Cerebral Palsy Overview
CP defines a group of neurological conditions related to damage to the brain that typically occurs during fetal development, birth, or at some point during infancy. The underlying root of the symptoms is damage or a lack of development in the brain’s motor areas.Get A 100% Free CASE Evaluation
Cerebral palsy can have a variety of effects. It’s characterized by symptoms that don’t worsen over time. The effects may be seen in one arm or leg, or may be limited to one side of the body. They can be limited to just the legs, involve all limbs, or a combination of them. Damage to motor areas in the brain most commonly affects flexor muscles that enable one to bend their limbs, or the extensor muscles that let one straighten them.
The most common symptoms of CP include weakness, tremors, deep tendon reflexes, and muscular hypertonicity, or stiff, abnormally toned, and spastic muscles. Many patients present with a scissor-like gait, using their toes to walk. Intellectual impairment is often associated with the condition, although some people with CP have normal to above average intelligence. Other symptoms associated with cerebral palsy include:
- Growth problems
- Impaired vision or hearing
- Unusual touch and pain perceptions
- Difficulty speaking
- Problems sucking or swallowing
- Balance problems
- Difficulty with fine motor skills
- Gastrointestinal problems
- Reduced bone mass (in non-ambulatory individuals)
Signs of CP are often not present at birth, but parents may notice motor skill impairments before 18 months. Infants are often slow to reach milestones such as rolling over, sitting, or crawling. In addition to developmental delays, children may have decreased muscle tone (hypotonia), or they may have stiff, rigid muscles with increased tone (hypertonia). The former may progress to the latter after two or three months of birth.
Types of Cerebral Palsy
- Spastic cerebral palsy: The most common form, it prevents individuals from relaxing their muscles. Attempting to stretch the muscles causes them to tighten further. Typical traits include pulling the elbows towards the body, the hands and wrists close to the chin, and keeping the fists clench tightly. Spasticity also causes the legs to cross, and rotate inward at the hips. An exaggerated startle response, spinal curvature, and weak respiration are seen in some patients as well.
- Athetosis: Patients with this type of CP have slow, writhing movements. In response to stress or stimulation, their hands, feet, arms, and legs move more, but the motions may be completely absent during sleep. An extensor thrust, during stimulation, causes the arms to move outward and toward the back, and the palms to turn floorward. The patient’s fingers spread and may overextend, and the knees and feet turn inward. Flexing of the neck and backward and sideward motion of the head can make it difficult to eat, drink, and breathe.
In some cases, a child may have both these forms of CP in different parts of the body. A rare form, ataxic cerebral palsy, affects balance, coordination, and fine motor functions.
Causes, Diagnosis, and Treatments
The known causes of cerebral palsy include infections during pregnancy, such as rubella and tissue infections. Anemia, drugs/alcohol abuse, and viral infections in pregnant women can cause CP as well. Premature birth is a risk factor, especially with bleeding inside the head, as is any lack of oxygen during development or delivery. Jaundice, or an excess of bile pigment in the baby’s brain following birth, separation of the umbilical cord and placenta too soon, and severe head injuries can also cause damage that leads to CP.
Diagnosis is often challenging in the first year of life. Babies with CP may develop a hand preference too early. Doctors perform physical tests that check the infant’s motor skills, reflexes, and general movement. Other diseases are often ruled out to diagnose cerebral palsy, the symptoms of which do not worsen over time.
Treatments for those with CP include:
- Physical therapy to strengthen muscles and improve fitness; strength training, assistance with walking, and efforts to improve gross motor functions may be applied.
- Medications may include botulinum toxin to relax muscles by blocking the release of acetylcholine, or baclofen in cases of spastic or dystonic CP to reduce spasticity in the lower limbs.
- Surgery on the spinal cord may be performed to address spasticity, or to address hip dislocation; non-invasive bracing, reconstructive procedures, femoral resections, and soft-tissue releases are options.
Other treatments focus on secondary conditions such as aspiration pneumonia from gastroesophageal reflux. Nasogastric tube feeds are often limited to reduce nasal discomfort and aspiration. As more individuals with CP are surviving until adulthood, preventative care to avoid drowning, reduce cardiovascular risk, and pedestrian automobile crashes is being prescribed. Screening for digestive disorders, ischemic heart disease, cerebrovascular disease, and breast/brain cancer is common, given the higher risk compared to the overall population.