Cerebral Palsy

What is cerebral palsy?

Cerebral palsy is a group of conditions that is caused by damage to a developing brain. The damage typically occurs before birth and affects a person’s movement and posture. Cerebral palsy symptoms and effects differ for each person, along with the best treatment plan. Many individuals can live longer and fuller lives due to all the medical and technological advances.

How common is cerebral palsy?

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Cerebral palsy is considered uncommon, but not rare, with up to 10,000 babies born each year who will later be diagnosed with the group of disorders. Nearly 1,500 children will be diagnosed in later years when there are noticeable delays in walking or movement. The group of conditions affect nearly one million people in the United States.

What are the types of cerebral palsy?

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There are three main types of cerebral palsy, including:

  • Spastic (muscle tightness and spasms)
  • Dyskinetic (muscle control issues)
  • Mixed (features of both spastic and dyskinetic types)

 

There are subtypes of cerebral palsy that are based on the affected part of the individual’s body. Patterns include:

  • Quadripeligic (all the limbs are affected)
  • Monoplegic (one limb is affected)
  • Paraplegic (the legs are affected)
  • Diplegic (arms are more affected than legs)
  • Hemiplegic (the left or right side of the body is more affected than the other)

 

Spastic CP is the most common type of cerebral palsy and affects roughly 80% of people with a CP diagnosis. Stiff muscles and awkward movements are common with spastic CP.

A diagnosis of dyskinetic CP means that it is difficult for people when it comes to controlling the movement of their:

  • Hands
  • Arms
  • Feet
  • Legs

Dyskinetic CP includes athetoid, choreoathetoid, and dystonic cerebral palsies, resulting in uncontrollable movements that may be slow and writhing or rapid and jerky. Dyskinetic CP sometimes affects the face and tongue, making it difficult to:

  • Suck
  • Swallow
  • Speak

There is also ataxic CP, which influences a person’s balance and coordination. Ataxic cerebral palsy is characterized by unsteadiness when a person walks and having a hard time with quick movements or controlled movements, such as writing.

If you notice these characterizations in your child or a loved one, speaking with a healthcare provider is the first step toward getting answers and a possible referral to a CP specialist.

What are symptoms of cerebral palsy?

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Symptoms of cerebral palsy depend upon the exact type of CP and what area of the body is affected by the conditions. Movement and coordination symptoms can include:

  • Stiff muscles and exaggerated reflexes (spasticity)
  • Uncontrolled jerky movements (tremors)
  • Lack of balance and muscle coordination (ataxia)
  • Trouble walking (crouching while walking, walking on toes, wide gait)
  • Difficulty with fine motor skills (picking up utensils, buttoning clothes)
  • Variations in muscle tone (too stiff, too floppy)
  • Stiff muscles with regular reflexes (rigidity)
  • Favoring one side of the body (reaching with one hand, dragging a leg while crawling)
  • Slow, writhing movements

 

Common speech and eating symptoms include delays in speech development or trouble speaking and/or difficulty eating or drooling or trouble with swallowing. Some of the typical development symptoms in children range from experiencing delays in hitting motor skills milestones and delayed growth to learning disabilities and intellectual disabilities.

There are other possible symptoms that can be attributed to brain damage introducing other neurological symptoms. These may include:

  • Seizures as a symptom of epilepsy
  • Trouble hearing
  • Vision trouble and changes in eye movements
  • Emotional conditions and behavioral issues
  • Bladder and bowel issues (constipation, urinary incontinence)
  • Pain or trouble feeling sensations (touch)

 

Children with CP might be diagnosed with epilepsy. Speak to their primary care provider once you notice any signs of these or worsening conditions that can be linked to cerebral palsy.

When should you see a doctor about cerebral palsy?

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Contacting your child’s healthcare provider should be done immediately if you notice:

  • Symptoms of a movement condition
  • Delays in development
  • Episodes of loss of awareness
  • Irregular bodily movements or posture
  • Trouble swallowing
  • Poor coordination
  • Eye muscle imbalance

 

Immediate intervention can result in a swifter diagnosis and developing a treatment plan to provide the best quality of life for your child.

How is cerebral palsy diagnosed?

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A trained healthcare provider can detect the earliest signs of CP that the average person or parent would not know to look for in a child. Bringing your baby for regular check-ups with a pediatrician can lead to earlier diagnosis by using a combination of methods.

Doctors may suspect cerebral palsy before a baby reaches 12 months old but wait to make an official diagnosis until a baby is between 18 and 24 months old. Your child’s provider can make a diagnosis by using:

  • A physical and neurological exam
  • Specialized assessment checklists
  • Imaging scans and magnetic resonance imaging (MRI)

 

A doctor will explain their recommended tests and why each one might be necessary depending on your child’s symptoms.

What are the causes of cerebral palsy?

