Cerebral palsy

What is cerebral palsy?

Cerebral palsy (CP) is a broad term that describes a group of neurologic (brain) disorders. It is a life-long condition that affects the communication between the brain and the muscles, causing a permanent state of uncoordinated movement and posturing. Cerebral palsy may be the result of an episode that causes a lack of oxygen to the brain.

What causes cerebral palsy?

Many cases of CP have unknown causes. The disorder occurs when there is abnormal development or damage to areas in the brain that control motor function. It occurs in approximately two out of every 1,000 live births. CP is more commonly seen in boys, multiple births, and in African-Americans. Risk factors for CP include the following:

• Prematurity.
• Very low birthweight (especially in babies weighing less than 1,000 grams, or 2.2 lbs.).
• Viruses.
• Chemical/substance abuse during pregnancy.
• Infection.
• Bleeding in the brain.
• Trauma.
• Complications of labor and delivery.

What are the symptoms of cerebral palsy?

The following are the most common symptoms of CP. However, each child may experience symptoms differently. The child may have muscle weakness, poor motor control, or have shaking, also called spasticity, of the arms or legs. Muscle stiffness in the form of stiff legs or clenched fists may also be seen. Cerebral palsy is classified according to the kind of motor function the child may have, including the following:

• Spastic diplegia ("di" - means two) - spastic movements of the arms or legs. Diplegia is also called paraplegia.
• Spastic quadriplegia ("quad" means four) - spastic movements in all four limbs (arms and legs).
• Spastic hemiplegia ("hemi" means half) - spasticity affecting one half, or side, of the body (such as right arm and right leg).
• Spastic double hemiplegia - spasticity in both sides of the body, but the amount of shaking is different when comparing the right side to the left side.
• Athetoid - involuntary (unable to control), purposeless, and rigid movement.

Children with cerebral palsy may have additional problems, including the following:

• Seizures.
• Vision, hearing, or speech problems.
• Learning disabilities and behavior problems.
• Mental retardation.
• Respiratory problems.
• Bowel and bladder problems.
• Bone abnormalities, including scoliosis (a lateral, or sideways, curvature and rotation of the back bones, giving the appearance that the person is leaning to one side).

Babies with CP are often slow to reach developmental milestones, such as learning to roll over, sit, crawl, or walk. They may also have certain reflexes present that normally disappear in early infancy. The symptoms of CP may resemble other conditions. Always consult your child's physician for a diagnosis.

How is cerebral palsy diagnosed?

The diagnosis of CP is made with a physical examination. During the examination, the physician obtains a complete prenatal and birth history of the child. The diagnosis of CP is not usually made until the child is at least 6 to12 months old. This is the time when the child should be achieving developmental milestones, such as walking, and hand and head control. Diagnostic tests may include the following:

Neurologic examination - to evaluate reflexes and brain/motor function.

X-rays - a diagnostic test which uses electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Feeding studies

Electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp.

Blood tests

Gait lab analysis - to evaluate the walking pattern of the child.

Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.

Computerized tomography scan (Also called CAT or CT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Genetic studies - diagnostic tests that evaluate for conditions that have a tendency to run in families.

Metabolic tests - diagnostic tests that evaluate the absence or lack of a specific enzyme (for example, amino acids, vitamins, carbohydrates) that are necessary to maintain the normal chemical function of the body.

Treatment of cerebral palsy

Specific treatment for cerebral palsy will be determined by your child's physician based on:

• Your child's age, overall health, and medical history.
• The extent of the condition.
• The type of CP.
• Your child's tolerance for specific medications, procedures, or therapies.
• Expectations for the course of the disease.
• Your opinion or preference.

Since CP is a life-long condition that is not correctable, management includes focusing on preventing or minimizing deformities and maximizing the child's capability at home and in the community. A child is best treated with an interdisciplinary team that may include the following healthcare providers:

• Pediatrician/family practitioner.
• Orthopaedic surgeon - a surgeon who specializes in conditions of the muscles, ligaments, tendons, and bones.
• Neurologist - a physician who specializes in conditions of the brain, spinal cord, and nerves.
• Neurosurgeon - a surgeon who specializes in operating on the brain and spinal cord.
• Ophthalmologist - a physician who specializes in eye problems.
• Dentist.
• Nurse.
• Orthotist - an individual who specializes in making braces and splints.
• Rehabilitation team (i.e., physical, occupational, speech therapy, audiology).

Management of CP includes non-surgical and surgical options. Non-surgical interventions may include:

• Rehabilitation.
• Positioning aids (used to help the child sit, lie, or stand).
• Braces and splints (used to prevent deformity and to provide support or protection).
• Medications (used to help control seizures or to decrease spasticity in the muscles; the medications may be given by mouth or as an injection).

Surgical interventions may be used to manage the following conditions:

• Orthopaedic problems that may include managing curvatures in the back, hip dislocations, ankle and foot deformities, and contracted muscles
• Spasticity

Long-term outlook for the child with cerebral palsy

Since CP is a life-long condition that is not correctable, management includes focusing on preventing or minimizing deformities and maximizing the child's capabilities at home and in the community. Positive reinforcement will encourage the child to strengthen his/her self-esteem and promote as much independence as possible.

The full extent of the problems is usually not completely understood immediately after birth, but may be revealed as the child grows and develops.