Cerebral palsy is the broad term for a neurological condition which affects muscle movement and balance and can affect the entire body. CP, as cerebral palsy is commonly known as, is due to brain damage or to abnormal brain development. The brain damage which causes CP can occur when the baby is still in the womb or during the delivery process; sometimes, CP-causing brain damage occurs shortly after birth. Cerebral palsy is considered congenital when a baby is born with it, but this does not mean that the condition is hereditary.
Researchers have divided cerebral palsy into nine general categories or forms:
• Spastic diplegia
• Spastic hemiplegia
• Spastic quadriplegia
• Athetoid dyskinetic cerebral palsy
• Choreoathetoid dyskinetic cerebral palsy
• Dystonic dyskinetic cerebral palsy
• Ataxic cerebral palsy
• Hypotonic cerebral palsy
• Mixed cerebral palsy
Eight of the forms have distinct symptoms which distinguish them from the others; as the name implies, mixed cerebral palsy is a combination of two or more forms.
Symptoms of Cerebral Palsy
Cerebral palsy has many symptoms, depending on the form the condition takes; symptoms range from mild to severe, depending on the extent and location of the brain damage or abnormality.
• Stiff muscles; too much muscle tone. Limbs may be held stiffly, bent and close to the body. Often arms and or legs are held in awkward, abnormal positions. Fingers may be clenched and hands held in abnormal positions. Movement is restricted or impossible. These symptoms are all characteristic of the three spastic forms of CP.
• “Floppy,” overly relaxed muscles. The patient may have a “rag doll” appearance. These symptoms are characteristic of hypotonic cerebral palsy.
• Combination of stiff and “floppy” muscles. This is most characteristic of mixed CP.
• Involuntary movements. This is most characteristic of the dyskinetic forms of CP. Children may exhibit slow, writhing movements.
• Difficulties with balance and depth perception. This is most characteristic of ataxic CP.
Conditions Associated with Cerebral Palsy
• Mental retardation. According to the National Institute of Neurological Disorders and Stroke, approximately two-thirds of people with CP have some degree of mental impairment; mental retardation in CP ranges from mild to severe. However, not all patients with CP are mentally retarded or learning disabled; some patients with CP have higher IQs than average and may be very intellectually gifted. Speech and communication problems, which can accompany CP, sometimes make it difficult to assess the person’s intelligence.
• Speech and communication difficulties. The speech of CP patients may be difficult to understand. Some CP patients have difficulty processing the spoken word or speaking with the correct syntax.
• Hearing difficulties and/or vision difficulties. These problems make communication even more difficult. Eyes which do not focus correctly may be a problem with CP; the condition can cause strabismus—cross eyes or lazy eye. Another (rarer) vision problem which can occur with CP is cortical blindness. The patient’s eyes are normal, but they are blind because the brain cannot process the visual information.
• Swallowing difficulties. Drooling. Swallowing difficulties may lead to malnutrition in CP patients. They may also cause aspiration—food is inhaled into the lungs because of choking; aspiration can lead to pneumonia.
• Difficulty with constipation or with bowel and bladder control.
• Seizures. Fifty percent of CP patients may have seizures. These range in severity from the convulsions of tonic-clonic seizures to mild, focal (partial) seizures—which may be noticeable only as temporary confusion, a temporary loss of attention, or mild muscle twitches.
• Scoliosis. Some patients with CP have or develop scoliosis—curvature of the spine which make walking even more difficult.
Possible Complications of Cerebral Palsy
• Contractures. Contractures occur when the stiff, spastic muscles pull too tightly on the bones and joints; the muscle cannot move and the bone and/or joint may become deformed from the pressure.
• Falls. Because of difficulty with movement and balance, CP patients who can walk may be prone to falling.
• Aspiration pneumonia and other respiratory problems because of swallowing difficulties and difficulty with diaphragmatic breathing. Such problems are especially likely for CP patients who are confined to a wheelchair.
• Malnutrition because of swallowing and chewing difficulties.
• Indigestion because of poor muscle motility. The food does not move in the esophagus and the rest of the digestion tract as it should.
• Behavior and emotional problems. The brain damage or brain malformations present in CP combined with the stress of dealing with physical disabilities can lead to behavioral and emotional problems for many CP patients.
• Delayed development and growth. Developmental delays (failing to reach for an object, sit up, crawl, stand, or walk at the age most babies do) are generally the first sign that an infant may have CP.
