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WHAT IS CEREBRAL PALSY?
Cerebral palsy (CP) is a broad term that describes a group of brain disorders that affect a child’s movement, muscle tone, and motor skills. Starting in early childhood, these disorders can also severely affect coordination, swallowing, speaking, reasoning, and response to sensation. It affects all aspects of development and is one of the leading disabilities in children. Although cerebral palsy is a chronic condition, it is not a “disease.” Rather, it is a neurological disorder that impacts the brain’s ability to control voluntary muscle movement.
CAUSES & RISK FACTORS
How Common is Cerebral Palsy?
Every year, over 8,000 babies and 1,500 preschool-age children are diagnosed with cerebral palsy, (totaling nearly 10,000 children each year). An estimated total of 500,000 children and adults currently live with cerebral palsy today.
What Causes Cerebral Palsy?
Cerebral palsy is the result of damage to the brain during fetal development or birth. Many cases of cerebral palsy receive a diagnosis shortly after birth, but some diagnoses occur later when an infant demonstrates problems with coordination and movement.
Common Risk Factors for Cerebral Palsy Include the Following:
- Head injuries or trauma during birth or early infancy
- Asphyxia (lack of oxygen to the brain before, during, or after birth)
- Hemorrhaging (profuse bleeding in the brain); blood-clotting disorders; inadequate blood flow to the brain
- Prenatal exposure to alcohol or drugs
- Bacterial or viral infections
- Mercury poisoning from fish, toxoplasmosis poisoning from uncooked meat
- Lead poisoning
- Very low birth weight (VLBW)
- Shaken baby syndrome (SBS)
- Car accidents during infancy
- Complications during labor and delivery
Although it is a common belief that any cerebral palsy diagnosis is immediate and always the result of complications during labor, this factor is the cause of only 5 to 10 percent of cerebral palsy diagnoses. Cerebral palsy can result from any of the above risk factors. Brain damage that causes cerebral palsy can occur before or after birth, or during the first three to five years of a healthy child’s life. Therefore, it is important to protect oneself (e.g. practicing good infant safety habits, minimizing infant and toddler exposure to infections) in order to reduce the chances of a cerebral palsy diagnosis during the first few years of infancy.
TYPES & SYMPTOMS
What are the Different Types of Cerebral Palsy?
The main types of cerebral palsy include the following:
- Spastic Cerebral Palsy – Caused by damaged to the brain’s motor cortex, spastic cerebral palsy accounts for nearly 70-percent of diagnoses. Symptoms include stiffness and muscle movement difficulties. Spastic cerebral palsy may affect different parts of the body to different degrees of severity. Spastic quadriplegia affects all four limbs (arms and legs). Spastic diplegia (also known as spastic paraplegia) affects either the arms or the legs. Spastic monoplegia causes spasticity and stiffness in one limb only. Spastic hemiplegia causes stiffness on one side of the body, while spastic double hemiplegia causes stiffness on both sides of the body (although one side is usually worse than the other).
- Athetoid Cerebral Palsy – Also known as dyskinetic or dystonic cerebral palsy, athetoid cerebral palsy is the result of damaged basal ganglia (a group of nuclei that control balance and coordination). Symptoms include involuntary tremors and rigid movement. This type of CP accounts for 10 to 20 percent of diagnoses.
- Ataxic Cerebral Palsy – As the result of damage to the cerebellum (the part of the brain that connects with the spine), this type of CP can result in problems with gait, balance, coordination, and depth perception.
- Mixed – In unique cases, cerebral palsy may be a combination of the other three types.
What are the Symptoms of Cerebral Palsy?
Because there are different types of cerebral palsy, symptoms can vary widely. However, general symptoms to look for pre-diagnosis include the following:
Early Signs (Babies Under 6 Months)
- Head lags when picking baby up
- Baby feels stiff
- Baby’s limbs feel floppy
- When cradled, baby’s neck and back seem to overextend
- Legs cross or “scissor” stiffly and often
- Problems sucking or swallowing during feeding
Signs in Toddlers and Preschool Children
- Delayed or missing developmental milestones (such as speech or intellectual)
- Abnormal muscle tone (hypotonia, hypertonia, or dystonia)
- Involuntary drooling
- Problems with speech (dysarthria)
- Poor coordination
- Stiff or jerky movements
- Problems with posture and balance
- Impaired gross motor skills
- Lack of fine motor control
- Poor oral motor function
- Contractures (shortening of muscles)
- Involuntary tremors
Spastic Cerebral Palsy Symptoms
- Inability to use all four limbs or extremities
- Trouble swallowing, eating, or speaking
Athetoid Cerebral Palsy Symptoms
- Slow-moving or writhing body
- Jerky movements of limbs or extremities
- Trouble holding head up
- Difficulty swallowing or speaking
Ataxic Cerebral Palsy Symptoms
- Trouble making voluntary muscle movements
- Problems with posture and balance
- Struggles with cognitive or intellectual abilities
- Absent language skills
DIAGNOSIS & TREATMENT
How is Cerebral Palsy Diagnosed and Treated?
Doctors primarily evaluate the signs of cerebral palsy that can occur from birth through age 5. For this reason, it is important to contact a physician immediately if you notice the telltale signs of cerebral palsy. Doctors look for developmental delays (such as not reaching for objects by 4 months or sitting up by 7 months), problems with gross motor skills (crawling, walking, or moving arms), problems with coordination, muscle tone too tight (hypertonia) or too loose (hypotonia), and problems with reflexes (e.g. “fisted” hands that do not relax on their own).
Specialists also evaluate the presence of associated conditions such as intellectual disabilities, seizures, scoliosis, hip dysplasia, vision or hearing impairment, bowel and bladder problems, or speech delays. Finally, children usually undergo a series of four exams (magnetic resonance imaging (MRI) computed tomography scan (CT), electroencephalogram (EEG), and cranial ultrasound) to confirm a positive cerebral palsy diagnosis.
After a cerebral palsy diagnosis, most doctors recommend that a child enroll in an early childhood intervention (ECI) program for help with activities such as feeding. Children typically receive occupational therapy for help with gross motor development and physical therapy to assistance with balance, coordination, and reflexes. Other types of rehabilitation may include speech therapy along with advice from nutritionists and social workers. Since there is no “cure” to cerebral palsy, the main focus of intervention and therapy is to help children achieve as many developmental milestones as physically possible. This can go a long way in helping children with CP live happier lives with their families and within the community. Contact The Warren Center for more information on early childhood intervention and services for children with cerebral palsy.