Cerebral Palsy

1 What is Cerebral Palsy?

Cerebral palsy is a disorder of movement, muscle tone or posture, caused due to damage to the brain during its development usually before birth. The signs and symptoms usually appear during infancy. Cerebral palsy can cause impaired movement often accompanied by exaggerated reflexes, stiffness or rigidity of the limbs and trunk, abnormal posture, involuntary movements and unsteadiness of walking.

The functional abilities of people with cerebral palsy vary. Some people are able to walk while some are not. Some people may have normal to near normal intellectual function while some may have disabled intellectual function. Difficulty in swallowing, imbalance of eye muscle, seizures, blindness or deafness may be present in people with cerebral palsy. People with cerebral palsy have muscle stiffness that results in reduced joint movements.

2 Symptoms

Movement and coordination problems are the main symptom of cerebral palsy.

Movement and coordination problems in cerebral palsy are:

  • Variations in muscle tone; either stiffness or floppiness
  • Stiff muscles with either exaggerated reflexes (spasticity) or normal reflexes (rigidity)
  • Ataxia (Lack of muscle coordination)
  • Involuntary movements or tremors
  • Athetosis (slow, writhing movements)
  • Delayed motor skills 
  • Favoring one side of the body such as, reaching with only one hand or dragging a leg while crawling.
  • Difficulty walking such as a stooped posture (crouched gait)
  • Excessive drooling or problems with swallowing
  • Delayed speech development or difficulty speaking
  • Intellectual disabilities
  • Difficulty with vision and hearing
  • Seizures
  • Impaired touch or pain sensation
  • Urinary incontinence (inability to hold urine)
  • Mental health problems

The disability may be confined to one limb or one side of the body or whole body may be affected. Since the brain disorder doesn't change with time, symptoms don't worsen with age. However, muscle shortening and rigidity worsens with age and hence aggressive treatment is required.

3 Causes

The abnormality in brain development, usually before child birth, causes cerebral palsy. However, the exact reason for this abnormality isn't identified. The causes of abnormal brain development are:

  • Maternal infections that affect the developing fetus.
  • Mutation of genes that control brain development. 
  • Traumatic head injury to an infant.
  • Disruption of blood supply to the developing brain, fetal stroke.
  • Asphyxia (lack of oxygen to the brain) associated with difficult labor.
  • Inflammation of the brain due to infections.

4 Making A Diagnosis

The doctor will also perform physical evaluation. Your child might be referred to pediatric neurologist (doctor trained in treating children with brain and nervous system conditions).

Your doctor is likely to ask following questions:

  • What concerns do you have about your child's growth or development?
  • Does your child eat well?
  • Is your child responsive to touch?
  • Have you noticed your child favoring one side of the body?
  • Can your child roll over, sit up, crawl, walk or speaking?

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

  • List out all the symptoms.
  • Do we need any diagnostic test?
  • Do we need to consult specialists?
  • How commonly do we need to monitor the disorders?
  • How are the disorders associated with cerebral palsy screened?
  • How will you monitor my child's health and development?

Some of the tests that are likely to be recommended are:

  • Brain scans: Imaging tests such as MRI, can detect areas of damage in brain.
  • Magnetic resonance imaging (MRI) often identifies lesions or abnormalities in your child's brain. Since the test is noisy and take up to an hour to complete, you child is likely to receive mild sedative before the test. 
  • Cranial ultrasound: It uses high-frequency sound waves to obtain images of the brain. This test is usually performed during infancy.
  • Computerized tomography (CT) scan: It uses numerous X-ray images to create detailed image of the brain and help to identify abnormalities in the brain. The child may receive mild sedative since s/he needs to be still.
  • Electroencephalogram (EEG): EEG is performed to determine if your child has seizure associated with cerebral palsy. EEG records the electrical activity of your child's brain. If your child is epileptic, the normal pattern of brain waves changes.
  • Laboratory tests: Your child's blood may be checked for blood-clotting disorders that might cause stroke which can be mistaken for cerebral palsy. Blood tests may be used to detect genetic or metabolic problems.
  • Additional tests: These tests are useful to detect vision impairment, hearing impairment, delayed speech or intellectual disabilities.

