What is Cerebral Palsy?

Cerebral palsy is the name given to a group of conditions that affect the brain, impacting coordination and movement. It is the most common condition that affects movement in children, and has been recorded since the 5th century BCE, in the Ancient Greek writing of Hippocrates. However, it wasn’t until the 19th century that the condition was studied in depth, by the English surgeon William John Little, who was diagnosed with spastic diplegia, a form of cerebral palsy. There is currently no cure for the condition, though research is continuously being carried out, and a number of therapies are conducted to help ease the symptoms of the condition. The Canadian physician William Osler is responsible for the name ‘cerebral palsy’, which has roots in the German term for cerebral child-paralysis.

What are the types of cerebral palsy?

There are five different types of cerebral palsy:

Spastic cerebral palsy

Spastic cerebral palsy makes up almost 80% of all diagnoses of cerebral palsy. It can also be referred to as hypertonic cerebral palsy. This particular form of the condition is caused by damage to the motor cortex, which is responsible for voluntary control over movement, as well as the pyramidal tracts, which are essential in sending messages to muscles. Whichever side of the motor cortex is damaged, mobility issues will be seen on the opposite side of the body.

Athetoid cerebral palsy

This is a much less common form of the condition, sometimes referred to as non-spastic cerebral palsy. It is triggered by damage to the basal ganglia, which is responsible for voluntary control of eye movement. It can sometimes be caused by damage to the cerebellum, which is responsible for balance and coordination.

This means that within this condition, the face, limbs and torso can be subject to involuntary movements.

Ataxic cerebral palsy

Ataxic cerebral palsy causes ataxia, which is an imbalance, and loss of control over coordination and speech. Again, this type of cerebral palsy is caused by damage to the cerebellum.

Hypotonic cerebral palsy

This type of cerebral palsy is distinguished by having low muscle mass, which leads to poor strength. This can hinder walking and crawling.

Mixed cerebral palsy

In some instances, the brain is damaged in more than one place, and each can lead to multiple types of cerebral palsy. This is the most common form after spastic cerebral palsy, and usually is a blend of spastic and athetoid types.

Not only does the type of cerebral palsy describe the area of the brain that is injured, but it also indicates the location of the movement issue that occurs with it. For example, in the condition ‘spastic diplegia’, spastic indicates damage to the motor cortex, whilst diploid indicates that damage affects two limbs.

The different locations are as follows:

•  Monoplegia – a movement issue that affects only one limb.
•  Diplegia – a movement issue that affects two limbs, usually the legs.
•  Hemiplegia – one whole side of the body is affected; usually the arm is more affected than the leg.
•  Double hemiplegia – movement issues affect all limbs, but one side of the body is more impacted than the other.
•  Triplegia – indicates that three limbs are impacted.
•  Quadriplegia – this is when all limbs are affected.

Of course, within these terms, the severity of the movement issues varies from person to person. Cerebral palsy affects people in different ways, meaning that even people with the same diagnosis can experience the condition completely differently from one another.

Signs and symptoms of cerebral palsy

Symptoms are usually noticed within the first three years of a child’s life. The general symptoms of cerebral palsy are as follows:

•  Children not achieving development targets at the appropriate time, such as sitting by themselves, walking and crawling.
•  Stiffness or floppiness in the limbs.
•  Tremors.
•  Muscle spasms.
•  Weakness in the limbs.
•  Walking on tiptoes.
•  Involuntary movements.
•  Issues with swallowing and eating, dribbling or drooling.
•  Problems with hearing.
•  Scoliosis (when the curve of the spine is not normal).
•  Learning disabilities.
•  Problems with eyesight and eye movement.
•  Constipation.
•  Epilepsy.
•  Sleep issues (problems getting to sleep or staying asleep).
•  Gastro-oesophageal reflux disease.
•  Weak bladder control.
•  Speech issues.
•  Musculoskeletal pain.
•  Muscle fatigue.
•  Seizures.

There are different symptoms for the different types of cerebral palsy. Someone may have a type of cerebral palsy that does not impact the muscles in their face, thus they would not have issues swallowing.

What causes cerebral palsy?

Cerebral palsy is typically caused by an issue in the womb, which causes the development of the baby’s brain to be negatively affected.

The main causes can be:

Genetic mutation

Scientists have discovered that genetic mutations can be responsible for causing the condition.

Infections

If the mother becomes ill with certain infections, they can affect the development of the baby in the womb. Infections include chickenpox, rubella, cytomegalovirus and infections of the placenta and the foetal membranes.

The child may also have an infection which causes inflammation in the brain.

Limited oxygen or blood supply

If the baby’s brain does not receive a sufficient amount of oxygen, it can cause damage to the brain. A lack of blood supply can lead to the baby having a stroke in the womb.

A head injury

A serious head injury post-birth can also cause cerebral palsy.

What are the risk factors for cerebral palsy?

