Medical Conditions
Overview of Cerebral Palsy
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Overview
Cerebral palsy is a general term that describes a group of disorders that appear in the first few years of life and affect a child's ability to coordinate body movements. These disorders are caused by damage to a child's brain early in the course of development. The damage can occur during fetal development, during the birth process or during the first few months after birth.
This group of disorders ranges from mild to severe. Physical signs of cerebral palsy include weakness and floppiness of muscles or spasticity and rigidity. In some cases, neurological disorders — such as mental retardation or seizures — also occur in children with cerebral palsy.
Cerebral palsy isn't curable. However, getting the right therapy for your child can make a big difference. Today, children with cerebral palsy benefit from a wide range of treatment options and innovations, including physical therapy, speech therapy, medications, educational programs and computerized aids.
Result of Injury
Cerebral palsy results from an abnormality in or injury to the cerebrum — the largest area of the brain, which controls sensation and voluntary motor function. Although cerebral palsy affects movement, the underlying problem originates in the brain, not in the muscles themselves.
A small number of children with cerebral palsy acquire the disorder after birth. In these cases, doctors can sometimes pinpoint a specific reason for the neurological problem. For example, cerebral palsy can develop following an illness during early infancy, such as bacterial meningitis — an infection and inflammation of the membranes and fluid surrounding the brain and spinal cord. It can also be the result of a head injury.
However, doctors don't completely understand the cause of most cases of cerebral palsy, which are present at birth (congenital). For many years, doctors and researchers believed that cerebral palsy was caused by a lack of oxygen during birth. Now they believe that only a small number of cases are caused by problems during labor and delivery.
Doctors and researchers have now identified many possible causes of congenital cerebral palsy, including:
* Maternal infection during pregnancy, such as rubella or other viral infections
* Severe jaundice in newborns, which may be caused by infection, severe bruising or problems with red blood cells due to ABO or Rh incompatibility — two incompatibilities between the blood of the mother and her fetus
* Abnormal brain development before birth, resulting from genetic causes or metabolic disorders
* Disturbance to brain circulation before birth, caused by an artery spasm or blood clot, similar to a stroke in adults
What To Look For
There are three major types of cerebral palsy:
* Spastic cerebral palsy. Most children with cerebral palsy have spastic cerebral palsy. This form of the condition causes muscles to stiffen, which makes movement difficult. It can affect both legs (spastic diplegia), or it can affect one side of the body (spastic hemiplegia). In the most severe cases, all four limbs and the trunk are affected (spastic quadriplegia).
* Athetotic cerebral palsy. Ten to 20 percent of people with cerebral palsy have this form, which is also referred to as extrapyramidal cerebral palsy. It affects the entire body and often causes uncontrolled, slow movements.
* Ataxic cerebral palsy. This is the least common of the major types of cerebral palsy. It affects balance and coordination.
Some children have signs and symptoms of more than one type of cerebral palsy, which may be referred to as a mixed form of the condition.
In general, children with cerebral palsy exhibit a wide variety of signs and symptoms, ranging from mild to severe. These signs and symptoms don't worsen with age. They may include:
* Lack of muscle coordination when performing voluntary movements (ataxia)
* Stiff muscles and exaggerated reflexes (spasticity)
* Asymmetrical walking gait, with one foot or leg dragging
* Variations in muscle tone, from too stiff to too floppy
* Excessive drooling or difficulties swallowing, sucking or speaking
* Tremors
* Difficulty with precise motions, such as writing or buttoning a shirt
Some children with cerebral palsy have severe mental retardation, but others are extremely bright. Many need a wheelchair and extensive, lifelong care, but some require little or no special assistance.
If your baby seems to display weakness or paralysis in a limb or isn't developing motor skills at the expected times, talk to your family doctor or pediatrician. Every baby develops at his or her own pace, so there's no need to panic if your baby doesn't meet one of the monthly milestones described in a parenting book. But it's important to share any concerns about your baby's development with your doctor.
For example, children usually become right-handed or left-handed by age 2. Infants who appear right-handed or left-handed at younger ages may actually have impaired movement of one hand.
How is CP Diagnosed?
Early signs of cerebral palsy may be present from birth, but it's often difficult to make a definite diagnosis during the first six months. Cerebral palsy is generally diagnosed by age 1 or 2.
If your child shows some signs of cerebral palsy, your doctor will likely schedule an appointment to observe your child and to talk to you about your child's physical and behavioral development. In this evaluation, your doctor will check your child's reflexes, muscle tone and movements. Additional tests may rule out other disorders that can cause movement problems. Your doctor may have your child undergo these procedures:
* Computerized tomography (CT) scan. Images created with a CT scanner show the structure of your child's brain, as well as the presence and extent of any damage.
* Magnetic resonance imaging (MRI) scan. The cylinder-shaped MRI scanner uses no X-rays. Instead, a computer creates tissue-slice images of the brain from data generated by a powerful magnetic field and radio waves. These images can be viewed from any direction or plane.
* Other tests. Some children may need genetic or metabolic tests to help rule out other conditions.
You may be referred to a specialist to help determine if your child has cerebral palsy or some other condition. Your doctor may recommend a visit to a doctor with specialized training in the development of the brain and nervous system in children (pediatric neurologist), a doctor who specializes in childhood development (developmental pediatrician), or a doctor who specializes in physical therapy and rehabilitation (physiatrist).
Additional Effects of CP
Besides difficulty with movement and posture, cerebral palsy may result in these health problems:
- Development of joint deformities or dislocation, if there's considerable spasticity
- Nutrition problems, if there are swallowing or feeding difficulties
Some children with cerebral palsy will have multiple handicaps and may require long-term care. Some of the associated problems may include:
- Difficulty with vision, hearing and speech
- Dental problems
- Mental retardation
- Seizures
- Abnormal sensation or perception
- Incontinence