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Cerebral Palsy by Jessica McFarlane

The mystery is over. Here are some facts about cerebral palsy.

Cerebral Palsy (CP) affects many people. 700,000 adults and children have the condition in America. People do not know enough about CP and when they meet someone who has it, they do not know how to act. On this page, you will find facts about CP, how to act around someone with CP and links to other CP resources.

What is Cerebral Palsy?

Cerebral palsy is a physical disability. CP occurs by an injury to the brain during, before or after birth. "Cerebral" refers to the brain and "palsy" to the lack of motor control. In some cases, there may be seizure, mental retardation, and impairment of sight, hearing or speech. The degree of involvement varies.

Cerebral Palsy is not progressive, communicable, inherited or a primary cause of death. Nor is it "curable" in the accepted sense, although an individual with cerebral palsy often responds to training andtherapies. It is not a disease and should never be referred to as such. It is a condition.

What causes Cerebral Palsy?

Cerebral Palsy is caused by damage to the brain. This damage can be caused by:

"RH Incompatibility": A blood conflict between mother and unborn baby may occur if a certain element -RH factor- is missing in the mother's blood and is present in the father.

Lesch-Nyhan Syndrome - This rare genetic defect causes one type of cerebral palsy.

Mother's Illness - Certain diseases (such as German Measles) in the mother can seriously affect the unborn baby.

Severe Lack of Oxygen - If a baby doesn't get oxygen for a long time (for example, due to complications in labor), cerebral palsy may result.

Copyright 2001

Cerebral Palsy is a term used to describe a group of disabling conditions, which affect movement and posture. It is caused by defect or lesion to one or more specific areas of the brain, usually occurring during foetal development before, during or shortly following birth or during infancy. "Cerebral" refers to the brain and "Palsy" to muscle weakness and poor control. Cerebral palsy itself is not progressive, i.e., it does not get worse. Cerebral palsy is not communicable. It is not a disease and should not be referred to as such. Although cerebral palsy is not "curable" in the accepted sense, training and therapy, "Conductive Education" can help improve function

Children can have problems such as weakness, stiffness, awkwardness, slowness, shakiness and difficulty with balance. These problems can range from mild to severe. In mild cerebral palsy, the child may be slightly affected in one arm or leg, and the problem may be barely noticeable. In severe cerebral palsy, the child may have a lot of difficulties, with the whole body affected. It must be emphasized that damage to the brain is a one-time event and does not continue. Damaged brain cells cannot be repaired but undamaged brain cells will continue to develop and mature.

The complexity of Cerebral Palsy and its effects vary from one person to another. It is often difficult to classify precisely which type of Cerebral Palsy a child has.

An understanding of the different types of Cerebral Palsy makes it easier to appreciate the child's development and how the child learns to move.

There are three main types:
Spastic - Stiff and difficult movement
Athetoid - Involuntary and uncontrolled movement
Ataxic - Disturbed sense of balance and depth perception

Many children do not have just one type; there may be a mixture of these types for any individual. The most common type of mixed cerebral palsy is a mix of spastic cerebral palsy and athetoid cerebral palsy.

Spastic

Spastic Cerebral Palsy is the most common type of Cerebral Palsy. Spastic cerebral palsy affects 70 to 80% of people with cerebral palsy. With spastic Cerebral Palsy, the area of the brain controlling movement is affected. Spasticity means stiffness or tightness of muscles. The muscles are stiff because the message to the muscles is relayed incorrectly through the damaged part of the brain. When people without cerebral palsy perform a movement, some group of muscles become tighter and some groups of muscles relax. In children with spastic cerebral palsy, both groups of muscles may become tighter; this makes the movement difficult.

Cerebral Palsy, particularly spastic Cerebral Palsy, is also classified according to the number of limbs involved. One side of the brain controls the opposite side of the body so that when one side of the brain is affected, the other side of the body is weak.

The term "plegia" is commonly used. For example,

• Monoplegia - involvement of one limb
• Diplegia - involvement of two limbs
• Hemiplegia - involvement of limbs on one side of the body
• Quadriplegia - involvement of all of the limbs

These technical terms can be useful in describing the type and extent of Cerebral Palsy. However, they are only labels - the important thing is that a child is an individual and his/her needs are special.

Athetoid

Athetoid or Dyskinetic cerebral palsy affects 10-20% of people who have cerebral palsy.

