Understanding Cerebral Palsy: Causes and Support

Cerebral palsy (CP) refers to a group of permanent neurological disorders that affect movement and muscle coordination, becoming apparent in infancy or early childhood. Approximately 3 out of every 1000 newborns are affected by CP, caused by damage to the brain or atypical brain development, disrupting the brain’s control over movement, posture, and balance. It is the most common motor disability in childhood.

The abnormal development or damage to the brain that leads to CP may occur before birth, during birth, within the first month after birth, or in the early years of a child’s life. CP associated with brain development abnormalities or brain injury before or during birth is referred to as congenital cerebral palsy.Most cases of cerebral palsy (85%-90%) are congenital.

The specific causes are not clear. A small number of CP cases are caused by brain development abnormalities or damage occurring more than 28 days after birth. This is known as acquired cerebral palsy and is often associated with infections (such as meningitis) or head injuries.

All individuals with cerebral palsy exhibit symptoms that affect their movement and posture, and some may also experience intellectual disabilities, seizures, sensory disruptions, vision, hearing, or speech impairments, or spinal changes (such as scoliosis), and other physiological issues such as joint contractures. It is different from paralysis, which refers to muscle weakness or issues with muscle use. Cerebral palsy is caused by abnormal brain development or damage to the developing brain, affecting the patient’s ability to control their muscles.

The symptoms of cerebral palsy do not worsen over time, but some symptoms may become more or less pronounced as the child grows. Children with cerebral palsy may show:

Delayed development of motor skills

Difficulty with fine motor skills

Poor muscle coordination

Asymmetrical or atypical gait

Muscle stiffness or weakness

Exaggerated responses

Tremors or involuntary movements

The symptoms of cerebral palsy vary widely among individuals, as there are many different types and degrees of severity. A key sign that a child may have CP is a delay in motor or movement milestones (such as rolling over, sitting, standing, or walking). Here are some other possible symptoms of cerebral palsy. It is important to note that some children without CP may also exhibit these symptoms.

When lying on their back, if you pick them up, their head hangs down

Feels stiff

Feels floppy

When held, their back and neck seem to overextend, often showing a desire to push away from you

When lifted, their legs become stiff and cross like scissors

She cannot roll over in any direction

She cannot bring her hands together

She has difficulty covering her mouth with her hands

She only reaches out with one hand while the other remains clenched

Crawling in an unbalanced manner, using one hand and one leg to push, dragging the other hand and leg

Moving by scooting on their bottom or jumping on their knees, but not crawling on all fours

Symptoms of CP vary from person to person. Those with severe cerebral palsy may require special equipment to walk or may not be able to walk at all and may need lifelong care. Those with mild cerebral palsy may walk awkwardly but may not need any special assistance.

Intellectual disability – About 30-50% of individuals with CP have intellectual disabilities.

Seizure disorders – Up to half of children with CP have one or more seizures. Children with both cerebral palsy and epilepsy are more likely to have intellectual disabilities.

Growth delays – Children with moderate to severe CP often experience growth delays. The muscles and limbs affected by CP are often smaller.

Spinal deformities and arthritis – Scoliosis, kyphosis, and lordosis are associated with CP. Joint compression and misalignment can lead to pain, cartilage breakdown, and bone enlargement (osteoporosis).

Vision impairments – Many children with CP have strabismus, often referred to as “crossed eyes,” which can lead to vision loss if untreated, affecting distance judgment. Some children with CP have difficulty understanding and organizing visual information. Other children may have poor vision in one or both eyes or be blind.

Hearing loss – Hearing impairments are more common in individuals with CP than in the general population. Some children have partial or complete hearing loss, particularly due to jaundice or hypoxia during brain development.

Speech and language disorders – Such as difficulty organizing words and unclear speech, present in over 75% of individuals with CP.

Excessive drooling – Some individuals with CP drool because they cannot control the muscles of their throat, mouth, and tongue.

Incontinence – Incontinence is a possible complication of CP caused by poor bladder muscle control.

Sensory and perception difficulties – Some individuals with CP may experience pain or have difficulty sensing simple sensations like touch.

Learning difficulties – Children with CP may have trouble processing certain types of spatial and auditory information.

Infections and chronic illnesses – Many adults with CP are at higher risk for heart disease, lung disease, and pneumonia.

Contractures – Muscles may painfully fixate in one position, known as contractures, which can increase muscle spasms and joint deformities in individuals with CP.

Malnutrition – Swallowing, sucking, or feeding difficulties make it hard for many individuals with CP, especially infants, to obtain adequate nutrition, increasing or maintaining weight.

Dental issues – Poor oral hygiene puts many children with CP at risk for gum disease and cavities.

Lack of exercise – Many children with CP cannot participate in activities intense enough to develop and maintain strength and health. Inactive adults with CP often show increased severity of illness and decreased overall health and well-being.