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Irregular brain development or damage to the developing brain causes cerebral palsy at three possible stages, which are:

  • Before birth
  • At birth
  • In early infancy

 

The precise cause is often unknown, particularly since a multitude of factors can cause changes to a person’s brain development. These include:

  • Gene changes
  • Maternal infections (affecting unborn babies)
  • Stroke
  • Brain bleeds
  • Lack of oxygen
  • Infant infections
  • Traumatic head injury

What are cerebral palsy risk factors?

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There are a number of risk factors that can increase the likelihood of a child developing cerebral palsy. Speaking with your doctor beforehand and trying to provide full medical and family history may go a long way toward identifying relevant risk factors.

 

Maternal Health

The risk of a baby developing cerebral palsy can significantly increase if you experience certain infections or toxic exposures during a pregnancy.

  • Cytomegalovirus (a common virus with flu-like symptoms)
  • Herpes
  • Syphilis
  • German measles (rubella)
  • Toxoplasmosis
  • Intrauterine infections
  • Zika virus infection (spread through mosquito bites)
  • Exposure to methyl mercury (or certain other toxins)

 

There are slightly elevated risks associated with a baby having cerebral palsy if their mother has a history of thyroid conditions, preeclampsia, or seizures.

Infant Illnesses

  • Bacterial meningitis
  • Viral encephalitis
  • Bleeding into the brain
  • Severe or untreated jaundice

 

Pregnancy and Birth Factors

  • Low birth weight. The risk of cerebral palsy increases as the birth weight drops. Babies who weigh less than 5.5 pounds are at a higher risk of developing CP.
  • Premature birth. There is a greater cerebral palsy risk the earlier that a baby is born.
  • Delivery complications. Labor and delivery events can influence a baby’s risk of CP.
  • Multiple babies. The risk of CP increases with the number of babies sharing a uterus, potentially relating to the greater likelihood of premature birth and a low birth weight. A baby’s risk of CP can also increase if one or more of the babies dies.

It is understandable that these risks would raise alarm or cause fears in first-time or expecting parents. Speaking to a doctor about your medical history and asking them any questions is a good way to alleviate your concerns or any uncertainty.

What are common cerebral palsy complications?

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Understanding how muscle weakness, muscle spasticity, and trouble with coordination can affect a child in the long term will provide insight into how they can live with cerebral palsy. Complications in childhood or adulthood include:

  • Muscle tissue shortening (contracture). Contracture can slow bone growth and result in bones bending, which often results in joint changes, dislocation, or partial dislocation.
  • Malnutrition. Not getting enough nutrition as an infant can impair growth and weaken a child’s bones. Some children and adults may need a feeding tube.
  • Heart and lung disease. Difficulty with swallowing can lead to respiratory issues like aspiration pneumonia — or inhaling food, drink, saliva, or vomit into the lungs.
  • Osteoarthritis and/or osteoporosis. Pressure on or misalignment of joints and/or bone fractures are all possible complications of cerebral palsy due to muscle spasticity and/or low bone density.
  • Mental health conditions. Depression, social isolation, and difficulty when it comes to coping with disabilities are common in people living with CP.

 

There may be other issues that you or a loved one need to discuss with a doctor as cerebral palsy progresses. Additional complications that a person may encounter include:

  • Sleep conditions
  • Chronic pain
  • Skin breakdown
  • Intestinal issues
  • Poor oral health

How can you prevent cerebral palsy?

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There is often little that can be done to prevent cerebral palsy, but steps can be taken to reduce the risk of it in children. Taking the following steps if you are or plan to become pregnant can be ways to better ensure a safe and healthy birth.

  • Get vaccinated
  • Take care of yourself
  • Receive early and ongoing prenatal care
  • Avoid alcohol, tobacco, and illegal drugs

 

To avoid a rare instance of CP caused by brain damage in childhood, there are certain best practices. Reduce the risk of head injuries by ensuring that your child sits in a car seat and always wears a bicycle helmet.

Is there treatment for cerebral palsy?

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How a doctor treats CP will depend on a handful of factors, such as severity, symptoms, and how those symptoms affect the individual. A team of professionals is usually involved for any well-rounded CP treatment plan. Your loved one’s treatment options might include:

  • Medications (to treat seizures, spasticity, or other effects)
  • Physical and occupational therapy (to build strength and mobility)
  • Speech therapy (to improve communication)
  • Mental health therapy (with a therapist or counselor)
  • Surgeries (to reduce muscle spasms, correct joint/spine problems, control brain activity)
  • Social work and educational support

 

Learning about all of the available options for your child is an active and worthwhile approach to navigating cerebral palsy. Your child’s doctor might find that a certain combination of treatments is the best path forward for a well-rounded life.

What is the outlook for people living with cerebral palsy?

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Cerebral palsy is a permanent, lifelong condition. Even without a cure, the outlook for cerebral palsy varies from person-to-person. Medical care, supportive treatments, and ongoing medical and technological innovations have altered the landscape of what life with CP looks like.

There is a longer life expectancy for people living with CP, including those who have moderate or severe cases. A healthcare provider is the best person to explain a person’s life expectancy and the factors associated with CP that can affect that estimate.

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