Cerebral Palsy

Cerebral palsy (CP) is a broad term that describes a group of non-progressive neurological (brain) injuries. This condition affects the communication between the brain and the muscles. It is an improving condition causing increased muscle tone and posturing may result from several problems, such as lack of oxygen to the brain, genetic conditions, infections, brain hemorrhage, severe cases of jaundice and injury to the head.

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 three out of every 1,000 live births. Risk factors for CP include the following:

•    Prematurity
•    Blood clotting disorders
•    Very low birthweight (especially in babies weighing less than 3.3 lbs.)
•    Viruses
•    Chemical or substance abuse during pregnancy
•    Infection
•    Bleeding in the brain
•    Trauma

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 poor muscle control with 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 (or dyskinetic). Involuntary (unable to control), purposeless and rigid movement
•    Ataxic. Affects balance, leading to an unsteady gait, and motions, which require fine coordination, such as writing

Children with CP may have additional problems, including:

•    Seizures
•    Vision, hearing or speech problems
•    Learning disabilities and behavior problems
•    Intellectual disability
•    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.

How is cerebral palsy diagnosed?

The diagnosis of CP is made with a physical examination. During the examination, the doctor 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 to 12 months old. This is the time when the child should be achieving developmental milestones, such as walking, and hand and head control. However, approximately half of the children suspected to have CP at 12 months appear to grow out of it by age 2. Diagnostic tests may include:

•    Neurological examination. This is to evaluate reflexes and brain and motor function.
•    X-rays. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. Learn more about having an X-ray.
•    Feeding studies. Learn more about the CHOC Feeding Program.
•    Electroencephalogram (EEG). A procedure that records the brain’s continuous, electrical activity by means of electrodes attached to the scalp. Learn more about having an EEG.
•    Blood tests
•    Gait lab analysis. This is to evaluate the walking pattern of the child.
•    Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. Learn more about having an MRI.
•    Computed tomography scan (also called CAT or CT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce images of the body. Learn more about having a CT scan.
•    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.

How is cerebral palsy treated?

Management of cerebral palsy 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 health care providers:

•    Pediatrician/family practitioner
•    Orthopedic surgeon
•    Neurologist
•    Neurosurgeon
•    Ophthalmologist
•    Dentist
•    Nurse
•    Orthotist
•    Rehabilitation team (for example, physical, occupational, speech therapy, audiology)

Management of CP includes nonsurgical and surgical options. Nonsurgical interventions may include:

•    Rehabilitation. Learn more about Rehabilitation Services at CHOC.
•    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). Learn more about our medications for spasticity, including baclofen and Botox injections.
•    Orthopaedic surgery for correction and prevention of deformity that may include managing curvatures in the back, hip dislocations, ankle and foot deformities, and contracted muscles