Cerebral palsy is an umbrella term for describing a group of
chronic disorders that impair a person’s ability to control body movement and
posture. These disorders result from injury to the motor areas of the brain.
Cerebral palsy affects two to six infants out of every 1,000 births, and is the
most common disability among children in the U.S. The problem causing cerebral
palsy may occur while the infant is still in the womb or after birth, and the
problem is not always detectable during a child’s first year of life. Children
with mild cerebral palsy may only have a minor limp or an uncoordinated walk,
while patients with severe cases will require care and supervision throughout
their lives. Many of the infants born with cerebral palsy also experience some
degree of mental retardation and/or have seizures.
Patients with cerebral palsy can have a variety of symptoms.
These symptoms usually do not worsen over time and include:
- Difficulty with fine motor skills, such as writing and using scissors
- Involuntary muscle movements
- Difficulty maintaining balance and walking
- Learning problems
- Vision defects, such as crossed eyes
- Speech difficulty
- Sucking and swallowing problems
Cerebral palsy may affect one arm or leg, an arm and leg on
the same side, only the legs, all four limbs, or any combination of arms and
legs. Whatever the affected areas may be, the muscle types involved are
often the same. Muscles that enable people to bend their arms and legs are
called flexor muscles. Extensor muscles are the opposite of flexors and
enable a person to straighten these limbs back out. It is the inability to
control these and other muscles that defines the most common cerebral palsy
syndromes.
Spastic cerebral palsy
Spastic cerebral palsy is the most common form and is the type seen in 75 to
80 percent of cases. Patients with this form are unable to relax their muscles,
which respond by tightening further if the patient or someone else tries to
stretch them. This spasticity affects the function of individual muscles,
especially flexor muscles.
When spasticity occurs in the arms, the flexors tighten, pulling
the elbows toward the body, and hands and wrists toward the chin. The hands
themselves form tight fists. This constant tightened state may in turn weaken
the extensor muscles, stretching them to the point where some of their
functionality is lost. When spasticity occurs in the legs, the flexor muscles in
the calves are affected. When this happens, the heels become raised, pushing the
toes downward and often causing a child to walk on their toes.
Spasticity in the legs also affects the adductor muscles (the
inner thigh muscles). Adductor muscles pull a body part toward its midline, such
as those that pull the arms to a person’s side or close a person’s legs. In
patients with cerebral palsy, the inward pull of the adductor muscles is so
strong that the legs cross over each other or scissor. This motion also rotates
the legs inward at the hips, pulling them away from the hip sockets, which can
lead to abnormal socket development and hip dislocation.
Other conditions associated with spastic cerebral palsy may
include an exaggerated response to startle stimulation, a degree of mental
impairment, and weak respiration. Some children with spastic cerebral palsy
develop a curvature of the spine. This results from remaining in a constant
upright position, which prevents the trunk muscles needed for supporting the
spine from developing properly.
Athetosis
Whereas spastic cerebral palsy doesn’t permit the muscles to relax, with
athetosis, the muscles are subjected to excessive and uncontrollable movement.
These movements also increase with a child’s excitement and in response to
surrounding environmental stimulation. Likewise, the more relaxed a child is,
the less often these abnormal movements occur. When a child is sleeping, the
movements stop altogether.
The movements of a stimulated child form what is called an
extensor thrust. When this happens, the arms rapidly extend outward and back,
the palms turn toward the floor, the fingers spread and overextend, the knees
come together, and the feet turn inward with the toes up. The child’s neck
flexes, pulling the head back and to the side, and the mouth opens with the
tongue sticking out. These movements can present extreme difficulty for a child
when eating and drinking. The child may also have shallow and irregular
respiration, which affects oxygen flow to the brain and increases the chance for
respiratory infections. Patients with athetotic cerebral palsy also have
difficulty with balance and walking.
The characteristics of each of these syndromes are not mutually
exclusive, and a child may have spastic cerebral palsy in his or her legs as
well as a degree of athetosis elsewhere.
