Definition

Cerebral palsy (CP) is a group of chronic disorders that affect the ability to control movement. It appears in the first few years of life. Generally, the disorders do not worsen over time.

Causes

CP occurs due to damage to areas of the brain that direct movement. This damage interferes with the brain's ability to control movement and posture. CP may develop before, during, or after birth.

Causes include:

    
  • Brain tissue that may not develop correctly during pregnancy—growing fetus may experience a lack of oxygen or nutrients
  • Child sustains a head injury or brain infection
  • Mother and child'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
  • Child does not get enough 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
  • Child has genetic/metabolic abnormalities

    • Risk Factors

    Factors that increase the risk of CP include:

        
  • Infection or blood clotting problems during pregnancy
  • Vaginal bleeding during pregnancy
  • Seizures or intellectual disability in the expectant mother
  • Complicated or premature delivery
  • Cord prolapse
  • Breech birth
  • Low Apgar score—a rating of the child's condition just after birth
  • Low birth weight
  • High birth weight
  • Type 1 diabetes in the expectant mother
  • Premature birth
  • Multiple births, such as twins or triplets
  • Small head
  • Seizures
  • In vitro fertilization (IVF) —in part due to multiple births associated with IVF

    • Symptoms

    Symptoms of CP vary widely. They may include difficulty with fine motor tasks like writing or using scissors difficulty maintaining balance or walking, and involuntary movements. The symptoms differ from person to person and may change over time.

    CP first shows up in children aged three years or younger. Symptoms vary depending on what areas of the brain are affected. Some children may have severe disabilities. Although symptoms may change as the child grows older, the child's condition is unlikely to worsen.

    Symptoms include:

        
  • Late to turn over, sit up, smile, or walk
  • Trouble writing, buttoning a button, or other fine motor activities
  • Difficulty walking or standing
  • Tight, spastic muscles
  • Weak muscles
  • Poor balance
  • Speech problems
  • Tremors
  • Unintentional body movements
  • Difficulty swallowing
  • Drooling

    • Some people with CP suffer from other medical disorders as well, including:

        
  • Seizures
  • Intellectual disability
  • 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 if food or water has accidentally entered the lungs
  • Skin breakdown
  • Low bone density and fractures

    • Diagnosis

    Doctors diagnose CP by testing motor skills and reflexes, looking into medical history, and using a variety of specialized tests.

        
  • You may have your brain's electrical activity tested. This can be done with an Electroencephalogram (EEG).
  • You may have pictures taken of structures inside your head. This can be done with:    
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan

    • MRI Scan

    MRI of the Brain

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    Treatment

    There is no treatment to cure CP. 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.

    Medication

    Drugs help control muscle spasms and seizures.

        
  • Glycopyrrolate—to decrease drooling
  • Pamidronate—to treat osteoporosis
  • Medicines that may be used to treat spasticity:     
  • Botulinum toxin
  • Baclofen
  • Diazepam
  • Tizanidine

    • Surgery

    Certain operations may improve the ability to sit, stand, and walk.

    Physical Aids

    Braces and splints help keep limbs in correct alignment and prevent deformities. Positioning devices enable better posture. Walkers, special scooters, and wheelchairs make it easier to move around.

    Special Education

    Programs designed to meet the child's special needs may improve learning. Some children do well attending regular schools with special services. Vocational training can help prepare young adults for jobs.

    Rehabilitation Services

    Speech, physical, and occupational therapies may improve the ability to speak, move, walk, and perform activities of daily living. Physical therapy helps strengthen muscles. Children can learn different ways to complete difficult tasks.

    Family Services

    Professional support helps a patient and family cope with CP. Counselors help parents learn how to modify behaviors. Caring for a child with CP can be stressful. Some families find support groups helpful.

    Other Treatment

    Therapeutic electrical stimulation might help.

    Prevention

    Several of the causes of CP 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. Get 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 riding a bicycle.
  • Seek help if you have, or want to, hurt the child.
  • Keep poisons away from your child.
  • Closely supervise bathing.
  • Get your child immunized at the recommended time.
  • If your baby becomes sick, call the doctor right away.