Cerebral palsy Q and A
What is cerebral palsy?
Cerebral palsy (CP) is the name given to a group of disorders that affect body posture and movement (motor disorders).
People with CP have damage to the part of the brain that controls muscle tone, disrupting the brain’s ability to control movement and posture. A person with CP may have difficulty with mobility and speech, and with fine motor skills such as writing, and they may have difficulty controlling their facial muscles so they might drool or have unusual facial expressions.
CP is a condition, not a disease: you can’t ‘catch’ CP from someone, and it’s not hereditary.
CP begins early in life, with the brain damage beginning during pregnancy, during birth or before age 5.
About one or 2 babies out of every 1000 live births have CP. Most at risk of CP are premature babies, babies with a low birth weight (less than 2.5 kg) and multiple-birth babies, such as twins or triplets.
The brain abnormality that results in motor problems is non-progressive (it does not worsen over time); however, a person’s symptoms and movement problems can change over time.
What causes cerebral palsy?
Quite often the exact cause of CP is unknown, although many different types of injury can cause it. In the majority of cases, CP occurs during pregnancy. It may be due to ongoing oxygen deprivation of the fetus, metabolic or blood abnormalities, or even the mother having rubella (German measles) during pregnancy. Poor oxygen supply to the brain or injuries during birth can also result in CP. In other cases, the brain damage may be caused by illness, such as meningitis, or it might be due to accidental injury in early childhood.
What are the symptoms of cerebral palsy?
If a child has CP, the early signs are likely to appear before the age of about 3 years. Children with CP are often slow to achieve developmental milestones, such as learning to sit up, crawl, roll over, and walk.
The symptoms of CP vary from person to person, and can change over time. Some people with mild CP may walk a little awkwardly but otherwise can function well, whereas a person with severe CP may have contorted arms and legs and may need lifelong care. Many people with CP also have difficulty in controlling the muscles involved in speech, making it difficult for them to talk clearly.
The symptoms a person displays depend on which of the 4 main types of CP they have.
A person with spasticity — meaning an increase in muscle tone — has very stiff, weak muscles, with the limbs that are affected being poorly developed. Spastic CP may affect both arms and both legs, one arm and one leg on one side of the body or mainly the legs. The majority of children with CP have spasticity, making their movements stiff and awkward.
Athetoid or dyskinetic CP
Less than a quarter of children with CP will display athetosis, in which the person has slow, uncontrollable, writhing movements (and sometimes jerky, abrupt movements) of the arms, legs and body. The face and tongue can also be affected, making it very difficult to talk.
About one in 10 children displays ataxic symptoms, in which a person has poor muscle co-ordination, with muscle weakness and trembling, and difficulty with balance and depth perception. A person with ataxic CP may be unsteady when they walk, and may walk with their legs widely spaced apart. People with ataxic CP may also find it difficult to make quick movements or movements that need a lot of muscle control, such as writing or doing up buttons.
Many children with CP display a mix of the above symptoms, most often spastic and athetoid symptoms.
Other health issues
Some people with CP have other health problems as well, such as poor vision, seizures, loss of hearing or below-normal intelligence (although about 40 per cent of people with CP have normal or near-normal intelligence).
How is cerebral palsy treated?
Unfortunately, there is no cure for CP; however, there are many resources available to help make life easier for people with CP and their carers. Healthcare professionals work together to provide a treatment programme suited to the individual to help them manage their CP and learn to become as independent as possible.
Your doctor or paediatrician may be able to prescribe medicines that can control seizures and muscle spasms. Medicines are also used to control spasticity. Botulinum toxin A (brand names include Botox and Dysport), a neurotoxin derived from the bacterium Clostridium botulinum, is sometimes injected into the calf muscles to relax tight muscles and make walking easier by improving the position of the ankle and allowing the foot to make heel-to-floor contact, so helping to amend tip-toe walking.
Special braces or splints may be recommended to aid balance and movement, or surgery may be recommended to aid mobility.
A physiotherapist can provide exercises to be conducted at home that will help with mobility. They can also advise parents on how to position their child properly and lift them safely. They can also advise on the best walking aids and seating aids to make life more comfortable.
A speech therapist can help with eating and communication difficulties, and can help with communication aids, sign language, or symbol language to replace speech or assist with speech.
An occupational therapist can help provide equipment or adaptations to the home or workplace to help a person with CP function as well as possible in everyday life.
Hyperbaric oxygen therapy (breathing pure oxygen while in a sealed, pressurised container) has been promoted by some for people with CP. However, research has not so far shown that hyperbaric oxygen benefits CP.
What is the outlook for someone with CP?
Each person is different, with the severity of CP playing a key role in the outlook of a person with CP. Some people with CP may need no extra support to enjoy everyday activities, while others may need ongoing assistance and equipment such as a wheelchair or walker to help them move around, or special equipment such as an electronic device to help them communicate.
Many people with CP are otherwise healthy and may live to old age, while others may have other health problems that affect their everyday life and long-term outlook.
The outward appearance of a person with CP may not reflect their intellectual capabilities or their abilities to gain qualifications, work and enjoy life in the community.
2. National Institute of Neurological Disorders and Stroke [website]. NINDs Cerebral palsy information page. https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebral-Palsy-Information-Page (accessed Aug 2018).
3. Mayo Clinic [website]. Cerebral palsy (updated 2018 Aug). Available at: https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999 (accessed 2018 Aug)