up, rolling over, crawling, walking and word use. There is a wide range of 'normal' times for achieving these milestones and being 'late' in one alone does not necessarily mean there is cause for concern over the child's development. You should speak to your doctor if you have concerns about your baby's developmental milestones. Routine check-ups with maternal child health nurses are also effective in identifying developmental concerns.
Other medical conditions can also cause similar symptoms and your child may be referred to a pediatrician for further assessment.
Because of the damage to the brain and problems with movement, people with cerebral palsy may have a range of health conditions and problems.
These can include:
Cerebral palsy can cause difficulty with mobility.
Around half of people with cerebral palsy have an intellectual disability and roughly one in five has a moderate or severe intellectual impairment.
While it is true that the more physically impaired a person is, the more likely they are to have an intellectual disability, it is important not to assume that this is always the case. Some people with CP may have severe physical disability, but no intellectual impairment, while others may have mild physical symptoms along with an intellectual disability.
A doctor who specializes in the diagnosis and treatment of health conditions in children and babies.
The clear watery fluid secreted into the mouth by salivary glands, which aids chewing, swallowing and digestion.
The diagnosis of cerebral palsy is often not straightforward. Other health conditions can cause similar symptoms to CP and need to be ruled out. It can take repeated visits and tests to diagnose CP.
Even when a diagnosis is made, it may take months or even years of reviewing the child's development to fully understand the types of symptoms, their severity and the affected parts of the body.
In an initial assessment, the child's movements will be assessed for signs that they have cerebral palsy. Further tests may be recommended in order to rule out other health conditions and assess brain and muscle function.
Tests can include:
Since cerebral palsy causes a wide range of symptoms and affects each person differently, as well as identifying the type of CP someone has, doctors may assess the symptoms according to:
A scan that uses X-rays to create a 3D image of the body. This can detect abnormalities more effectively than a simple X-ray can.
A type of imaging that uses a magnetic field and low-energy radio waves, instead of X-rays, to obtain images of organs.
All cells of the nervous system outside the brain and spinal cord.
People with cerebral palsy will generally have a team of healthcare professionals helping to provide ongoing care tailored for their needs. The types of treatment they may require depends on:
Medication can help improve symptoms that make movement difficult for people with cerebral palsy. Medications commonly prescribed include:
Other medications may also be recommended to treat conditions such as epilepsy, heartburn, sleeping problems and pain.
Various kinds of surgery may be recommended to help treat a range of issues with cerebral palsy.
Surgeries include:
Surgery may also be recommended to treat conditions, such as scoliosis, urinary incontinence, vision and eye movement disorders, salivary problems and heartburn.
Physiotherapists and occupational therapists can help people with cerebral palsy to improve their movement and learn more effective ways to perform daily activities.
They may use a variety of approaches including:
Therapists assist people with cerebral palsy in managing their daily activities.
Speech pathologists can help people with cerebral palsy improve their communication skills. This may include exercises to help improve speech or, if speech is very impaired, learn to use other methods to communicate, such as signing or using assistive technology (such as communication boards or speech-generating devices).
Speech pathology can also assist with swallowing, eating and drinking difficulties.
Psychologists can provide help for people with cerebral palsy in a number of ways. They can assess and provide guidance on a range of issues such as learning and development, dealing with chronic pain, improving sleep and emotional and behavioral issues. People with CP may suffer from depression and anxiety, and psychologists can also provide assistance, counselling and therapy for these conditions.
Social workers can provide home-based support for people with cerebral palsy and their families.
Ophthalmologists and optometrists can provide treatments for vision problems associated with cerebral palsy, including short-sightedness and strabismus (also known as turned eye or squint).
Audiologists can assess hearing loss and provide hearing aids.
People with cerebral palsy may need to take care with their nutrition for several reasons, including having difficulty swallowing, needing to control energy intake because they find it difficult to be physically active, constipation and heartburn.
Doctors and dietitians can help to provide tailored nutritional advice for meal planning.
A connecting surface or tissue between two bones.
A healthcare professional trained to deliver occupational therapy, which involves teaching a person self care, work and play activities to promote independence and reduce disability.
A doctor who specializes in diagnosing and managing conditions of the eye and visual system.
A branch of medicine that specifically deals with artificial devices that support body parts, such as splints, braces or shoe inserts.
An eye condition in which light is focused in front of the retina. It causes blurred vision, particularly at distances. Also known as myopia.
A health professional trained in the diagnosis, management and treatment of individuals with speech and language problems, or those who have difficulty with feeding and swallowing.
A bundle of nerve tissue that runs from the brain through the spinal column and connects the brain to the body, transmitting sensory and motor signals.
Also known as 'cross-eyed'. It is a condition where the eyes are not properly aligned and look in different directions.
A professional specializing in mental development, diagnoses and management of mental health conditions.
A nerve toxin produced by the bacterium Clostridium botulinum, which causes muscle paralysis. It can be used cosmetically (known as Botox or by its other trade names) in low doses to relax facial wrinkles and for various medical purposes.
As well as the health problems associated with cerebral palsy, a number of other complications may occur.
Managing medications for cerebral palsy can be complex, particularly if a number of medications are required to manage different symptoms and health problems.
Medications to relax muscles can have a range of side effects including drowsiness, confusion and lack of coordination. Rarely, the botulinum toxin can cause serious problems with breathing and swallowing.
Discussing medications, side effects and how to best manage them is part of treating CP. If you have any concerns, you can talk to your doctor or other health professionals.
People with CP who have problems with swallowing or heartburn can be at greater risk of developing respiratory problems, such as pneumonia and chronic lung disease.
Living with CP can take a toll on the body. Muscle contracture (permanent shortening), bone abnormalities and abnormal postures can place extra strain on bones and joints. As a person with CP gets older, this can increase the risk of problems such as osteoarthritis and osteoporosis.
Living with CP can be challenging and adults with CP are at greater risk of developing depression. If you think you may be depressed, you can talk to your GP or a mental health professional. There are many treatments that can help overcoming depression.
A connecting surface or tissue between two bones.
A nerve toxin produced by the bacterium Clostridium botulinum, which causes muscle paralysis. It can be used cosmetically (known as Botox or by its other trade names) in low doses to relax facial wrinkles and for various medical purposes.
Cerebral palsy causes lifelong disability and there is no cure. Treatments can help to reduce symptoms and improve independence and quality of life for people with CP.
Although the damage to the brain that causes CP does not get worse, over time symptoms can change and people with CP may experience some physical complications, as described above.
Most cases of cerebral palsy cannot be prevented. Where there is a concern that women are at increased risk of delivering their babies very prematurely, doctors may recommend taking doses of magnesium sulfate, a compound that has been shown to reduce the risk of premature babies developing CP.
For newborn babies who have suffered a lack of oxygen before birth, treatments such as the use of a cooling cap, which reduce the temperature of the brain, may help to reduce the risk of brain damage.