Cerebral palsy is a term used to describe a set of neurological disorders affecting movement. This is the most major form of childhood disability.
It affects about 764,000 people in the USA.
The disorder renders certain parts of the body hard to move. There are many degrees of severity.
Due to damage to other areas of the brain, it may cause voluntary or involuntary movements, or both.
Cerebral palsy is not contagious, it does not necessarily affect intelligence or cognitive capacity, and it is not progressive, so with age it does not get worse. Some people report symptoms improving over time.
People with cerebral palsy appear to have a normal lifespan, and good quality of life can be expected in many cases.
Causes
Muscle control is carried out in a part of the brain called the cerebrum. The upper part of the brain is the cerebrum. Damage to the cerebrum can cause cerebral palsy before, during, or within 5 years of birth.
The cerebrum also bears responsibility for memory, thinking ability, and communication skills. That is why some people suffering from cerebral palsy have communication and learning difficulties. Damage to the cerebrum may impair vision and hearing sometimes.
Many newborns during labor and childbirth are deprived of oxygen.
It was believed in the past that this lack of oxygen during birth contributed to damage to the brain.
Nevertheless, studies during the 1980s found that less than 1 in 10 cases of cerebral palsy were due to lack of oxygen during birth.
The damage most often occurs prior to birth, usually within the first 6 months of pregnancy.
This has at least three possible reasons.
Periventricular leukomalacia (PVL)
PVL is a form of damage which affects the white matter of the brain due to a lack of oxygen in the womb.
If the mother has an infection during pregnancy, such as rubella or German measles, low blood pressure, premature birth, or if she uses an illegal drug, this can happen.
Abnormal development of the brain
Disruption in brain development can affect how the brain communicates with muscles and other functions of the body.
The brain of the embryo, or fetus, is especially vulnerable during the first 6 months of pregnancy.
Damage may be caused by mutations in the genes responsible for the development of the brain, certain infections such as toxoplasmosis, a parasite infection, herpes-like viruses and head trauma.
Intracranial hemorrhage
Bleeding happens within the brain even while a fetus is having a stroke.
Bleeding in the brain can interrupt blood supply to vital brain tissue, which can cause damage or death to this tissue. The blood that has escaped can clot and damage surrounding tissue.
During pregnancy several factors can cause a stroke in a fetus:
Several factors can cause a stroke in a fetus during pregnancy:
- a blood clot in the placenta that blocks the flow of blood
- a clotting disorder in the fetus
- interruptions in arterial blood flow to the fetal brain
- untreated pre-eclampsia in the mother
- inflammation of the placenta
- pelvic inflammatory infection in the mother
During delivery, the risk is increased by the following factors:
- emergency cesarean
- the second stage of labor is prolonged
- vacuum extraction is used during delivery
- fetal or neonatal heart anomalies
- umbilical cord abnormalities
Anything that increases the risk of preterm birth or low birth weight also raises the risk of cerebral palsy.
Factors that may contribute to a higher risk of cerebral palsy include:
- multiple births, for example, twins
- damaged placenta
- sexually transmitted infections (STIs)
- consumption of alcohol, illegal drugs, or toxic substances during pregnancy
- malnourishment during pregnancy
- random malformation of the fetal brain
- small pelvis in the mother
- breech delivery
Brain damage after birth
A small proportion of cases occur after birth, due to damage. This may be due to an infection like meningitis, a head injury, a drowning accident, or poisoning.
If damage occur, it will do so soon after birth. The human brain becomes more resilient with age, and is able to withstand further damage.
Symptoms
A child with cerebral palsy may have issues with muscle and movement including low muscle tone. Muscle tone refers to an automatic capacity of a person to tighten and relax a muscle when necessary.
Features can include:
- overdeveloped or underdeveloped muscles, leading to stiff or floppy movements
- poor coordination and balance, known as ataxia
- involuntary, slow writhing movements, or athetosis
- stiff muscles that contract abnormally, known as spastic paralysis
- crawling in an unusual way
- lying down in awkward positions
- favoring one side of the body over the other
- a limited range of movement
Other signs and symptoms include:
- late achievement of developmental milestones such as crawling, walking, or speaking
- hearing and eyesight problems
- problems controlling bladder and bowel movements
- seizures
- drooling, and problems with feeding, sucking, and swallowing
- being easily startled
Symptoms normally start to show during the first 3 years of life.
Types
There are four types of cerebral palsy: Spastic, athetoid-dyskinetic, ataxic, and hypotonic.
Spastic cerebral palsy
There are three different types of spastic cerebral palsy.
Spastic hemiplegia: On one side of the body a child with spastic hemiplegia usually has spasticity, or muscle stiffness. This is usually just a hand and an arm, but may include a leg as well. It is possible that the side affected may not develop properly. Problems with speech can arise. Commonly, intelligence is not affected. Seizures could even occur.
Spastic diplegia: The lower limbs are affected, and the upper body has no or just a little spasticity. The leg and hip muscles are strong. Legs cross at knees, making it harder to walk. When upright the crossing of the legs is often referred to as scissoring.
