Cerebral palsy: An overview
Cerebral palsy: An overview
Key points to remember
- cerebral palsy is caused by damage to areas of the brain and has permanent effects on movement and posture
- it is the most common physical disability in childhood
- early intervention is the key to getting the best outcome for children with cerebral palsy
- access to services, including physical therapies, is essential to increase the child's progress in all areas of development
- 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 movement and posture. 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 1 in every 500 babies. Cerebral palsy is often called 'CP' for short.
It can cause a range of movement problems such as limited mobility, weakness of hands and/or legs, stiffness or floppiness, clumsiness or poor coordination, difficulty starting and controlling movement and reduced smoothness (fluidity) of movements, shakiness and poor balance.
As the child grows, secondary complications such as tightness of joints and hip problems can occur.
Cerebral palsy is described in a variety of ways
We describe cerebral palsy (CP) by:
- The distribution of muscles affected.
- The types of movement patterns seen.
- The effect of the CP on your child's ability to perform tasks, such as general mobility and manipulation of objects.
Distribution of muscles affected
- including both arms and both legs; the muscles of trunk, face and mouth can also be involved (quadriplegia)
- one side of the body may be affected (hemiplegia), or
- there may be muscle control issues in mostly the lower limbs (diplegia), or
- one arm or leg may be affected (monoplegia)
Types of movement patterns seen
Many children have a mixture of several of these movement patterns.
- spastic CP which is the most common type of CP - 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
- dyskinetic CP - when there are abnormal involuntary movements or postures, for example, dystonia (frequent twisting or repetitive movements, or abnormal postures) and athetosis (uncontrolled extra movement particularly in the arms, hands and feet, and around the mouth)
- ataxic CP (or ataxia) which is the least common type - children with ataxia have unsteady shaky movements or tremor and problems with balance
Effect of CP on the ability to perform tasks, such as general mobility and manipulation of objects
Your therapist or doctor may use a standardised scale such as the Gross Motor Function Classification System (GMFCS) or Manual Ability Classification System (MACS) or Communication Function Classification System (CFCS) to help you and others understand your child's level of functioning.
In addition to movement problems children with CP often have:
- problems with speech, hearing or vision
- intellectual or learning difficulties
- perceptual difficulties such as judging the size and shape of objects
- gastro-oesophageal reflux
- orthopaedic problems (with bones, muscles and joints)
- feeding and swallowing difficulties
- saliva control problems
- repeated chest infections
- behavioural difficulties and frustration
There is a wide range of intellectual ability in children with CP. Children with a very severe physical disability can have completely normal intelligence.
What causes cerebral palsy?
There are many different causes. A problem with the brain can occur:
- during pregnancy - if the brain does not form or grow properly, or as a result of another problem such as infection
- during labour - for example, if the baby does not receive enough oxygen. Some babies may have difficulty during labour because of problems with the placenta that have occurred before delivery. Problems during labour account for a relatively small proportion of CP (around 10 percent)
- 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 2 years of life, which cause permanent brain injury
- in children born extremely prematurely – these children are particularly at risk of developing CP
In some children, despite a careful review and various tests, the cause of CP 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 CP 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 may include:
- speech and language therapy to help with any communication problems and to provide help with eating, drinking or saliva problems
- physiotherapy and occupational therapy to encourage development of motor function, and motor control and to limit secondary complications (such as contractures)
- splints (orthoses) which are often used to help with walking, standing and hand function
- providing mobility equipment such as walking frames and/or wheelchairs and adaptive equipment such as bath seats to help family/whānau where needed - this equipment enables children and their families to take part in all the everyday family activities and childhood tasks
- changes to homes and educational buildings so the child can access them more independently
- botulinum toxin A (Botox®) injections to relax tight muscles – these may be given under anaesthesia or sedation depending on local practice
- oral medications including baclofen and diazepam
- orthopaedic surgery, such as soft tissue surgery to release tight muscles, or bony surgery to realign bones and joints
Other important factors in the management of cerebral palsy
It is important that children with CP receive adequate nutrition. This may involve help from a dietitian, speech language therapist, occupational therapist or the child’s paediatrician. Some children need to have their feeding by mouth supplemented with tube feeding. See the page on tube feeding.
Hearing and vision
It is important to make sure that the child's hearing and vision are checked.
Children who also have epilepsy may need to take medication to control epilepsy.
Educational support services
Children with CP should access educational support services in their preschool years as a foundation for future learning. All children have a right to education and to attend their local mainstream school or early childhood centre.
As the problems associated with CP are so varied, the level of support they require in an educational setting will vary. Physical disabilities and learning difficulties can both create significant barriers to children with CP in accessing education.
Some children manage well in a mainstream environment with no support. Other children will need one on one support or significant changes to the curriculum to support both their physical and learning needs. Some children will need support from physiotherapists, occupational therapists, and speech language therapists in school. These professionals will work closely with families and schools to make sure your child's educational needs are being met.
Once children reach school age, families may also choose to enrol their child in a special needs school where specialised teaching and therapy staff work onsite to deliver adapted curriculum programmes.
Some treatments used overseas for children with cerebral palsy are not currently available in New Zealand
Intrathecal baclofen (ITB)
Medication is given into the space around the spinal cord. Note that this procedure is not usually available in New Zealand at present.
Selective dorsal rhizotomy (SDR)
This procedure to treat spasticity involves cutting spinal nerve rootlets. It is appropriate for carefully selected children with CP. It is not available in New Zealand. Parents considering SDR for their child should discuss this with their paediatrician who can then choose to refer to a paediatric rehabilitation specialist for further discussion.
Complementary and alternative therapy and treatment approaches
Some parents want to look at complementary and alternative treatment approaches. Please see Complementary and alternative medicine: General advice for parents.
If you are considering stem cell therapy or hyperbaric oxygen therapy for your child with CP, please see the following information:
For information about coping with a diagnosis, early intervention, financial support, needs assessment and special education, see the disablity support section of this website.
Acknowledgement and copyright notice
This material has been adapted by the Paediatric Society of New Zealand from:
- Cerebral palsy: An overview. Royal Children's Hospital (RCH). Melbourne. http://www.rch.org.au/kidsinfo/fact_sheets/Cerebral_Palsy_an_overview/ [Accessed 28/04/2015]