Cerebral Palsy

Definition

Cerebral palsy (CP) is a group of chronic disorders that affect the ability to control movement. It appears in the first few years of life. Generally, the disorders do not worsen over time.

Causes

CP occurs due to damage to areas of the brain that direct movement. This damage interferes with the brain's ability to control movement and posture. CP may develop before, during, or after birth.

Causes include:

Brain tissue that may not develop correctly during pregnancy—growing fetus may experience a lack of oxygen or nutrients
Child sustains a head injury or brain infection
Mother and child's blood types are not compatible
Mother has rubella while pregnant
Stroke or bleeding occurs in the baby's brain during development or after birth
Child does not get enough oxygen during or after birth
There are abnormalities of the umbilical cord or placenta, or the placenta separates too early from the wall of the uterus
Child has meningitis, encephalitis, seizures, or head injury
Child has genetic/metabolic abnormalities

Risk Factors

Factors that increase the risk of CP include:

Infection or blood clotting problems during pregnancy
Vaginal bleeding during pregnancy
Seizures or intellectual disability in the expectant mother
Complicated or premature delivery
Cord prolapse
Breech birth
Low Apgar score—a rating of the child's condition just after birth
Low birth weight
High birth weight
Type 1 diabetes in the expectant mother
Premature birth
Multiple births, such as twins or triplets
Small head
Seizures
In vitro fertilization (IVF) —in part due to multiple births associated with IVF

Symptoms

Symptoms of CP vary widely. They may include difficulty with fine motor tasks like writing or using scissors difficulty maintaining balance or walking, and involuntary movements. The symptoms differ from person to person and may change over time.

CP first shows up in children aged three years or younger. Symptoms vary depending on what areas of the brain are affected. Some children may have severe disabilities. Although symptoms may change as the child grows older, the child's condition is unlikely to worsen.

Symptoms include:

Late to turn over, sit up, smile, or walk
Trouble writing, buttoning a button, or other fine motor activities
Difficulty walking or standing
Tight, spastic muscles
Weak muscles
Poor balance
Speech problems
Tremors
Unintentional body movements
Difficulty swallowing
Drooling

Some people with CP suffer from other medical disorders as well, including:

Seizures
Intellectual disability
Learning disabilities
Vision or hearing problems
Failure-to-thrive
Decreased ability to feel pain or identify items by touch
Problems with bowel and bladder control
Breathing problems if food or water has accidentally entered the lungs
Skin breakdown
Low bone density and fractures

Diagnosis

Doctors diagnose CP by testing motor skills and reflexes, looking into medical history, and using a variety of specialized tests.

You may have your brain's electrical activity tested. This can be done with an Electroencephalogram (EEG).
You may have pictures taken of structures inside your head. This can be done with:
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI) scan

MRI Scan

Treatment

There is no treatment to cure CP. The brain damage cannot be corrected. Therapy aims to help the child reach his or her full potential. Children with CP grow to adulthood and may be able to work and live independently.

Medication

Drugs help control muscle spasms and seizures.

Glycopyrrolate—to decrease drooling
Pamidronate—to treat osteoporosis
Medicines that may be used to treat spasticity:
- Botulinum toxin
- Baclofen
- Diazepam
- Tizanidine

Surgery

Certain operations may improve the ability to sit, stand, and walk.

Physical Aids

Braces and splints help keep limbs in correct alignment and prevent deformities. Positioning devices enable better posture. Walkers, special scooters, and wheelchairs make it easier to move around.

Special Education

Programs designed to meet the child's special needs may improve learning. Some children do well attending regular schools with special services. Vocational training can help prepare young adults for jobs.

Rehabilitation Services

Speech, physical, and occupational therapies may improve the ability to speak, move, walk, and perform activities of daily living. Physical therapy helps strengthen muscles. Children can learn different ways to complete difficult tasks.

Family Services

Professional support helps a patient and family cope with CP. Counselors help parents learn how to modify behaviors. Caring for a child with CP can be stressful. Some families find support groups helpful.

Other Treatment

Therapeutic electrical stimulation might help.

Prevention

Several of the causes of CP that have been identified through research are preventable or treatable:

Before getting pregnant, receive a vaccination for rubella.
Seek out early prenatal care.
Receive testing for blood-type problems. Get treatment if tests reveal incompatible blood types.
Do not smoke, drink alcohol, or use drugs while pregnant.
Put the baby in a child safety seat when in the car.
Insist that the child wear a helmet when riding a bicycle.
Seek help if you have, or want to, hurt the child.
Keep poisons away from your child.
Closely supervise bathing.
Get your child immunized at the recommended time.
If your baby becomes sick, call the doctor right away.

RESOURCES

4MyChild http://www.cerebralpalsy.org

United Cerebral Palsy http://www.ucp.org

CANADIAN RESOURCES

The Cerebral Palsy Association of BC http://www.bccerebralpalsy.ca

Ontario Federation for Cerebral Palsy http://www.ofcp.ca

References

Ashwal S, Russman BS, Blasco PA, et al. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2004;62(6):851-863.

Cerebral palsy. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated December 14, 2012. Accessed February 1, 2013.

Cerebral palsy (CP). Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities website. Available at: http://www.cdc.gov/ncbddd/cp/index.html. Updated September 7, 2012. Accessed February 1, 2013.

Cerebral palsy: hope through research. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/cerebral%5Fpalsy/detail%5Fcerebral%5Fpalsy.htm. Updated August 23, 2012. Accessed February 1, 2013.

Hazneci B, Tan AK, Guncikan MN, Dincer K, Kalyon TA. Comparison of the efficacies of botulinum toxin A and Johnstone pressure splints against hip adductor spasticity among patients with cerebral palsy: a randomized trial. Mil Med. 2006;171(7):653-656.

Johnson SL, Blair E, Stanley FJ. Obstetric malpractice litigation and cerebral palsy in term infants. J Forensic Leg Med. 2011;18(3):97-100.

Nolan KW, Cole LL, Liptak GS. Use of botulinum toxin type A in children with cerebral palsy. Phys Ther. 2006;86(4):573-584.

Park ES, Park CI, Chang HC, Park CW, Lee DS. The effect of botulinum toxin type A injection into the gastrocnemius muscle on sit-to-stand transfer in children with spastic diplegic cerebral palsy. Clin Rehabil. 2006;20(8):668-674.

Steinbok P. Selection of treatment modalities in children with spastic cerebral palsy. Neurosurg Focus. 2006;21(2):e4.

10/30/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Mergler S, Evenhuis HM, Boot AM, et al. Epidemiology of low bone mineral density and fractures in children with severe cerebral palsy: a systematic review. Dev Med Child Neurol. 2009;51(10):773-778.

2/4/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Delgado MR, Hirtz D, Aisen M, et al. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2010;74:336-343.

7/30/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: United States Food and Drug Administration. FDA approves drug for chronic drooling in children. United States Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm220444.htm. Published July 28, 2010. Accessed July 30, 2010.

Revision Information

Reviewer: Rimas Lukas, MD
Review Date: 09/2012 -
Update Date: 02/01/2013 -

Redmond Regional Medical Center