What is cerebral palsy?
Cerebral palsy (CP) is caused by an injury to the immature brain that causes a disorder of movement and posture. It can occur before or during childbirth, or in their first two years of life.
Children and adults with cerebral palsy have problems moving, controlling and coordinating their muscles. Some people with cerebral palsy also have intellectual disabilities, seizures and difficulties seeing or hearing. Although there is no cure, healthcare providers can reduce symptoms with therapy, medications and surgery.
How common is cerebral palsy?
Cerebral palsy is the most common motor disability in kids in the United States. Of every 1,000 babies born in the U.S. every year, between 1 and 4 have cerebral palsy. Boys are slightly more likely to get CP, and the condition is more common among multiples. Babies born prematurely or with a low birth weight have a higher risk of CP.
What are the types of cerebral palsy?
Cerebral palsy is classified in two ways – what parts of the body are most affected, and what movement disorder is most prominent.
There are four types of movement disorders of cerebral palsy. They result from damage to different areas of the brain.
The types of cerebral palsy are:
- Spastic cerebral palsy: Around 75% of people with CP have spastic cerebral palsy. People with spastic CP have stiff, tight muscles that contract uncontrollably. Their movements, including walking and talking, may appear jerky due to muscle spasticity (stiffness).
- Dyskinetic cerebral palsy: Also known as athetoid cerebral palsy, this type of CP causes irregular movements in the limbs, face and tongue. The motions may be smooth and slow or quick and jerky. The person may look like they’re writhing or twisting. The movements are more severe when the person is active. People with dyskinetic CP often have trouble swallowing their saliva, so they may drool.
- Ataxic cerebral palsy: This type of CP causes problems with depth perception, coordination and balance. It may be hard for them to stand or walk without swaying or falling. Kids with this type of CP often walk with their feet spread apart. They may look like they’re shaking when they move.
- Mixed types: Damage to more than one area of the brain can cause several symptoms at once. A person with mixed CP has a combination of symptoms of spastic, dyskinetic and ataxic cerebral palsy.
The areas of the body that cerebral palsy may affect:
- All four extremities (quadriplegia).
- Only the legs (diplegia).
- Extremities on one side of the body (hemiplegia).
Symptoms and Causes
What are the signs of cerebral palsy?
Cerebral palsy affects everyone differently, and symptoms range from mild to severe. Some people with CP have mild weakness in one arm or leg. Other people with CP have severe disabilities that make it difficult to talk, walk or perform daily tasks.
Signs of cerebral palsy can appear at birth or within the first years of life. Symptoms vary depending on the type of CP. They include:
- Developmental delays: Babies with CP often have delays in meeting developmental milestones such as sitting up, rolling over, crawling or walking. Children with CP may have a speech delay or learning disability.
- Low muscle tone: Some babies with CP have low muscle tone (hypotonia). They feel floppy, weak or limp and have poor posture. Infants with hypotonia might not be able to control their heads. Their limbs may be very flexible.
- Increased muscle tone: Some types of CP cause increased muscle tone (hypertonia). Babies with CP may seem as if they’re always arching their backs or stretching their arms. Their legs may stiffen and move like scissors, and their muscles may contract uncontrollably.
- Difficulty speaking and swallowing: Problems with muscle tone and muscle control can make it challenging for people with CP to talk. They may have trouble eating or drinking due to problems with chewing, swallowing and controlling the mouth, tongue and throat muscles.
- Preference for one side of the body: Babies with hemiplegic CP may crawl using only one leg and one arm. They may reach for objects with only one hand. Older children may limp when they walk.
What conditions can occur along with cerebral palsy?
Cerebral palsy often occurs with a range of other conditions and disorders. Children and adults with CP may also have:
- Bladder and bowel control problems.
- Chronic (long-term) pain.
- Epilepsy and seizure disorders.
- Gastrointestinal (GI) issues, digestive problems and chronic gastroesophageal acid reflux (GERD).
- Intellectual disabilities, learning difficulties and behavioral issues.
- Spinal abnormalities and scoliosis.
- Vision or hearing problems.
What causes cerebral palsy?
CP results from damage to the developing brain. The damage can happen in the womb, during birth or in the first two years of a baby’s life. In many cases, providers don’t know what caused the brain damage.
