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Cerebral Palsy
all information

Cerebral Palsy

(CP)

En Español (Spanish Version)

Definition

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. 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 head injury, jaundice , Rh incompatibility , and rubella (German measles).

Some people with cerebral palsy are also affected by other medical disorders, such as seizures or mental impairment, but cerebral palsy does not always cause profound impairment.

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.

Child's Brain

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© 2008 Nucleus Medical Art, Inc.

Causes

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.

Causes include:

  • 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.
  • Unknown

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • Infection or blood clotting problems during pregnancy
  • Vaginal bleeding during pregnancy
  • Seizures or mental retardation 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
  • Premature birth
  • Multiple births (such as twins, or triplets)
  • Small head
  • Seizures

Symptoms

Symptoms of cerebral palsy 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 age three and 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 or her condition is unlikely to worsen.

Symptoms include:

  • 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
  • Tremors
  • Unintentional body movements
  • Difficulty swallowing.
  • Drooling

Some people with cerebral palsy suffer from other medical disorders as well, including:

  • Seizures
  • Mental retardation
  • Learning disabilities
  • Vision or hearing problems
  • Failure-to-thrive
  • Decreased ability to feel pain or identify items by touch
  • Problems with bowel and bladder control
  • Breathing problems if food or water has accidentally entered the lungs
  • Skin breakdown

Diagnosis

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 of the head—a type of machine that uses a magnetic field, radio waves, and a computer to make pictures of structures inside the head

Treatment

There is no treatment to cure cerebral palsy. The brain damage cannot be corrected. Therapy aims to help the child reach his or her full potential. Children with CP grow to adulthood and may be able to work and live independently.

Medication

Drugs help control muscle spasms and seizures.

  • Botulinum toxin and implantable pumps delivering the medication baclofen may be used for spasticity (increased muscle tone).
  • Glycopyrrolate may help with drooling.
  • Pamidronate may help with osteoporosis in some people with cerebral palsy.

Surgery

Certain operations may improve the ability to sit, stand, and walk.

Physical Aids

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.

Special Education

Programs designed to meet the child's special needs may improve learning. Some youngsters do well attending regular schools with special services. Vocational training can help prepare young adults for jobs.

Rehabilitation Services

Speech, physical, and occupational therapies may improve the ability to speak, move, walk, and perform activities of daily living. Physical therapy helps strengthen muscles. Youngsters can learn different ways to complete difficult tasks.

Family Services

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.

Other Treatment

Therapeutic electrical stimulation might help.

Prevention

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 and 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.
  • Prevent access to poisons.
  • Closely supervise bathing.
  • Get your child immunized at the recommended time.
  • Seek medical care when the baby becomes sick.

RESOURCES:

Cerebral Palsy Information
http://www.cerebralpalsyinfo.org

United Cerebral Palsy
http://www.ucpa.org

CANADIAN RESOURCES:

The Cerebral Palsy Association of BC
http://www.bccerebralpalsy.com/weblinks.htm

Ontario Foundation for Cerebral Palsy
http://www.ofcp.on.ca/aboutcp.html

References:

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. DynaMed website. Available at: http://dynamed102.ebscohost.com/Detail.aspx?id=114012 . Accessed October 30, 2007.

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/ .

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 . Aug 2006;20(8):668-74.

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 November 2007 by J. L. Chang, MD, FAASM

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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