Q: What exactly is cerebral palsy? A: Cerebral palsy is a general term that describes disorders of movement, muscle tone, gait and/or posture that are caused by a primary brain dysfunction prior to age 3.
Q: What exactly is cerebral palsy?
A: Cerebral palsy is a general term that describes disorders of movement, muscle tone, gait and/or posture that are caused by a primary brain dysfunction prior to age 3.
CP is a non-progressive condition; the brain dysfunction does not typically get worse over time. It is the most common motor disability in young kids, affecting about 3 per every 1,000.
The development of the human brain and nervous system begins just a couple of weeks after conception and continues for years after birth. CP can be caused by anything that causes the brain to develop abnormally; it is classified by the symptoms and limbs affected:
- Spastic CP, accounting for over three-quarters of cases of CP, manifests with stiff, tight, rigid and/or poorly stretchable muscles. It is called spastic hemiplegia if it affects one side of the body, spastic diplegia (paraplegia) if the legs are affected more than the arms, and spastic quadriplegia if all four limbs are affected.
- Dyskinetic CP is manifested by abnormal body movements.
- Ataxic CP is when walking coordination (gait) is abnormal.
- Mixed CP is a mixture of any of these.
The symptoms from CP range from mild to moderate to severe. For example, up to 25 percent of CP patients cannot walk on their own.
There are many other symptoms CP patients may have:
- If swallowing or sucking is affected the baby may drool more than normal, and if severe they may not be able to get adequate nutrition.
- Vision and/or hearting can be affected.
- The child may not be able to develop urinary and/or bowel control.
- A third to a half of CP patients have some amount of mental retardation (meaning over half have normal or above normal intelligence!).
- Up to half of CP patients develop a seizure disorder.
The causes of the brain dysfunction that manifests as CP can occur before, at the time of or after birth. Over three-quarters occur before birth and are due to genetic problems, infections, disruption of oxygen to the fetus’ brain (from any cause) or other causes; and likely a combination of these in many cases.
Decreased oxygen during birth can cause CP; less than 10 percent of cases are from this. ?Being premature, having an abnormal presentation (the head not coming out first) and maternal infections are risk factors for perinatal causes.
Infections, trauma, bleeding into the brain (from any cause), decreased oxygenation (from heart or lung problems) or metabolic problems (such as severe jaundice) can all cause brain dysfunction after birth.
CP is often suspected by a child’s caregivers who notice an abnormality in the baby’s muscle tone, or who note the baby is not rolling over, sitting, crawling, walking or achieving some other developmental milestone as expected (whether late, asymmetric or with some other abnormality noted). Other symptoms, as noted above, may also raise suspicion.
Evaluation of a child suspected of having CP starts with a history (closely evaluating developmental milestones) and physical exam (carefully looking for muscle changes). Brain MRI or CT imaging can help evaluate the extent of brain damage and possible causes of CP (such as bleeding into the brain); bedside ultrasound may be done in newborns, especially if they are not stable enough for other imaging.
An electroencephalogram (EEG, to look at the electrical activity of the brain) can help evaluate a (suspected) seizure disorder. An electromyogram (EMG) can give information on possible muscle or nerve disorders. Blood tests may look for metabolic abnormalities (from thyroid conditions to certain genetic defects). Hearing and vision testing may also be indicated.
Treatment for CP is designed specifically for each individual patient, and should involve the appropriate specialists (pediatrician, speech therapist, occupation therapist, physical therapist, neurologist, orthopedist, neurosurgeon, social worker, others) as needed.
Treatments are aimed at minimizing complications (such as placing a feeding tube in patients with swallowing or sucking problems at risk for nutritional problems), maximizing the patient’s development (including physical and occupational therapy, addressing vision or hearing issues and giving other supportive therapy, including family counseling) and minimizing symptoms (such as medications and even interventional or surgical treatments for spasticity, treating seizures, etc.). With appropriate therapeutic services many CP patients are integrated into regular school classes and do very well.