Several factors can influence a baby’s risk of having cerebral palsy. Babies born prematurely (before 37 weeks) or with low birth weight have a higher risk. Brain damage that leads to CP can result from:
- Complications during birth: A small number of babies with CP develop the condition because of a birth injury. Several complications during childbirth can block oxygen flow to the baby, which can cause CP.
- Infection: Infections during pregnancy, such as toxoplasmosis or rubella (German measles), can cause brain damage that leads to CP. Diseases such as meningitis and encephalitis during the first two years of life can also lead to CP.
- Injury or disease: A baby who has a head injury or stroke during the first two years may develop cerebral palsy. Babies who have sickle cell disease, blood clotting disorders or heart conditions have a higher chance of CP.
- Jaundice in newborns: Without treatment, severe jaundice can cause brain damage in newborns. Jaundice causes the skin and whites of the eyes to appear yellow. When a pregnant woman lacks a blood protein (Rh factor) and her baby has the protein, severe jaundice and other complications can occur.
Diagnosis and Tests
How is cerebral palsy diagnosed?
To diagnose cerebral palsy, your healthcare provider will check your child’s muscle tone, motor skills, coordination and movement. Your provider will ask several questions about your baby’s development and birth history. You should share information about milestones your baby has reached, as well as any delays.
Your healthcare provider may order imaging scans to see a clear picture of your child’s brain. Magnetic resonance imaging (MRI) and computed tomography (CT) scans show the location and severity of brain damage. These images allow your child’s provider to make an accurate diagnosis and recommend the most effective therapies. However you don’t need an imaging scan to diagnose cerebral palsy, so your child’s provider may recommend waiting until they’re older to avoid having to place your child under anesthesia for the study. Or they may suggest your child gets the scan at the same time that they’re under anesthesia for another procedure or test.
Management and Treatment
Can cerebral palsy be treated?
The goal of treatments for CP are to improve movement, speech and quality of life. Therapy is the most common treatment for cerebral palsy.
It’s crucial to start therapy as early as possible. Skilled therapists can help children learn to walk, communicate and take care of themselves. They can also help you learn how to provide therapeutic opportunities for your child at home. Treatment plans are different for everyone and may include:
- Therapy: Physical, occupational and speech therapies improve how a child moves, plays and interacts with the world.
- Medications: Botulinum toxin (Botox®) injections temporarily weaken the muscles to improve range of motion and stiffness. Muscle-relaxing drugs such as baclofen can help with stiffness and spasms.
- Surgery: Your provider may recommend surgery to improve mobility. Surgeons can lengthen tendons and muscles or repair problems in the spine. Certain patients may benefit from a procedure called selective dorsal rhizotomy (SDR). In SDR, surgeons decrease muscle spasticity in the legs by cutting through overactive nerves in the spine.
Can I prevent cerebral palsy?
Although it isn’t possible to prevent cerebral palsy, you can reduce the risk of having a baby with CP. If you’re pregnant or planning to start a family, ensure that you get proper prenatal care. Your provider will monitor you and your baby and address health issues if they arise.
Take your baby to your healthcare provider for regular checkups. Stay up to date on vaccines to protect your child from infections that can cause cerebral palsy.
Outlook / Prognosis
What is the outlook for people with cerebral palsy?
The outlook for people with CP varies widely and depends on the severity of the condition. Many kids with cerebral palsy get better with therapy and other treatments. People with mild cerebral palsy live full, independent lives. If symptoms are more severe, the child may need round-the-clock care to help with eating, bathing, dressing and using the bathroom.
Most children with CP learn to walk, either independently or with a walker or crutches. Cerebral palsy is not a progressive disease. While symptoms can affect your child differently as they grow and develop, they should not get worse over time unless another medical condition causes health problems.
When should I see my healthcare provider about cerebral palsy?
If you’re concerned about your child’s development, talk to your provider. It’s essential to have your child evaluated if you notice delays in crawling, walking, talking or meeting other developmental milestones. If your child has CP, early treatment can greatly improve their quality of life.
A note from Cleveland Clinic
If your child has cerebral palsy, you may feel overwhelmed and worried about the future. Talk to your healthcare provider about finding a support network for caregivers and family members. Therapy and other treatments help many people with CP live independent lives. Advances in technology — such as robotic devices that help with walking — have been life-changing for people with cerebral palsy. Promising research and breakthroughs in treatment offer hope for people with CP and allow more opportunities for kids and adults to reach their full potential.