What’s to know about cerebral palsy?

Cerebral palsy is a term used to describe a set of neurological conditions that affect movement. It is the most common form of childhood disability.

It affects around 764,000 individuals in the United States.

The condition makes it hard to move certain parts of the body. There are many degrees of severity.

Because of damage to certain parts of the brain, voluntary or involuntary movements or both can be affected.

Cerebral palsy is not contagious, it does not necessarily affect intelligence or cognitive ability, and it is not progressive, so it does not get worse with age. Some people find that symptoms improve over time.

People with cerebral palsy tend to have a normal lifespan, and in many cases, a good quality of life can be expected.

Causes

Muscle control takes place in a part of the brain called the cerebrum. The cerebrum is the upper part of the brain. Damage to the cerebrum before, during, or within 5 years of birth can cause cerebral palsy.

The cerebrum is also responsible for memory, ability to learn, and communication skills. This is why some people with cerebral palsy have problems with communication and learning. Cerebrum damage can sometimes affect vision and hearing.

Some newborns are deprived of oxygen during labor and delivery.

In the past, it was thought that this lack of oxygen during birth led to the brain damage.

However, during the 1980s, research showed that fewer than 1 in 10 cases of cerebral palsy stem from oxygen deprivation during birth.

Most often, the damage occurs before birth, probably during the first 6 months of pregnancy.

There are at least three possible reasons for this.

Periventricular leukomalacia (PVL)

PVL is a kind of damage that affects the brain’s white matter because of a lack of oxygen in the womb.

It may occur if the mother has an infection during pregnancy, such as rubella or German measles, low blood pressure, preterm delivery, or if she uses an illegal drug.

Abnormal development of the brain

Disruption of brain development can affect the way the brain communicates with the body’s muscles and other functions.

During the first 6 months of pregnancy, the brain of the embryo or fetus is particularly vulnerable.

Damage can stem from mutations in the genes responsible for brain development, certain infections such as toxoplasmosis, a parasite infection, herpes and herpes-like viruses, and head trauma.

Intracranial hemorrhage

Sometimes, bleeding inside the brain happens when a fetus experiences a stroke.

Bleeding in the brain can stop the supply of blood to vital brain tissue, and this tissue can become damaged or die. The escaped blood can clot and damage surrounding tissue.

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 happen because of damage after birth. This can happen because of an infection such as meningitis, a head injury, a drowning accident, or poisoning.

When damage occurs, it will do so soon after the birth. With age, the human brain becomes more resilient and able withstand more damage.

Symptoms

An infant with cerebral palsy may have muscular and movement problems, including poor muscle tone. Muscle tone refers to a person’s automatic ability to tighten and relax muscle when required.

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: A child with spastic hemiplegia will typically have spasticity, or muscle stiffness, on one side of the body. This is usually just a hand and an arm, but it may also involve a leg. The side that is affected may not develop properly. There may be speech problems. Intelligence is not usually affected. Seizures may occur.

Spastic diplegia: The lower limbs are affected, and the upper body has no spasticity or only a little. The leg and hip muscles are tight. Legs cross at the knees, making walking more difficult. The crossing of the legs when upright is often referred to as scissoring.

Spastic quadriplegia: The legs, arms, and body are affected. This is the most severe form of spastic cerebral palsy. It may involve cognitive deficits. Walking and talking will be difficult. Seizures may occur.

Athetoid or dyskinetic cerebral palsy

Also known as athetoid dyskinetic cerebral palsy, this is the second most common type. Intelligence is usually normal, but muscle problems affect the whole body. Weak or tight muscle tone causes random and uncontrolled body movements.

The child will have problems walking, sitting, maintaining posture, and speaking clearly because the tongue and vocal cords are hard to control. Some children drool if they have problems controlling facial muscles.

Ataxic cerebral palsy

Balance and coordination are most affected. Tasks that need fine motor skills will be difficult, such as tying shoelaces, buttoning up shirts, and cutting with scissors.

Balance difficulties may cause the child to walk with their feet far apart. Most children with ataxic cerebral palsy have normal intelligence and good communication skills, but some may have erratic speech.

Hypotonic cerebral palsy

Hypotonic cerebral palsy results from an injury to the cerebellum.

Muscle problems appear earlier. The infant’s head and body will be floppy, “like a rag doll.” There is only moderate resistance when an adult tries to move the infant’s limbs. The infant may rest with their elbows and knees loosely extended, instead of flexed. There may be breathing difficulties.

Treatment

There is no cure for cerebral palsy, but treatment can help manage symptoms and increase independence.

When a child receives a diagnosis of cerebral palsy, a team of health professionals will help to look after their needs. The team may include a doctor, a pediatrician, a speech therapist, and an educational psychologist, among others.

An individual care plan will address the needs of the child and the family. As the child gets older, the plan will be reviewed and revised.

Treatment depends entirely on individual needs. The aim is to help the child achieve as much independence as possible.

Prevention

Most of the time, it is not possible to prevent cerebral palsy, but some actions can reduce the risk.

A woman who is planning to become pregnant should ensure that all 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

For second or subsequent pregnancies, it may be useful to identify potential Rh incompatibility, as this can increase the risk of cerebral palsy.

In children

Much of this article has discussed cerebral palsy in children.

The condition often sets in before a child is even born, and can affect the development of muscle tone, movement, and sensory perception as a child grows. Normal childhood milestones, such as walking or talking for the first time, will usually occur later in children with cerebral palsy.

As the condition is not curable but does not get worse, it remains until adulthood.

In adults

Because cerebral palsy is non-progressive, it will not worsen as the individual ages. However, it is likely to present certain difficulties. These difficulties generally fall into two categories: Motor and intellectual.

The most common challenges to individuals 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 can be challenging, there is no reason that an individual can not enjoy a fulfilling and positive life.

Diagnosis

Any parent who is concerned about their child’s development should see their doctor.

The doctor will ask the parents about the infant’s history and development and the mother’s medical history during her pregnancy.

The doctor will examine the child and observe their posture, movements, muscle tone, motor skills, and they will check the child’s reflexes.

If age-appropriate, the doctor may refer the child to an educational psychologist to assess intellectual development.

Ruling out other conditions

Other conditions with similar symptoms may need to be ruled out, such as a tumor or muscular dystrophy.

Tests that can help with diagnosis include:

• Blood tests
• Head ultrasound
• MRI orCT scan

At the age of 2 to 3 years, a more comprehensive diagnosis of cerebral palsy is usually possible, but the severity is not usually fully assessed until the age of 4 to 5 years.

A diagnosis of cerebral palsy requires regular assessments, to make comparisons and determine what the developmental needs and issues are.

It takes time to make a comprehensive and confident diagnosis, as a careful assessment must be carried out several times.

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