Athetoid is the word used for the uncontrolled movements that occur in this type of cerebral palsy. People with Athetoid cerebral palsy will have muscles which change from floppy to tense. These movements will often affect the hands, feet, arms or legs. Sometimes the muscles in a persons face or tongue will be affected, causing drooling. The movements a person with Athetoid cerebral palsy has, will often increase during stressful times, and will most likely disappear while sleeping.

A lack of control is often most noticeable when the child starts to make a movement. Children with athetoid cerebral palsy often have very weak muscles or feel floppy when carried. People with this type of cerebral palsy may have problems coordinating muscle movements that are needed for speech this is called dysarthria.

Ataxic

Ataxic cerebral palsy only affects 5 - 10% of people with cerebral palsy. This type of cerebral palsy is fairly rare, and affects balance and coordination. They are very unsteady when they walk and they often have shaky hand movements and jerky speech. Ataxic Cerebral Palsy is the result of damage to the cerebellum at the base of the brain.

Cerebral palsy (CP) is one of the most common causes of chronic childhood disability, with a frequency of 1.4 - 2.7% of live births.  The prevalence of cerebral palsy has remained very stable for many years at this percentage.  While the improved survival of extremely preterm infants may result in an increasing number of children with cerebral palsy, preemies constitute a small minority of the overall number of disabled children. About 10% of preemies born at less than 1000 grams will eventually be diagnosed with cerebral palsy.  Estimates range from 17 - 60% of CP cases that have no known perinatal or neonatal etiology.

The diagnosis of cerebral palsy means that there has been some injury to the brain during development which has resulted in difficulty transmitting impulses from the brain to the muscles, disrupting coordinated movement. Cerebral palsy comes in a variety of forms and with a continuum of severity.  It can be so mild that it is only noticeable when the individual is stressed or involved in certain activities.  It can be so severe as to limit most voluntary movement.  It can take several years for the full impact of a child’s cerebral palsy to become apparent.  However, children do not switch from one form of cerebral palsy to another, nor from one impairment level to another, after the condition is fully expressed.

Children who have mild motor impairment and who are suspected of cerebral palsy at one year of age are often free of motor symptoms by early school age.  These children, however, are more likely to have other developmental problems, including mental retardation, learning disability, seizures, and speech problems than those with no early motor problems.  Early identification and treatment of cerebral palsy and/or other related developmental problems may stabilize the impairment and reduce associated disability. (Overview by Dr. Sheena Carter)

Cerebral palsy (CP), a disorder caused by damage to the brain, especially affecting ability to control movement and posture. Palsy is a synonym for paralysis, although a more accurate description of the usual muscular symptoms might be weakness (paresis), and inability to make voluntary movements and suppress involuntary ones.

Depending on the location and extent of the damage, cerebral palsy can be mild, revealing itself as a kind of awkwardness, or severe, largely incapacitating a child from infancy. It is sometimes associated with other problems such as seizures (epilepsy), mental retardation, ear and hearing problems, eye and vision problems, communication problems (see communication skills and disorders), and impairment of other senses. Some of the children most severely affected with cerebral palsy may not survive infancy, but most will have a normal life span.

Cerebral palsy is not contagious. It is not progressive-it does not get worse as time passes, and may instead improve somewhat with therapy (see below). It is not inherited, except in rare cases where it is associated with a genetic disorder, notably Lesch-Nyhan syndrome.

Most cases are caused by brain damage during pregnancy, childbirth, or the neonatal period (just after birth); this is called congenital cerebral palsy, because it is present at or around the time of birth. However, approximately 10 percent of the cases are acquired cerebral palsy, in which CP has been triggered by events after birth, such as a traumatic brain injury, infections such as meningitis, and other types of brain damage, including injury from child abuse and neglect.

Just why CP occurs is far from clear. Approximately 58% of the cases of cerebral palsy occurred in children who were born at full term and full weight, and in whom doctors could discern no cause of brain damage, at the present state of knowledge and technology. However, studies have shown that numerous conditions are risk factors for cerebral palsy, not necessarily leading to it, but increasing the risk that a child will have it. Among the main risk factors are:

• Infections in the mother during pregnancy, including rubella (German measles); sexually transmitted diseases such as gonorrhea, chlamydia, and syphilis; and various other bacterial and viral infections, some of which attack the baby's nervous system.

