Cerebral palsy is a group of chronic disorders impairing control of movement that appear in the first few years of life and generally do not worsen over time. These disorders are caused by faulty development of or damage to motor areas in the brain that disrupts the brain's ability to control movement and posture.
Cerebral palsy may be congenital or acquired after birth. Congenital causes include brain injury or malformation due to:
- Intrauterine hypoxia (low blood oxygen)
- Problems with the placenta
- Genetic abnormalities
In many instances, the cause of the brain abnormality is unknown.
Several of the causes of cerebral palsy that have been identified through research are preventable or treatable, including:
Some people with cerebral palsy are also affected by other medical disorders, such as ]]>seizures]]> or ]]>intellectual disability]]> . But, cerebral palsy does not always cause intellectual disability.
Although its symptoms may change over time, cerebral palsy by definition is not progressive. If a patient shows increased impairment, the problem may be something other than cerebral palsy.
Roughly two out of 1,000 children are affected. Cerebral palsy isn't curable. However, getting the right therapy for your child can make a big difference in reducing the long-term impact of the condition.
Damage to areas of the brain that direct movement interferes with the brain's ability to control movement and posture. Cerebral palsy may develop before, during, or after birth.
- Brain tissue may not develop correctly during pregnancy. The growing fetus may experience a lack of oxygen or nutrients.
- Child sustains a head injury or brain infection.
- Mother's and baby'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.
- Baby is deprived of 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.
- Baby has genetic/metabolic abnormalities.
Despite common misconceptions, cerebral palsy is caused by problems surrounding the delivery of the infant less than 1% of the time.
Cerebral palsy occurs in 2 out of every 1,000 births in the developed world.
Risk factors include:
- Infection or blood clotting problems during pregnancy
- Vaginal bleeding during pregnancy
- Seizures or intellectual disability in the expectant mother
- Complicated or premature delivery
- Breech birth
- Low Apgar score (a rating of the baby's condition just after birth)
- Low birth weight
- Large birth weight
- Type 1 diabetes]]> in the expectant mother
- ]]>Premature birth]]>
- Multiple births (eg, twins or triplets)
- Small head
- ]]>In vitro fertilization]]> (in part due to multiple births associated with in vitro fertilization)
Symptoms of cerebral palsy vary widely and may include difficulty with fine motor tasks (such as writing or using scissors), difficulty maintaining balance or walking, and involuntary movements. The symptoms differ from person-to-person and may change over time.
Cerebral palsy 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, his condition is unlikely to worsen.
- 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
- Unintentional body movements
- Difficulty swallowing
Some people with cerebral palsy suffer from other medical disorders as well, including:
Doctors diagnose cerebral palsy by testing motor skills and reflexes, looking into medical history, and employing a variety of specialized tests.
Tests may include:
- Electroencephalogram (EEG)]]> —a test that records the brain's electrical activity using electrodes placed on the surface of the head
- ]]>CT scan]]> of the head—a type of x-ray that uses a computer to make pictures of structures inside the head
- ]]>MRI scan]]> —a test that uses magnetic waves to make pictures of structures inside the head
There is no treatment to cure cerebral palsy. The brain damage cannot be corrected. Therapy aims to help the child reach his full potential. Children with CP grow to adulthood and may be able to work and live independently.
Drugs help control muscle spasms and seizures.
Certain operations may improve the ability to sit, stand, and walk.
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 about.
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.
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.
Professional support helps a patient and family cope with cerebral palsy. ]]>Counselors]]> help parents learn how to modify behaviors. Caring for a child with cerebral palsy can be very stressful. Some families find ]]>support groups]]> helpful.
Therapeutic electrical stimulation might help.
Several of the causes of cerebral palsy 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 on 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.
Cerebral Palsy Information
United Cerebral Palsy
The Cerebral Palsy Association of BC
Ontario Foundation for Cerebral Palsy
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;62:851-863.
Centers for Disease Control and Prevention. National Center on Birth Defects and Developmental Disabilities website. Available at: http://www.cdc.gov/ncbddd/dd/ddcp.htm .
Cerebral palsy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 3, 2009. Accessed February 4, 2009.
Cerebral palsy. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm .
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;171:653-656.
March of Dimes Birth Defects Foundation website. Available at: http://www.marchofdimes.com/ .
Matejovsky TG, Hoon AH. Cerebral palsy. MedLink Neurology website. Available at: http://www.medlink.com . Accessed February 4, 2009.
Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/cerebralpalsy.html .
Nolan KW, Cole LL, Liptak GS. Use of botulinum toxin type A in children with cerebral palsy. Phys Ther . 2006;86:573-584.
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;20:668-674.
Steinbok P. Selection of treatment modalities in children with spastic cerebral palsy. Neurosurg Focus. 2006;21:e4.
UCP Child Development Centers website. Available at: http://www.ucpa.org .
Last reviewed January 2009 by ]]>J. Thomas Megerian, MD, PhD, FAAP]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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