5 Treatment

Your child's cerebral palsy may be treated by a medical team. Medical team includes pediatric neurologist (specialist in diagnosing and treating children with neurological disorders), orthopedic surgeon (specialists in treating muscle and bone disorders), physical therapist (specialist to improve strength and walking skills of your child), occupational therapist (specialists who helps to develop daily skills and teach your child to use adaptive product), speech-language pathologist (specialist in diagnosing and treating speech and language disorders in your child), developmental therapist (specialist to help your child develop age-appropriate behaviors, social skills and interpersonal skills) and mental health specialist. The medical team may include:

 A social worker who helps your family in finding services and planning for transitions in care.
 Special education teacher who addresses learning disabilities, determines educational needs and identifies appropriate educational resources.

Medications are given to improve functional abilities, treat pain and control complications of cerebral palsy. Discuss with your doctor to know which medications are appropriate and what are their side effects. The selection of medications depends on whether certain muscles (isolated) or the whole body (generalized) is affected. Drug treatments include:

  • Isolated spasticity: When certain muscle is affected, injection of onabotulinumtoxin A (Botox) is directly injected into the affected muscle, nerve or both every 3 months. This injection is associated with pain, bruising, severe weakness and difficulty swallowing and breathing.
  • Generalized spasticity: Drugs that relax stiffened muscles are given if muscles of whole body are affected. These drugs include diazepam, dantrolene and baclofen. Diazepam can cause dependence hence long-term use is not recommended. Other side effects include drowsiness, weakness and drooling. Side effects of dantrolene are sleepiness, nausea and/or diarrhea. Side effects of baclofen include sleepiness, confusion and nausea. Medications like trihexyphenidyl, scopolamine or glycopyrrolate are used to reduce drooling. 

Functional abilities are improved with the help of non-drug therapies which include:

  • Physical therapy: Muscle training and exercises can improve child's strength, flexibility, balance, motor development and mobility.
  • Occupational therapy: Occupational therapists can encourage your child's independent participation in daily activities.
  • Speech and language therapy: Speech-language pathologist improves your child's ability to speak clearly or use sign language. Speech therapists may also treat difficulties with muscles involved in eating and swallowing
  • Recreational therapy: Some children, with the help of recreational therapies like horseback riding, may improve your child's motor skills, speech and emotional well-being.
  • Surgical or other procedures: Usually bone abnormalities are corrected by surgery. The treatment options include:

 Orthopedic surgery: Severe contractures or deformities may need surgery to correct their positions. Surgical procedures lengthen muscles and tendons that have shortened. Surgery helps to reduce pain and improve mobility.

 Selective dorsal rhizotomy: It is a procedure in which nerves serving the spastic muscles are cut. This helps to relax muscles and reduce pain but may result in numbness.

Your child may be treated by a medical team which includes pediatric neurologist (specialist in diagnosing and treating children with neurological disorders), orthopedic surgeon (specialists in treating muscle and bone disorders), physical therapist (specialist to improve strength and walking skills of your child), occupational therapist (specialists who helps to develop daily skills and teach your child to use adaptive product), speech-language pathologist (specialist in diagnosing and treating speech and language disorders in your child), developmental therapist (specialist to help your child develop age-appropriate behaviors, social skills and interpersonal skills) and mental health specialist. The medical team may include:

 A social worker who helps your family in finding services and planning for transitions in care.

 Special education teacher who addresses learning disabilities, determines educational needs and identifies appropriate educational resources.

Medications are given to improve functional abilities, treat pain and control complications of cerebral palsy. Discuss with your doctor to know which medications are appropriate and what are their side effects. The selection of medications depends on whether certain muscles (isolated) or the whole body (generalized) is affected. Drug treatments include:

  • Isolated spasticity: When certain muscle is affected, injection of onabotulinumtoxin A (Botox) is directly injected into the affected muscle, nerve or both every 3 months. This injection is associated with pain, bruising, severe weakness and difficulty swallowing and breathing.
  • Generalized spasticity: Drugs that relax stiffened muscles are given if muscles of whole body are affected. These drugs include diazepam, dantrolene and baclofen. Diazepam can cause dependence hence long-term use is not recommended. Other side effects include drowsiness, weakness and drooling. Side effects of dantrolene are sleepiness, nausea and/or diarrhea. Side effects of baclofen include sleepiness, confusion and nausea. Medications like trihexyphenidyl, scopolamine or glycopyrrolate are used to reduce drooling. 