• Premature birth.
• Low birth weight, though some infants who weighed under 2 pounds at birth and spent months in neonatal intensive care have been unimpaired.
• Difficult or abnormal delivery, especially awkward fetal presentation (position at birth), lengthy or too abrupt labor, or obstruction of the umbilical cord.
• Hypoxia, or insufficient oxygen, in the brain, for a variety of reasons, such as premature separation of the placenta during delivery or swelling of the brain due to illness.
• Incompatability between parents' and fetus's blood types, especially Rh incompatibility.
• Jaundice of the newborn or hyperbilirubinemia (see liver and liver problems), sometimes associated with Rh incompatibility.
• Medications and drug abuse taken by the mother.
• Lead poisoning.
• Smoking by the mother.
• Alcohol abuse by the mother.

Cerebral palsy is generally recognized in the early years, as developmental delay becomes apparent. Though various kinds of medical scans can help doctors identify some brain abnormalities, the disorder is most often seen in its symptoms. These may include:

• Retention of primitive reflexes, involuntary reactions to particular stimuli that are normally found only in newborns.
• Muscular weakness and "floppiness" (hypotonia).
• Assumption of abnormal, awkward positions, which (if uncorrected) can lead to skeletal disorders.
• Favoring one side of the body over the other.
• Poor muscle control and lack of coordination.
• Muscle spasms or seizures.
• Problems with sucking, chewing, and swallowing.
• Unusual tenseness and irritability in infancy.
• Inability to control bladder and bowels (incontinence).
• Difficulty in speaking.
• Difficulty in concentrating, which has adverse effects on learning.
• Trouble in interpreting sense perceptions, such as inability to identify objects by touch.
• Other problems with the senses, especially hearing and vision.

Doctors classify cerebral palsy in two ways: by the affected limbs and by the nature of the movement disturbance:

By affected limbs:

• Diplegia, where limbs on opposite sides are affected, such as both legs.
• Hemiplegia or hemiparesis, where the arm and leg on one side are affected.
• Quadriplegia or quadriparesis, where all four limbs are affected

• Spastic cerebral palsy, where muscles are tense, contracted, and resistant to movement; the most common form of cerebral palsy, especially in low birth weight or premature babies.
• Athetoid cerebral palsy, where the affected parts of the body perform involuntary writhing movements, such as turning, twisting, facial grimacing, and drooling, often associated with jerky, abrupt, flailing motions (chorea). This form of cerebral palsy generally involves damage only to the motor centers, not to other parts of the brain, but the unknowing often take such "strange" and "unnatural" movements as signs of mental or emotional disturbance.
• Ataxic cerebral palsy, where the main characteristic is lack of balance and coordination and disturbed depth perception, due to damage to the cerebellum. Ataxia involves trouble maintaining balance and swaying when standing.
• Rigidity, where muscles are extremely tight and resistant to movement.
• Tremor, where muscles uncontrollably shake, interfering with coordination.

No cure exists for cerebral palsy, but various kinds of therapies are used to help each child do as much as he or she is capable of doing. Among these are:

• Physical therapy, the use of therapeutic exercises and activities to extend the child's range of controlled movement, generally focusing on gross motor skills. Some of these use the Bobath technique, in which exercises first focus on countering primitive reflexes and then on extending the range of voluntary movement, sometimes with the help of behavior modification, offering positive reinforcement to help children act against the body's awkward inclinations. Physical therapists also help children learn how to use orthopedic devices, such as wheelchairs and walkers.
• Biofeedback, in which children are given information about the functioning of a particular part of the body, often by electrical machines that produce visual or auditory signals, and are taught to concentrate on changing the visual picture or sound. Through such techniques, children with cerebral palsy can gain increased control over movements and are sometimes able to do things like drink from a cup or control their bladder-things previously beyond their range of skills.
• Occupational therapy, the use of therapeutic exercises and activities to extend the child's range of controlled movement, generally focusing on fine motor skills, many of them self-help skills. For children that may mean learning how to dress themselves, comb their hair, brush their teeth, drink from a cup, or hold a pen or pencil. For young adults that includes preparation for living as self-sufficiently and independently as possible (see vocational rehabilitation services).
• Speech and language therapy, which can help children overcome some speech and hearing impairments, and also learn to use the great variety of mechanical and electronic devices that have been developed to help them, such as voice synthesizers or specially adapted computers (see ear and hearing problems; communication skills and disorders).
• Drugs, including muscle relaxants for spastic muscles and anti-seizure drugs, if epilepsy is involved. Drugs are best used sparingly, however, since the long-term side effects on the already-damaged and still-developing nervous system are unknown.
• Surgery,
• Orthopedic devices, such as wheelchairs, walkers, page-turners, specially equipped automobiles, and the like.