Cerebral Palsy (CP)

CP is caused by abnormal brain development or damage to the developing brain that affects a person's ability to control their muscles. It is the most common motor disability in childhood.

Symptoms vary from person to person. A person with severe CP might need to use special equipment to be able to walk or might not be able to walk at all and might need lifelong care. A person with mild CP, on the other hand, might walk a little awkwardly, but might not need any special help. The disorder does not get worse over time, though the exact symptoms can change over a person's lifetime.

What are the Types of Cerebral Palsy?

There are several types, classified by the kind of movement affected, the body parts affected, and how severe the symptoms are. Some types involve intellectual and developmental disabilities (IDDs) as well as movement problems.

• Spastic cerebral palsy - This type is the most common form of the disorder. People with spastic cerebral palsy have stiff muscles which cause jerky or repeated movements. There are different forms of spastic cerebral palsy, depending on the body parts affected. These forms are:
  • Spastic hemiplegia or hemiparesis - This type affects the arm, the hand, and sometimes the leg on only one side of the body. Children with this form may have delays in learning to talk, but intelligence is usually normal.
  • Spastic diplegia or diparesis - People with this form mostly have muscle stiffness in the legs, while the arms and face are less severely affected. Intelligence and language skills are usually normal.
  • Spastic quadriplegia or quadriparesis - This is the most severe form of cerebral palsy, involving severe stiffness of the arms and legs and a floppy, or weak, neck. People with spastic quadriplegia are usually unable to walk and often have trouble speaking. This form may involve moderate to severe IDD as well.
• Dyskinetic cerebral palsy - This type involves slow and uncontrollable jerky movements of the hands, feet, arms, or legs. The face muscles and tongue may be overactive and cause some children to drool or make faces. People with this type often have trouble sitting straight or walking. People with this form of the disorder do not usually have intellectual problems.
• Ataxic cerebral palsy - This form of the disorder affects balance and depth perception. People with ataxic cerebral palsy walk in an unsteady manner and have a hard time with quick or precise movements such as writing, buttoning a shirt, or reaching for a book.
• Mixed types - This kind includes symptoms that are a mix of the other types.

What are the Symptoms of Cerebral Palsy?

Signs vary greatly because there are many different types and levels of disability. The main sign that a child might have CP is a delay reaching motor or movement milestones (such as rolling over, sitting, standing, or walking). Following are some other signs of possible CP. It is important to note that some children without CP also might have some of these signs.

In a baby younger than 6 months of age

• His head lags when you pick him up while he's lying on his back.
• He feels stiff.
• He feels floppy.
• When held cradled in your arms, he seems to overextend his back and neck, constantly acting as if he is pushing away from you.
• When you pick him up, his legs get stiff and they cross or scissor.

In a baby older than 6 months of age

• She doesn't roll over in either direction.
• She cannot bring her hands together.
• She has difficulty bringing her hands to her mouth.
• She reaches out with only one hand while keeping the other fisted.

In a baby older than 10 months of age

• He crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg.
• He scoots around on his buttocks or hops on his knees, but does not crawl on all fours.

What Causes Cerebral Palsy?

Cerebral palsy is caused by abnormal development of the brain or damage to the developing brain that affects a child's ability to control their muscles. There are several possible causes of the abnormal development or damage. People used to think that CP was mainly caused by lack of oxygen during the birth process. Now, scientists think that this causes only a small number of cases.

The abnormal development of the brain or damage that leads to CP can happen before birth, during birth, within a month after birth, or during the first years of a child's life, while the brain is still developing. CP related to abnormal development of the brain or damage that occurred before or during birth is called congenital CP. The majority of CP (85% to 90%) is congenital. In many cases, the specific cause is not known.

A small percentage of CP is caused by abnormal development of the brain or damage that occurs more than 28 days after birth. This is called acquired CP and usually is associated with an infection (such as meningitis) or head injury.

Cerebral Palsy Risk Factors

Some of the risk factors are:

• Low birthweight: Children who weigh less than 5 pounds, 8 ounces (2,500 grams) at birth, and especially those who weigh less than 3 pounds, 5 ounces (1,500 grams) have a greater chance of having CP.
• Premature birth: Children who were born before the 37th week of pregnancy, especially if they were born before the 32nd week of pregnancy, have a greater chance of having CP. Intensive care for premature infants has improved a lot over the past several decades. Babies born very early are more likely to live now, but many have medical problems that can put them at risk for CP.
• Multiple births: Twins, triplets, and other multiple births have a higher risk for CP, especially if a baby's twin or triplet dies before birth or shortly after birth. Some, but not all, of this increased risk is due to the fact that children born from multiple pregnancies often are born early or with low birthweight, or both.
• Assisted reproductive technology (ART) infertility treatments: Children born from pregnancies resulting from the use of some infertility treatments have a greater chance of having CP. Most of the increased risk is explained by preterm delivery or multiple births, or both; both preterm delivery and multiple births are increased among children conceived with ART infertility treatments.
• Infections during pregnancy: Infections can lead to increases in certain proteins called cytokines that circulate in the brain and blood of the baby during pregnancy. Some types of infection that have been linked with CP include viruses such as chickenpox, rubella (German measles), and cytomegalovirus (CMV), and bacterial infections such as infections of the placenta or fetal membranes, or maternal pelvic infections.
• Jaundice and kernicterus: Jaundice is the yellow color seen in the skin of many newborns. When severe jaundice goes untreated for too long, it can cause a condition called kernicterus. This can cause CP and other conditions. Sometimes, kernicterus results from ABO or Rh blood type difference between the mother and baby.
• Medical conditions of the mother: Mothers with thyroid problems, intellectual disability, or seizures have a slightly higher risk of having a child with CP.
• Birth complications: Detachment of the placenta, uterine rupture, or problems with the umbilical cord during birth can disrupt oxygen supply to the baby and result in CP.

Treatment for Cerebral Palsy

Treatment is available at Kennedy Krieger Institute's Phelps Center for Cerebral Palsy. For more information, please visit the center's website. 

Source: Centers for Disease Control