There are other risk factors involved in a foetus developing cerebral palsy, which include:

•  Low birth weight or premature birth. If the baby is born before 37 weeks, or weighs less than 5.5 pounds at birth, they are at an increased risk of developing the condition.
•  Multiple births. Twins or greater multiple pregnancies are at a bigger risk.
•  If the mother is exposed to toxic substances, this can increase the risk of cerebral palsy.
•  Babies born through the administration of fertility treatments are at a high risk, which is thought to be due to the risk of premature birth and multiple pregnancies.
•  If the mother and the foetus have different blood types; specifically, if one has the Rh protein and one doesn’t, the foetus may be considered foreign by the blood cells, with the mother’s blood cells attacking the foetus’, resulting in brain damage.
•  If a child has jaundice which is left untreated, it can lead to cerebral palsy.

What are the complications of cerebral palsy?

There are many complications associated with cerebral palsy, including the following:

•  People with cerebral palsy are more likely to have behavioural and learning difficulties, though this is thought to be due to the damage to the brain, rather than being attributed to cerebral palsy itself. These may be emotional difficulties, problems with creating and sustaining relationships, attention and hyperactivity disorders, or behavioural difficulties.
•  People with cerebral palsy have a higher occurrence of neurodevelopmental conditions such as Autism Spectrum Disorder.
•  People with cerebral palsy have a higher occurrence of mental health and psychological issues, such as depression and anxiety.
•  Reduced life expectancy is a potential complication of cerebral palsy. It is a non-progressive condition, meaning that it does not get worse with time; however, depending on the severity, life expectancy can range anywhere between 30 and 90 years old. Someone with cerebral palsy can live a full lifespan.
•  Malnutrition is a potential complication, as issues with swallowing in some forms of the condition make it difficult for the individual to be fully nourished.
•  The misalignment of the joints can lead to osteoarthritis, a degenerative bone disease, and osteoporosis, caused by physical inactivity.

Can cerebral palsy be prevented?

In many cases, cerebral palsy cannot be prevented, but in some instances, it can be if certain measures are taken:

•  Getting vaccinated against diseases like rubella before you become pregnant, which is known to cause damage to foetal development.
•  Avoiding toxic substances such as tobacco, alcohol and drugs.
•  Ensuring that the child’s safety is looked after post-birth, to avoid any injuries to the head, making sure that they wear a helmet when needed etc.
•  Having regular check-ups with your healthcare provider whilst pregnant can ensure that your baby’s health is monitored, and can pick up signs of low birth weight and infections.

Living with cerebral palsy

Living with cerebral palsy is challenging for the individual and their family and close ones. A diagnosis is usually given in early childhood, which can come as a surprise to parents. They may believe that their lives will change dramatically. However, there are many treatments that can help to ease the symptoms of the condition. Many children and adults with cerebral palsy are happy. Due to the movement and mobility issues, schools, nurseries and places of work need to make reasonable adjustments for individuals with the condition. Many children with the condition will attend a school that can cater to their needs. Cerebral palsy is a physical disability, and individuals with the condition are entitled to support from their local authority.

How is cerebral palsy diagnosed?

It is important to diagnose cerebral palsy as soon as possible, in order to provide a plan of care which can help to reduce the severity of symptoms.

There are a series of tests that are carried out in order to look for signs of the condition, which include a CT scan, an MRI scan and a cranial ultrasound scan. An electroencephalogram can also help to diagnose the condition, and rule out epilepsy.

There are also tests that can be done to rule out other conditions that cause symptoms which are similar to cerebral palsy, such as blood tests and an electromyogram, which measures muscle function.

How is cerebral palsy treated?

As there is no cure for cerebral palsy, there are a series of treatments that have been formulated over the years to help people with the condition live as well as they can. These are put together into a care plan, formulated by a specialist, which is assessed as the child gets older. Some treatments include:

Physiotherapy

This is a key form of treatment for people with cerebral palsy, which helps to increase mobility and strength and expand the range of movement within the muscles.

Speech and language therapy

This is included in the care plan for people with a form of cerebral palsy that impacts their speech and communication. The therapist helps the child with exercises to improve speech, or teaches them other ways to communicate, such as sign language. The child may be given speech aids, such as electronic speech generators or devices with different buttons that can help them to share their thoughts and needs.

Occupational therapy

An occupational therapist helps to organise and devise a plan of ways that individuals with cerebral palsy can carry out different activities to make the most out of their energy, improve confidence and encourage independence.

Medicines

There are a number of medicines available to treat the symptoms of cerebral palsy, but it is unlikely that one person will have to take all of these medications, as the treatments are tailored to the type of cerebral palsy.

•  Diazepam, Zanaflex and Dantrium are examples of muscle relaxants which can help to loosen muscles.
•  Melatonin may be prescribed to help with sleep issues.
•  Laxatives are given to relieve constipation.
•  Anti-seizure medications may be given.
•  Sometimes Botox is administered to help with facial movement and drooling, and to help tighten weak muscles.

Surgeries

The individual may need surgery to help to relieve pain and symptoms, either on their limbs to help correct their positions, or to help extend muscles and tendons, which can help them to walk better or increase mobility. Surgery may also be performed to cut certain nerves, which helps to reduce pain.

Who can support?

• Cerebral Palsy UK is a charity that supports children, adults and their families who have been impacted by cerebral palsy, offering information, support and advice.
• Scope is a charity dedicated to disability equality. They provide information and support for people with disabilities, including cerebral palsy.
• Action Cerebral Palsy helps parents and professionals to educate them and support them in caring for children and adults with cerebral palsy.