Cerebral palsy is a group of chronic disorders impairing control of movement that appear in the first few years of life and generally do not worsen over time. These disorders are caused by faulty development of or damage to motor areas in the brain that disrupts the brain's ability to control movement and posture.

Cerebral palsy may be congenital or acquired after birth. More than 80% of people with cerebral palsy developed it either before they were born or before they were a month old. In many instances, the cause of the brain abnormality is unknown.

Several of the causes of cerebral palsy that have been identified through research are preventable or treatable, including head injury, jaundice, Rh incompatibility, and rubella (German measles).

Some people with cerebral palsy are also affected by other medical disorders, such as seizures or mental impairment, but cerebral palsy does not always cause profound impairment.

Although its symptoms may change over time, cerebral palsy by definition is not progressive. If a patient shows increased impairment, the problem may be something other than cerebral palsy.

Each year, about 5,000 American babies and infants are diagnosed with cerebral palsy. Cerebral palsy isn't curable. However, getting the right therapy for your child can make a big difference in reducing the long-term impact of the condition.

There are four main types of cerebral palsy - spastic, athetoid, ataxic, and mixed.

• Spastic: People with spastic cerebral palsy have increased muscle tone. Their muscles are stiff. Their movements can be awkward. Seventy to eighty percent of people with cerebral palsy have spasticity. Spastic cerebral palsy is usually described further by what parts of the body are affected. In spastic diplegia, the main effect is found in both legs. In spastic hemiplegia, one side of the person's body is affected. Spastic quadriplegia affects a person's whole body (face, trunk, legs, and arms).

• Athetoid or dyskinetic: People with athetoid cerebral palsy have slow, writhing movements that they cannot control. The movements usually affect a person's hands, arms, feet, and legs. Sometimes the face and tongue are affected and the person has a hard time talking. Muscle tone can change from day to day and can vary even during a single day. Ten to twenty percent of people with cerebral palsy have the athetoid form of the condition.

• Ataxic: People with ataxic cerebral palsy have problems with balance and depth perception. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something. People with ataxic cerebral palsy can have increased or decreased muscle tone. Five to ten percent of people with cerebral palsy have ataxia.

• Mixed: Some people have more than one type of cerebral palsy. The most common pattern is spasticity plus athetoid movements.

Causes

Damage to areas of the brain that direct movement interferes with the brain's ability to control movement and posture. Cerebral palsy may develop before, during, or after birth.

Causes include:

• Brain tissue may not develop correctly during pregnancy. The growing fetus may experience a lack of oxygen or nutrients.

• Child sustains a head injury or brain infection.

• Mother's and baby's blood types are not compatible.

• Mother has rubella while pregnant.

• Stroke or bleeding occurs in the baby's brain during development or after birth.

• Baby is deprived of oxygen during or after birth.

• There are abnormalities of the umbilical cord or placenta, or the placenta separates too early from the wall of the uterus.

• Child has meningitis, encephalitis, seizures, or head injury.

• Genetic/metabolic abnormalities

• Unknown

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

• Infection or blood clotting problems during pregnancy

• Vaginal bleeding during the last three months of pregnancy

• Protein in the expectant mother's urine

• Expectant mother has an overactive thyroid, seizures, or mental retardation.

• Complicated or premature delivery

• Breech birth

• Low Apgar score (a rating of the baby's condition just after birth)

• Low birth weight

• Premature birth

• Multiple births, twins, or triplets.

• Small head

• Seizures

Symptoms

Symptoms of cerebral palsy include difficulty with fine motor tasks (such as writing or using scissors), difficulty maintaining balance or walking, and involuntary movements. The symptoms differ from person-to-person and may change over time.

Cerebral palsy first shows up in children age three and younger. Symptoms vary depending on what areas of the brain have been affected. Some children may have severe disabilities. Although symptoms may change as the child grows older, his or her condition is not likely to worsen.

Symptoms include:

• Late to turn over, sit up, smile, or walk

• Trouble writing, closing a button, or other fine motor activities

• Difficulty walking or standing

• Tight, spastic muscles

• Weak muscles

• Poor balance

• Speech problems

• Tremors

• Unintended body movements

• Difficulties with sucking, swallowing.

• Drooling

Some people with cerebral palsy suffer from other medical disorders as well, including:

• Seizures

• Mental retardation

• Learning disabilities

• Vision or hearing problems

• Failure to thrive

• Decreased ability to feel pain or identify items by touch

• Problems with bowel and bladder control

• Breathing problems

• Skin breakdown

Diagnosis

Doctors diagnose cerebral palsy by testing motor skills and reflexes, looking into medical history, and employing a variety of specialized tests.

Tests may include:

Electroencephalogram (EEG) – a test that records the brain's activity by measuring electrical currents through the brain

CT Scan – a type of x-ray that uses a computer to make pictures of structures inside the body

Ultrasound– a test that uses sound waves to make pictures of structures inside the body

MRI Scan– a test that uses magnetic waves to make pictures of structures inside the body

Treatment

There is no treatment to cure cerebral palsy. The brain damage cannot be corrected. Therapy aims to help the child reach his or her full potential. Children with CP grow to adulthood and may be able to work and live independently.

Prevention

Several of the causes of cerebral palsy that have been identified through research are preventable or treatable:

• Before getting pregnant, receive a vaccination for rubella.

• Seek out early prenatal care.

• Receive testing for blood-type problems and treatment if tests reveal incompatible blood types.

• Do not smoke, drink alcohol, or use drugs while pregnant.

• Put the baby in a child safety seat when in the car.

• Insist that the child wear a helmet when on a bicycle.

• Seek help if you have or want to hurt the child.

• Prevent access to poisons.

• Closely supervise bathing.

• Get your child immunized at the recommended time.

• Seek medical care when the baby becomes sick.

RESOURCES:

Cerebral Palsy Information
http://www.cerebralpalsyinfo.org

United Cerebral Palsy
http://www.ucpa.org

References:

Batshaw ML. Children with disabilities (4th edition). Baltimore, MD: Paul H. Brookes Publishing Co.; 1997.

Geralis E (Editor). Children with cerebral palsy: a parents' guide. Rockville, MD: Woodbine House; 1991.

Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities website. Available at: http://www.cdc.gov/ncbddd/dd/ddcp.htm.

Hazneci B, Tan AK, Guncikan MN, Dincer K, Kalyon TA. Comparison of the efficacies of botulinum toxin A and Johnstone pressure splints against hip adductor spasticity among patients with cerebral palsy: a randomized trial. Mil Med. Jul 2006;171(7):653-6.

March of Dimes Birth Defects Foundation website. Available at: http://www.marchofdimes.com/.

Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/cerebralpalsy.html.

National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/.

Nolan KW, Cole LL, Liptak GS. Use of botulinum toxin type A in children with cerebral palsy. Phys Ther. Apr 2006;86(4):573-84.

Park ES, Park CI, Chang HC, Park CW, Lee DS. The effect of botulinum toxin type A injection into the gastrocnemius muscle on sit-to-stand transfer in children with spastic diplegic cerebral palsy. Clin Rehabil. Aug 2006;20(8):668-74.

Steinbok P. Selection of treatment modalities in children with spastic cerebral palsy. Neurosurg Focus. Aug 2006;15;21(2):e4.

UCP Child Development Centers website. Available at: http://www.ucpa.org.