Functional abilities are improved with the help of non-drug therapies which include:

  • Physical therapy: Muscle training and exercises can improve child's strength, flexibility, balance, motor development and mobility.
  • Occupational therapy: Occupational therapists can encourage your child's independent participation in daily activities.
  • Speech and language therapy: Speech-language pathologist improves your child's ability to speak clearly or use sign language. Speech therapists may also treat difficulties with muscles involved in eating and swallowing
  • Recreational therapy: Some children, with the help of recreational therapies like horseback riding, may improve your child's motor skills, speech and emotional well-being.
  • Surgical or other procedures: Usually bone abnormalities are corrected by surgery. The treatment options include:

 Orthopedic surgery: Severe contractures or deformities may need surgery to correct their positions. Surgical procedures lengthen muscles and tendons that have shortened. Surgery helps to reduce pain and improve mobility.

 Selective dorsal rhizotomy: It is a procedure in which nerves serving the spastic muscles are cut. This helps to relax muscles and reduce pain but may result in numbness.

6 Prevention

In most of the cases, the risk of cerebral palsy can be reduced but it can't be prevented. If you're pregnant or planning to become pregnant, following tips helps in minimization of complication of pregnancy:

  • Get vaccinated against disease such as, rubella that can damage fetal brain.
  • Being healthier during pregnancy lessens the risk of developing infection that may result in cerebral palsy in fetus.
  • Get early and continuous prenatal care.
  • Practice good child safety and take good care of yourself.
  • Prevent head injuries in your child.

7 Lifestyle and Coping

Following tips can be helpful to cope up to with Cerebral palsy:

  • Encourage your child to be independent. Provide constant support to your child.
  • Join a support group. Support groups and counseling can help your child to deal with new challenges.

8 Risks and Complications

There are various factors that increase risk of cerebral palsy. They include the factors in the mother (Maternal health), in the infant (Infant health) or others.

Maternal health: The risk of cerebral palsy in child increases if a pregnant woman suffers from certain infections or health problems. Some infections that are likely to increase the risk of cerebral palsy are:

  • German measles (rubella): It is a viral infection that can cause serious birth defects. Vaccination can prevent it.
  • Chickenpox (varicella): It is highly contagious viral infection that causes serious pregnancy complication. The virus causes itching and rashes. It can be prevented with a vaccine.
  • Cytomegalovirus: This viral infection cases flu-like symptoms and lead to birth defects.
  • Toxoplasmosis: It is a parasitic infection caused by parasites that are usually present in contaminated food, soil and the feces of infected cats.
  • Syphilis: It is a sexually transmitted bacterial disease.
  • Exposure to toxins like methyl mercury increases the chances of birth defects.
  • Other conditions like thyroid problems or seizure can also increase risk of cerebral palsy

Infant illness: Illness in neonates is associated with increased risk of cerebral palsy. These illness are:

  • Bacterial Meningitis: It is inflammation of covering of brain and spinal cord caused due to bacterial infections.
  • Viral encephalitis: It is inflammation of covering of brain and spinal cord caused due to viral infections.
  • Severe untreated jaundice: Jaundice is a condition that causes yellow discoloration of skin. Jaundice occurs when kidneys do not filter the byproducts of worn out blood cells from the blood stream.

Other factors related with increased risk of cerebral palsy are:

  • Premature Birth: Babies who are born in lesser than 37 weeks instead of 40 weeks have high risk of cerebral palsy.
  • Low birth weight: Babies with lower weight, less than 5.5 pounds, have increased chances of developing cerebral palsy
  • Breech births: It is found that babies with cerebral palsy have breech birth (feet-first instead of head-first during birth).
  • Multiple babies: Greater the number of babies sharing uterus, higher the risk of developing cerebral palsy. Death of one or more babies increases the chances of having cerebral palsy in the survivors.

Complications

  • Contracture: Severe contraction of muscle results in contracture (shortening of muscle tissue). Contracture inhibits bone growth and causes bones to bend resulting in joint deformities, dislocation or partial dislocation.
  • Malnutrition: Difficulty in swallowing may result in malnutrition, especially in an infant. Malnutrition may result in impaired growth and weaker bones.
  • Mental health condition: People with cerebral palsy often suffer from depression.
  • Lung disease: Lung disease and breathing disorders may be complications of cerebral palsy.
  • Neurological conditions: Movement disorders or worsened neurological symptoms could be complications of cerebral palsy.
  • Osteoarthritis: Osteoarthritis, painful degenerative bone disease, occurs due to pressure on joints from muscle spasticity.
Top