Bone health – Bone density is significantly lower in individuals with CP, increasing the risk of fractures.

Mental health issues – Individuals with CP are more likely to experience anxiety, depression, and social and emotional problems.

Cerebral palsy is most commonly diagnosed before the age of two, with some mild cases diagnosed before four or five years of age. Over time, doctors will conduct a series of tests to assess the child’s development, motor skills, muscle tone, hearing, vision, and posture to make a diagnosis and rule out other possible conditions. The earlier the diagnosis, the sooner early intervention can begin.

Doctors classify cerebral palsy (CP) based on the primary type of motor impairment involved. Depending on which area of the brain is affected, one or more types of motor impairments may occur:

Spasticity

Dyskinesia

Ataxia

There are four main types of CP:

The most common type is spastic CP, affecting approximately 80% of individuals with CP. Those with spastic CP have increased muscle tone, meaning their muscles are stiff, and their movements may be awkward.

Spastic cerebral palsy is typically described based on which parts of the body are affected:

Spastic diplegia/diparesis: In this type of CP, muscle stiffness primarily occurs in the legs, with the arms being less affected or not affected at all. Individuals with spastic diplegia may have difficulty walking due to tightness in the hip and leg muscles, causing their legs to pull together, turn inward, and cross at the knees (also known as scissors).

Spastic hemiplegia/hemiparesis: This type of cerebral palsy affects only one side of the body; typically, the arm is more affected than the leg.

Spastic quadriplegia/quadriparesis: Spastic quadriplegia is the most severe form of spastic cerebral palsy, affecting the limbs, trunk, and face. Individuals with spastic quadriplegia often cannot walk and frequently have other developmental disorders such as intellectual disabilities; seizures; or issues with vision, hearing, or speech.

This includes athetoid, choreoathetoid, and dystonic cerebral palsies. Individuals with dyskinetic CP have problems controlling the movements of their hands, arms, feet, and legs, making it difficult for them to sit and walk. These movements are uncontrolled, which may be slow and writhing or rapid and jerky. Sometimes, their face and tongue may be affected, leading to difficulties with sucking, swallowing, and speaking. The muscle tone in individuals with dyskinetic CP can vary not only from day to day but even within a single day.

Individuals with ataxic CP have problems with balance and coordination. They may walk unsteadily and have difficulty performing quick movements or actions that require a lot of control, like writing. When reaching for something, they may struggle to control their hands or arms.

Some individuals exhibit symptoms of more than one type of CP, with the most common being spastic-dyskinetic CP.

Examine your learning environment and remove or modify any objects that may hinder the child’s access and mobility.

Consider accessibility settings in restrooms, sinks, and other areas.

Ensure that all indoor and outdoor spaces, toys, and activities are accessible to the child, supporting their participation, play, and developmental goals.

Provide appropriate utensils, cups, and seating options during mealtime as needed.

Offer seating adjustments that are suitable for the child to sit comfortably.

If holding books is difficult for the child, provide tablets and/or audiobooks.

Provide tools suitable for writing and drawing for the child.

Support the child’s full participation in social interactions and group activities.

Provide personalized learning opportunities in natural environments and daily activities.

Encourage, praise, and support the child when they attempt or succeed in developmentally appropriate activities that may be challenging for them.

Allow extra time to complete tasks.

When you are with the child, ensure that your eyes are at the same level as the child’s.

Cerebral palsy cannot be cured, but therapies often improve the child’s abilities. The earlier treatment begins, the greater the chance for the child to overcome developmental challenges.

There is no standard treatment that works for every person with CP. Once a diagnosis is made, a team of healthcare professionals will work with the child and parents to identify specific deficits and needs, then develop an appropriate plan to address the core disabilities affecting the child’s quality of life.

Physical Therapy is typically the cornerstone of CP treatment in the first few years after birth. Specific exercises, such as stretching, resistance, or strength training programs and activities, can maintain or improve muscle strength, balance, and motor skills, and prevent contractures. Special braces (orthotics) can be used to improve mobility and stretch spastic muscles.

Occupational Therapy focuses on optimizing upper body function, improving posture, and maximizing the child’s capabilities. It helps individuals find new ways to meet their daily living needs in family, school, and community settings.

Recreational Therapy encourages participation in arts and cultural projects, sports, and other activities that help individuals expand their physical and cognitive skills and abilities.

Speech and Language Therapy can improve a child’s speaking abilities, help treat swallowing difficulties, and learn new ways to communicate, such as using sign language and/or special communication devices like those with speech synthesizers.

Treatment for feeding and drooling issues is often necessary when children with CP have difficulties eating and drinking, as they may have little control over the muscles of their mouth, chin, and tongue.

References

https://www.ninds.nih.gov/health-information/disorders/cerebral-palsy

https://www.cdc.gov/ncbddd/cp/facts.html

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