Causes of Cerebral Palsy
Throughout the entire nine months of pregnancy, the growing fetus is subject to many things which can affect its development. The brain is especially vulnerable during the first two trimesters. Brain damage can also occur from lack of oxygen during a difficult delivery; less than 10 percent of CP is caused by oxygen-deprivation during delivery. Sometimes CP is caused by infection, lack of oxygen, or head injury after birth.
Infections in either the mother or the unborn baby can cause the baby’s brain to be injured. Inflammatory pelvic disease in the mother is an especially high risk for the baby. The immune system fights infections by producing more cytokines (a type of immune cell); during the course of the infection fighting process, the cytokines produce inflammation. Although useful in fighting infection, inflammation can cause brain damage. Exposure to toxins can also put the unborn baby at risk for brain damage or brain malformations.
Premature babies are at especially high risk for developing brain damage after birth. Many preemies develop periventricular leukomalacias—lesions in the brain’s white matter. Periventricular leukomalacias inhibit circulation in the brain; the brain receives less oxygen and so the nervous system cannot communicate as well as it should with the muscles. Some 60 to 100 percent of babies with periventricular leukomalacias will develop CP.
Rh incompatibility is another risk factor for CP. In Rh incompatibility, the mother’s Rh blood type conflicts with the unborn baby’s Rh blood type. The mother’s body will develop antibodies against the baby’s blood and this can cause the baby’s brain to be damaged. Fortunately, testing for Rh incompatibility is a routine part of prenatal care in the U.S. Once detected, the condition can be treated and complications can be prevented.
Stroke in the unborn baby is another cause of CP, because strokes cause oxygen deprivation, leading to cell death and brain damage. Many people do not realize that babies can have strokes, but unborn babies are especially prone to the type of stroke which causes bleeding and they can also experience ischemic strokes—clots which block blood flow. High blood pressure or extremely low blood pressure in the mother can put the baby at high risk of stroke. Regular, quality prenatal care is vital for both the baby and the mother.
Women with mental retardation, gestational diabetes (diabetes which occurs only in pregnancy) or thyroid problems are also at greater risk for having a baby with CP. In addition, women with a seizure disorder are at high risk for having a baby with cerebral palsy. Being part of a multiple birth is also a risk factor for CP, as is low birthweight (even if the baby is full term).
Prognosis of Cerebral Palsy
The brain damage or brain malformations responsible for cerebral palsy do not grow worse with age, so the condition does not progress in this sense. With proper care, many CP patients live out a normal lifespan. However, the possible complications of CP can sometimes lead to life-threatening conditions, such as aspiration pneumonia or extreme malnutrition. The weak muscles of CP may grow weaker if the patient does not receive regular, appropriate physical therapy.
Treatment for Cerebral Palsy
Treatment for all forms of CP relies heavily on physical therapy. Physical therapy strengthens the muscles, prevents them from atrophying, and improves coordination. There are many forms of physical therapy used for CP. One controversial form, called conductive therapy or education, involves total immersion of the child in a regular, weekday education program aimed at improving the CP patient’s total quality of life.
Other newer therapies include hyperbaric oxygen therapy, suit therapy, and hippotherapy (horseback riding therapy). Alternative therapies such as massage or yoga also help some CP patients, but all therapies should only be done by a qualified, professional practitioner.
Medications are used to reduce spasticity and to control seizures when present. Medicine may also be used to deal with complications such as indigestion, poor appetite, acid reflux, constipation. Surgery is sometimes needed to correct bone deformities or scoliosis.
- “Cerebral Palsy: Hope Through Research” National Institute of Neurological Disorders and Stroke. Retrieved March 27, 2009 from the World Wide Web:https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebral-Palsy-Information-Page
- “Cerebral Palsy” March of Dimes. Retrieved March 28, 2009 from the World Wide Web:https://www.marchofdimes.org/complications/cerebral-palsy.aspx
- “Cerebral Palsy” MayoClinic.com Retrieved March 27, 2009 from the World Wide Web:http://www.mayoclinic.com/health/cerebral-palsy?DS00302
- Zach, Terrence, MD. and James C. Brown MD. “Periventricular Leukomalacias” updated February 14, 2008. eMedicine. Retrieved March 30, 2009 from the World Wide Web:https://emedicine.medscape.com/article/975728-overview