Definition Cerebral palsy (CP) is a non-progressive condition due to an injury to the brain before it is fully mature. This injury causes long-term problems with movement and often other difficulties as well.
What is going on in the body? CP affects 2 to 4 out of every 1,000 live-born infants. This rate has not changed much in the last 40 years, in spite of advances in managing childbirth and the care of newborn infants.
At one time, CP was thought to be caused by the infant getting too little oxygen during birth. More recent studies suggest that most cases come from problems during pregnancy.
In at least half of cases, the cause of CP is not known. Many infants who develop CP have no known risk factors. CP rarely occurs after birth.
The main problem of CP is permanent brain damage that causes trouble with movement. Other areas of functioning, such as intelligence, are also commonly affected.
What are the signs and symptoms of the disease? CP affects parts of the brain involved in the voluntary control of motion. Since most movements in young infants are of a reflex nature, it is difficult to diagnose CP in infants less than 6 months old. Some early signs can provide clues. CP should be suspected in any infant who is slow to gain normal motor skills. This is especially true when physical delays occur in an infant with normal intellectual development. Infants with CP may have muscle tone that is either lower or higher than normal. Co-ordination may also be impaired. Random writhing movements that occur for no apparent reason also may rarely occur.
Hearing loss can occur, and infants should be screened for it. Early treatment to try to preserve hearing can avoid delays in speech development.
Vision should be routinely checked. Premature infants often have serious vision problems. Strabismus, which means a squint or crossed eyes, occurs in about 75% of children with CP. Early diagnosis and treatment can prevent vision loss.
Speech and language disorders can occur. Affected children may also have trouble understanding language.
Mental retardation occurs in about 60% of children with CP. Those with normal intelligence may have learning disabilities.
Some form of seizure disorder develops in about 25% of the children with CP. Seizures are due to abnormal electrical activity in the brain. This may cause people to have convulsions or lose consciousness.
What are the causes and risks of the disease? Most infants who develop CP are born after a full-term pregnancy. Prematurity and low birth weight both increase the risk of CP. But even for very low birth weight infants, who weigh less than 1.5 kg, the risk of CP is only 15 to 20 percent. Premature infants who have bleeding inside the brain are at greatest risk for CP. Some cases may be related to problems in labour and delivery. CP can occur if the infant's brain is deprived of oxygen for a period of time.
What can be done to prevent the disease? Because the cause is usually unknown, CP is difficult to prevent. Of the known causes, prematurity is fairly common. Therefore, reducing the rate of prematurity may help reduce the incidence of CP. Some risk factors for prematurity are:
poverty of the mother
little or no antenatal care
previous preterm delivery
How is the disease diagnosed? CP is diagnosed by a history and physical examination. The doctor will look for signs of muscle problems related to nervous system injury. These include strength, movement, or co-ordination problems in an infant or young child. Changes in muscle tone are usually seen. Another sign is that an infant is unable to do certain things at the normal age. It may take time for the diagnosis to become clear. Some signs of the disorder may change over time. Some signs may appear after the diagnosis has been made. A paediatric neurologist, a doctor who specialises in nerve and brain disorders in children, can help to confirm the diagnosis.
What are the long-term effects of the disease? CP can affect different areas of the brain. There can be many long-term effects from brain injury involving many areas of functioning.
Affected children may have various limitations in activity due to movement problems. Severely affected children may be unable to feed or dress themselves.
The imbalance of muscle tone and strength can result in skeletal problems. Some of these are scoliosis, or curvature of the spine, the inability to bend the joints, and hip dislocation.
Control of seizures can be difficult. It may require complicated drug therapies.
Problems with social interaction may occur.
Mental retardation and learning disabilities can affect school performance.
Raising a child with disabilities can cause emotional, physical, and financial stress for a family.
What are the risks to others? CP cannot be transmitted to others.
What are the treatments for the disease? This disorder cannot be cured. Treatment is geared toward improving function and the quality of life for the affected child.
All children with CP have problems with muscle control. Many of them can benefit from physiotherapy. This will help them develop basic movement skills.
Early intervention programs can help younger infants and their parents maximise development. They also provide therapy, and help the family adjust to the disorder.
Occupational therapy can help the child with self-care and other activities of daily living.
Newer therapies can help with problems of muscle tone and skeletal deformities. These include drugs such as baclofen or methocarbamol, which help to relax muscles. Various types of surgery may also help with movement. This may include surgery on muscles, bones, joints, or the nervous system.
Speech and language therapy can help with speech difficulties.
Educational planning should start before the child reaches school age. Often children with CP are eligible for educational assistance.
Children with CP should be helped to lead as normal a life as possible. They should have the chance to participate in the same sorts of social and recreational activities as other children when ever possible.
What are the side effects of the treatments? All medications have possible side effects. These may include allergic reactions, stomach upset, or sleepiness. Specific side effects depend on the drugs used. All surgery carries a risk of bleeding, infection, and reactions to any analgesics used. Specific risks depend on the surgery performed.
What happens after treatment for the disease? Most children with CP need some type of assistance or treatment for life. Severely affected children may need intense, around-the-clock care for the rest of their lives.
How is the disease monitored? Continuous monitoring by the caregivers and doctors helps identify problems early. This allows treatment to be started at the earliest time to maximize function and quality of life for affected children.
Author: John Wegmann, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
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