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Cerebral palsy

Cerebral palsy is a condition that affects movement, posture and co-ordination. It usually becomes noticeable during the first two years of a child's life and varies greatly in severity.

With support from nurses, carers and other specialists from an early age, children with cerebral palsy can learn to manage their symptoms, helping them to become as independent as possible in later life.

About cerebral palsy

Cerebral palsy isn't a specific illness, it's a term used to describe movement disorders caused by damage to the brain. It isn't progressive, so the damage doesn't get worse throughout life. But the symptoms may change over time.

Cerebral palsy affects about one in 400 children, but all children are affected differently. Some children are affected mildly. In more severe cases it may be accompanied by other problems such as epilepsy, learning difficulties, and sensory problems such as deafness or a loss of sight. Children who are affected may need special assistance with daily activities and education.

Symptoms

Cerebral palsy is usually classified according to which area of the body is affected.

Which parts of the body are affected?

Cerebral palsy can affect different areas of the body:

  • hemiplegia means that only one side of the body is affected
  • diplegia means that only the legs are affected
  • triplegia means three limbs are affected
  • quadriplegia means that all four limbs are affected

Each person is affected differently by cerebral palsy and may have a mixture of symptoms. The severity of symptoms also varies greatly. Some people will be able to walk but may have problems with more complex movements; others may need a powered wheelchair to get around.

How are muscles affected?

There are three types of cerebral palsy, which cause different problems with movement.

Spastic cerebral palsy: This type of cerebral palsy makes it difficult to move your limbs and walk. If it is mild it might only affect certain activities such as running.

Athetoid or dyskinetic cerebral palsy: This causes slow involuntary, sometimes repetitive muscle movements and sometimes abrupt twitches. These movements can increase at emotional times, and they stop during sleep. Athetoid cerebral palsy can also make speaking difficult because of involuntary tongue movements and spasms in the vocal cords.

Ataxic cerebral palsy: This causes reduced levels of co-ordination and balance, muscle weakness, tremors and difficulty walking.

Complications

Not being able to move fully can limit how a child learns about space and how to interact with his or her surroundings. This can affect his or her learning opportunities and have an impact on overall development.

Children with cerebral palsy may also be more likely to have other problems such as epilepsy, learning or behavioural difficulties and sensory problems.

Causes

Cerebral palsy is caused by damage to the brain that happens during pregnancy, during birth, or just after it. Often it's impossible to say exactly why this happens. However, there are a number of potential causes of cerebral palsy, including:

  • an infection in the mother during pregnancy
  • an infection in the baby after birth, eg meningitis
  • bleeding in the brain
  • developmental brain problems
  • rarely, it can be inherited
  • premature birth or complications at birth
  • iodine deficiency in the mother

Scientists are continuing to research the causes of cerebral palsy with the hope of being able to prevent it in the future.

Diagnosis

If you think your child is having problems with movement, talk to your GP. He or she may refer your child to a paediatrician (a doctor who specialises in child health). Most children who have cerebral palsy are diagnosed around the age of two, but it can be at any age. Your doctor may monitor your child through development stages to rule out other similar conditions before making a diagnosis.

Movement disorders such as cerebral palsy are classified by the gross motor function classification system:

  • Level I - walks without restrictions; limitations in more advanced gross motor skills
  • Level II - walks without devices; limitations in walking outdoors and in the community
  • Level III - walks with mobility devices; limitations in walking outdoors and in the community
  • Level IV - self-mobility with limitations; children are transported or use power mobility outdoors and in the community
  • Level V - self-mobility is severely limited even with the use of supporting technology

Treatment

There is no cure for cerebral palsy. However, with the right support people who have it can be taught to become as independent as possible.

Non-medical treatment

A multidisciplinary team, which incorporates professionals who work in different areas of health and social care, can help support you and your child. Often this will include a phase of diagnosis followed by assessment. The details of these will vary according to how your local services are configured.

During diagnosis, your child may be admitted to hospital briefly or asked to attend as a day case for some tests.

During the assessment phase, there will often be a half or whole day of detailed evaluation of your child's abilities. This will include an assessment of movement, intelligence, vision, hearing and daily activities.

After diagnosis and assessment a detailed management plan can be developed specifically tailored to your child's needs. Some examples of the people who may be involved in managing a child with cerebral palsy are listed below.

  • General practitioner. Your GP, or family doctor, can give you general advice as well as help put you in contact with other support services. He or she may refer you to a paediatrician for more detailed assessment.
  • Paediatrician. Hospital paediatricians may be involved in the initial confirmation of the diagnosis. You will usually be referred to a community paediatrician. Based outside of hospital, he or she will often be a key figure in the management of your child, especially during the assessment phases when they will help to co-ordinate the activity of the other professionals involved.
  • Physiotherapist. Physiotherapists specialise in treating problems with movement. They play a key role in helping to manage children with cerebral palsy. A physiotherapist will monitor and record your child's progress, teaching them how to control head movements, roll over, crawl and walk as best as possible. They will also help to reduce abnormal movements, as well as instruct you how to carry your child, give advice on feeding and bathing, and advise on equipment that may be needed to help your child's mobility.
  • Speech and language therapist. A speech and language therapist will help identify and manage any problems your child has with communication. This may include teaching languages using sign or symbols or other communication aids.
  • Social worker. A social worker from your local authority will help provide advice on practical and financial matters.
  • Occupational therapist. An occupational therapist will assess how much the cerebral palsy affects life and recommend specific activities or equipment that will help to adapt to any difficulties and maximise independence.
  • Neurologist. Neurologists specialise in disorders of the central nervous system, and may be involved in the initial diagnostic phase or in the management of epilepsy.
  • Educational psychologists. An educational psychologist helps manage any learning difficulties. This could involve visits to your child's school to assess his or her progress.

Setting specific goals in the management of cerebral palsy - agreed on by the parents, the healthcare professional and other family members - can help get the best results.

Medicines

An injection of botulinum toxin A is sometimes used to relieve muscle stiffness. This is often used in older children who walk on tip-toes and who have very tight calf muscles and tendons.

Surgery

If you have spastic cerebral palsy an operation on the back called dorsal rhizotomy can help in some cases. This involves identifying and cutting specific nerves in the lower back. This is thought to help relieve spastic muscles. However, this is a very complicated procedure and it's only carried out in certain specific cases. It isn't certain to improve mobility and once it is carried out it can't be reversed and may have serious complications.

Another surgical treatment is tendonotomy, where tendons are cut to relieve stiffness.

Surgery should only be carried out by cerebral palsy specialists.

Living with cerebral palsy

Raising a child with cerebral palsy can have an impact on all the family - talk to your GP or paediatrician for more advice about this.

There are also many charities and patient groups that can give you further advice. See Further information for more details.

Further information

Scope

Sources

  • An introduction to cerebral palsy. Scope. www.scope.org.uk, accessed 26 October 2007
  • Cerebral palsy: what parents and doctors want to know. BMJ 2003; 326:970-974. www.bmj.com
  • Simon C, Everitt H, and Kendrick T, Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2005: 829
  • Cerebral palsy. The Chartered Society of the Physiotherapy. www.csp.org.uk, accessed 2 November 2007
  • Occupational therapist. NHS Careers. www.nhscareers.nhs.uk, accessed 2 November 2007
  • British National Formulary (BNF). BMJ Publishing Group, 2007. 54: 265
  • Selective dorsal rhizotomy for spasticity in cerebral palsy - guidance. NICE guidelines. www.nice.org.uk