Causes
While some of the causes of cerebral palsy are still unknown, there are many
known factors that can cause or contribute to brain damage before or after
birth. Preventive methods, such as proper prenatal care, can eliminate some
causes, while others are as yet unpreventable.
Some of the known causes or contributors to cerebral palsy
include:
- An infection, such as rubella (German measles) or toxoplasmosis (a
tissue infection), during pregnancy
- Drugs and/or alcohol abuse during pregnancy
- Blood type differences between mother and fetus
- Anemia (has too few red blood cells) during pregnancy
- Premature birth with internal bleeding in the baby's head
- Lack of oxygen to the baby during development or delivery
- Early separation of the placenta or damage to the umbilical cord
- Excessive bile pigment (jaundice) in the baby's brain after birth
- A viral infection that affects the brain (encephalitis)
- Hydrocephalus
- An infection of the membranes surrounding the brain and spinal cord
(meningitis)
- A severe head injury in the baby
- Severe convulsions in the baby
Diagnosis and treatment
Unless it is severe, cerebral palsy may be difficult to diagnose in a
child’s first year of life. Because much of the development in this first year
is based on motor functions, observation of these developing functions is often
needed to make an accurate diagnosis. Actions such as reaching for toys, rolling
over, sitting, standing, and walking develop during this time, and a delay in
this development will prompt a physician to look for other physical symptoms if
cerebral palsy is suspected. These signs may include abnormalities in muscle
tone, movements, and reflexes. A doctor may also look at an infant’s hand
preference. During their first year, babies normally do not show hand
preference. But infants with cerebral palsy in only one side of the body may
develop a hand preference early on, using their unaffected side to reach and
grab for toys even if they are closer to their opposite, affected hand.
Once cerebral palsy has been diagnosed, predicting how or when a
child will develop their motor milestones is often difficult. It is known that
once an activity has been learned, it does not regress. For example, walking can
be a very demanding and difficult task for children with cerebral palsy. Once
the child has learned to walk, they will always be able to walk unless something
other than cerebral palsy affects the child. If this sort of regression should
occur, it is important for parents or caretakers to call the doctor immediately.
While physical observation of motor functions is the best method
for diagnosing cerebral palsy, a physician may order other tests to rule out
other neurological disorders. For example, computed tomography (CT) scans,
magnetic resonance imaging (MRI), and head ultrasounds all take images of the
brain and surrounding areas and may be useful in detecting serious conditions
such as hydrocephalus (abnormal accumulation of fluid in the brain). While these
tests are not used to confirm or rule out cerebral palsy, these scans may reveal
the presence of brain cysts, scars, or other abnormalities that may have caused
the cerebral palsy.
Although cerebral palsy cannot be cured, in many instances it
can be effectively treated and managed. Treatment often involves a combination
of approaches and varies with each individual. Physical therapy can teach
patients how to train and exercise their muscles, speech therapy can help
improve speaking and other tasks involving the mouth, and eye surgery or
prescription lenses can repair or compensate for vision problems. Some patients
benefit from antispasticity medicines, while others require orthopedic surgery
or neurosurgery to change the position of an arm or leg, so assistance devices
such as crutches or braces can be used. Newer techniques include Botox
injections directly into involved muscles to decrease muscle rigidity and
Baclofen infusion pumps that provide a constant stream of muscle relaxant into
the spinal fluid.
Many people with cerebral palsy live productive and relatively
normal lives. In fact, in the last 40 years, the number of people with cerebral
palsy who are active in the workforce has almost doubled. Like many other
conditions, education about cerebral palsy and local support groups can be the
greatest tools for managing the disorder and preventing complications. The
following organizations can provide additional information about cerebral palsy:
United Cerebral Palsy Association
1660 L Street N.W., Suite 700
Washington D.C. 20036
(800) 872.5827
Easter Seals
230 West Monroe Street, Suite 1800
Chicago, IL 60606
(800) 221.6827
National Rehabilitation Information Center
4200 Forbes Blvd., Suite 202
Lanham, MD 20706
(800) 346.2742
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/2/2009...#8717