Spastic quadriplegia: This affects the legs, arms and body. This is the most severe form of spastic cerebral palsy. Cognitive deficits may be involved. It’ll be difficult to walk and to talk. Seizures could even happen.
Athetoid or dyskinetic cerebral palsy
Also known as cerebral palsy called athetoid dyskinetic, this is the second most common type. Intelligence is usually normal, but issues with the muscles affect the whole body. The weak or tight muscle tone is responsible for random and uncontrolled body motions.
The kid may have trouble walking, sitting, keeping balance and speaking clearly because it’s hard to control the tongue and vocal cords. Some kids drool off if they have facial muscle function issues.
Ataxic cerebral palsy
Balance and coordination are hardest hit. It would be difficult to perform activities that require fine motor skills, such as tying shoelaces, buttoning up shirts and cutting with scissors.
Difficulties with balance will cause the child to walk far apart with his or her feet. Most children with ataxic cerebral palsy have normal intelligence and good communication skills, but some may have erratic speech.
Hypotonic cerebral palsy
An injury to the cerebellum results in hypotonic cerebral palsy.
Muscle problems come up sooner. The infant’s head and body would be floppy, “like a rag doll.” If an adult attempts to move the infant’s limbs, there is only moderate resistance. The infant may rest loosely extended, rather than flexed with their elbows and knees. Breathing difficulties can arise.
Treatment
There is no cure for cerebral palsy, but treatments that can help handle symptoms and increase independence.
Once a child is diagnosed with cerebral palsy, a team of health care practitioners may work to take care of their needs. The team should include a doctor, a pediatrician, a speech therapist and, among others, an educational psychologist.
An individual care plan will address both the child and the family’s needs. The program will be checked and updated as the child grows older.
Treatment completely depends on individual needs. The aim is to help the child achieve as much independence as possible.
Prevention
Most of the time, cerebral palsy can’t be prevented, but certain behaviors can reduce the risk.
A woman planning to get pregnant should ensure all of her vaccinations are up to date.
During pregnancy, it is important to:
- attend all antenatal appointments
- avoid alcohol, tobacco, and illegal drugs
- carry out regular exercise, according to the physician’s advice
- eat healthily
It may be useful to detect possible Rh incompatibility for second or subsequent pregnancies, as this may increase the risk of cerebral palsy.
In children
Most of this article has written about childhood cerebral palsy.
The condition often sets in before a child is even born, and as a child grows, it can affect muscle tone, movement, and sensory perception. Normal childhood milestones, such as walking or talking for the first time, will usually occur later in children with cerebral palsy.
It persists until adulthood, because the condition is not curable but does not get worse.
In adults
Since cerebral palsy is non-progressive, it does not deteriorate as the individual ages. It’s likely to pose some difficulties though. In general these problems fall into two categories: motor and intellectual.
The most common obstacles for people with cerebral palsy as they age include:
- Walking: Because cerebral palsy affects movement and flexibility, musculoskeletal abnormalities can worsen as the person ages. This may necessitate the use of mobility aids, such as a stick or wheelchair.
- Swallowing problems: Known as dysphagia, problems with swallowing are common. They are generally caused by damage to the nerves in the neck or head. Symptoms can include coughing after eating or drinking, food getting stuck in the mouth, pneumonia, weight loss, and poor nutrition. Working with a speech or physical therapist can help.
- Premature aging: Although the total lifespan of individuals with cerebral palsy is similar to the general population, some signs of aging can arrive early. Because the condition puts additional strain on the body, there can be increased pain when, for instance, climbing the stairs. There is also an increased risk of dental problems, falls, and stiff muscles.
- Post-impairment syndrome: This is caused due to the increased energy that it takes to move around. Symptoms include weakness, increased pain, repetitive strain injuries, and fatigue. Working with a therapist can help strengthen the muscles most affected by the condition.
- Mental health conditions: Due to social stress, bullying, or teasing, individuals with cerebral palsy are more likely to become shy in social situations and have depression or anxiety disorders.
Although adulthood with cerebral palsy may be challenging, there is no reason a person can not experience a fulfilling and positive life.
Diagnosis
Any parent concerned about the development of their child should see his or her doctor.
During her pregnancy, the doctor will ask parents about the history and development of the infant, and the medical history of the mother.
The doctor will evaluate the child and observe their posture, movements, muscle tone, motor skills, and they will test the child’s reflexes.
The doctor may refer the child to an educational psychologist to assess intellectual development if the age is suitable.
Ruling out other conditions
Other conditions with similar symptoms, such as a tumor or muscular dystrophy may need to be ruled out.
Tests that can help with diagnosis include:
- Blood tests
- Head ultrasound
- MRI or CT scan
A cerebral palsy diagnosis requires frequent assessments, comparisons and determination of the developmental needs and problems.
It takes time to make a comprehensive and confident diagnosis, as several times a careful assessment has to be performed.
