Cerebral palsy: An overview

Cerebral palsy: An overview

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Key points to remember about cerebral palsy

  • cerebral palsy is a permanent physical condition that affects muscle control
  • it is the most common physical disability in childhood
  • early intervention is the key to getting the best outcome for children with cerebral palsy
  • management requires a team approach with parents, therapists, doctors, nurses and teachers all contributing to ensure the best progress is made

What is cerebral palsy?

Cerebral palsy is a permanent physical condition that affects muscle control. It is caused by damage to, or lack of development in a part of the brain that controls movement. Cerebral palsy is the most common physical disability in childhood occurring in one in every 500 live born babies. Cerebral palsy is often called 'CP' for short.
 
Cerebral palsy causes problems with motor control and co-ordination, such as weakness, stiffness in muscles, awkwardness, slowness, shakiness and difficulties with balance.
 
A child with cerebral palsy may have slight clumsiness in one arm or leg (monoplegia), one side of the body may be affected (hemiplegia), there may be muscle control issues in mostly the lower limbs (diplegia), or in both arms and legs and the torso (quadriplegia).
 
Other difficulties can include problems with speech, hearing or vision, epilepsy, intellectual or learning difficulties, perceptual difficulties such as judging the size and shape of objects, gastro-oesophageal reflux (heartburn), orthopaedic problems (with bones), constipation, feeding difficulties, saliva control problems or repeated chest infections.
 
There is a wide range of intellectual ability in children with cerebral palsy. Children with a very severe physical disability can have completely normal intelligence.
 
For more information on some of the difficultes associated with cerebral palsy see:

What are the types of cerebral palsy?

There are three types of cerebral palsy.
 
  1. Spastic cerebral palsy is the most common type of cerebral palsy. Spasticity means stiff or tight muscles. The muscles are stiff because the messages to the muscles are being sent incorrectly from the damaged parts of the brain. 
  2. Dyskinetic cerebral palsy is when there are abnormal involuntary movements. There are three different types of movement problems:
    - Dystonia is when there is frequent twisting or repetitive movements, or abnormal postures.
    - Athetosis is when there is uncontrolled extra movement particularly in the arms, hands and feet, and around the mouth. This lack of control is most obvious when the child starts to move - for example, when the child tries to grasp a toy or a spoon. Also, children with athetoid cerebral palsy often have very weak muscles or feel floppy when carried.
    - Chorea is when there are rapid jerky involuntary movements.
  3. Ataxic cerebral palsy (or ataxia) is the least common type. Children with ataxia have unsteady shaky movements or tremor and problems with balance. Some children also have dystonia. This means that they have involuntary muscle contractions (which they cannot control) causing abnormal movements and / or postures.
Many children have a mixture of several of these movement patterns.
 

What causes cerebral palsy?

There are many different causes. A problem with the brain can occur:
  • if the brain does not form or grow properly during pregnancy
  • during labour - for example, if the baby does not receive enough oxygen
  • in the first few days or weeks of life - for example, when an infant develops a severe infection, such as meningitis or there is a bleed into part of the brain
  • in children having accidents in the first two years of life, which cause permanent brain injury
  • children born extremely prematurely are particularly at risk of developing erebral palsy
In some children, despite a careful review and various tests, the cause of cerebral palsy remains unknown. With new technologies such as MRI brain scans and sophisticated blood tests, more causes are slowly being identified.

How is cerebral palsy managed?

Management of cerebral palsy is focused on the problems of muscle control and movement, and the treatment of additional health issues. Empowering, supporting and educating families is the most important aspect of care.
 
Treatment includes:
  • physiotherapy and occupational therapy to encourage motor development
  • orthotics for the lower limbs and splints for the uppoer limbs
  • botulinum toxin A (Botox) to relax tight muscles - given by injection, requiring light anaesthesia
  • oral medications including Diazepam and Baclofen
  • intrathecal baclofen - medication is given into the space around the spinal cord. (For more information see Where to go for more information about cerebral palsy below)
  • orthopaedic surgery, such as soft tissue surgery for the hip, or hamstring surgery for the knee
  • plastic surgery - tendon transfers and releases to improve arm use
  • speech athology to help with any communication problems and to provide help with eating, drinking or saliva problems

Where to go for information about cerebral palsy

On this website
 
Cerebral Palsy Society of New Zealand www.cpsoc.org.nz/CP/index.htm
The website provides information about cerebral palsy and services available in NZ.
 
Medsafe (New Zealand Medicines and Medical Devices Safety Authority) www.medsafe.govt.nz
The Medsafe website provides consumer medicine information on Lioresal® Intrathecal (baclofen) which is sometimes used in the treatment of cerebral palsy.
 
Royal Children's Hospital, Melbourne, Australia
The Royal Children's Hospital website lists a range of resources relevant to families of children with cerebral palsy.
 
Please note that while the following resources contain very useful information for New Zealand families, there are some sections in each resource which discuss services available only in Australia and instructions especially for patients of the Royal Children's Hospital in Melbourne, Australia.
 
Cerebral Palsy: An information guide for parentsThe resources listed at the website include:
Saliva control in children
Developemtnal delay: An information guide for parents
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Acknowledgements

Acknowledgements
This Royal Children's Hospital logofact sheet has been adapted from:
 
 
Content endorsed by the Paediatric Society of New Zealand 03 April 2012
© Paediatric Society of New Zealand and Starship Foundation 2005 – 2013
Printed on 21 May 2013. Content is regularly updated so please refer to www.kidshealth.org.nz for the most up-to-date version