Cerebral Palsy

Symptoms of cerebral palsy usually first appear during infancy or preschool years. 

In general, cerebral palsy causes impaired movement associated with abnormal reflexes, floppiness or rigidity of the limbs and trunk, abnormal posture, involuntary movements, unsteady walking, or some combination of these.

Cerebral palsy can affect the whole body, or it might be limited primarily to one limb or one side of the body. 

Some affected people can walk; others need assistance. Some people show normal or near-normal intellect, but others have intellectual disabilities. Epilepsy, blindness or deafness also might be present.

Cerebral palsy’s effect on function varies greatly. Muscle weakness, muscle spasticity and coordination problems can contribute to:

• Stiff muscles and exaggerated reflexes (spasticity)
• Stiff muscles with normal reflexes (rigidity)
• Lack of balance and muscle coordination (ataxia)
• Tremors or involuntary movements
• Slow, writhing movements
• Delays in reaching motor skills milestones, such as pushing up on arms, sitting up or crawling
• Favouring one side of the body, such as reaching with one hand or dragging a leg while crawling
• Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait
• Excessive drooling or problems with swallowing
• Difficulty with sucking or eating
• Delays in speech development or difficulty speaking
• Difficulty with fine motor skills, such as buttoning clothes or picking up utensils
• Eye muscle imbalance, causing focusing problems

Brain abnormalities associated with cerebral palsy might also contribute to other neurological problems, including:

• Difficulty seeing and hearing
• Intellectual disabilities
• Seizures
• Abnormal touch or pain perceptions
• Oral diseases
• Mental health conditions
• Urinary incontinence

Consult a doctor if you notice delays in your child’s development or have concerns about episodes of loss of awareness of surroundings or of abnormal bodily movements, abnormal muscle tone, impaired coordination, swallowing difficulties, eye muscle imbalance or other developmental issues.

Cerebral palsy is caused by an abnormality or disruption in brain development, most often before a child is born. 

In many cases, the cause is not known. Factors that can lead to problems with brain development include:

• Gene mutations that lead to abnormal development
• Maternal infections that affect the developing foetus
• Foetal stroke, a disruption of blood supply to the developing brain
• Bleeding into the brain in the womb or as a new-born
• Infant infections that cause inflammation in or around the brain
• Traumatic head injury to an infant from a motor vehicle accident or fall
• Lack of oxygen to the brain related to difficult labour or delivery, although birth-related asphyxia is much less commonly a cause than historically thought

Signs and symptoms of cerebral palsy can become more apparent over time, so a diagnosis might not be made until a few months after birth.

Investigations may include:

• Evaluation of signs and symptoms
• Assessment of growth and development
• Review of medical history and physical examination 

Tests may be used to make a diagnosis and rule out other possible causes.

Brain-imaging technologies can reveal areas of damage or abnormal development in the brain. These tests might include the following:

• MRI scan can often identify lesions or abnormalities in the brain
• Cranial ultrasound can provide a valuable preliminary assessment of the brain
• Electroencephalogram (EEG) can be used for evaluation of suspected seizures or epilepsy
• Laboratory tests of blood, urine or skin samples might be used to screen for genetic or metabolic problems

If your child is diagnosed with cerebral palsy, you will likely be referred to specialists to test your child for other conditions often associated with the disorder, such as vision, hearing, speech, intellectual or developmental tests. 

Children and adults with cerebral palsy require long-term care with a multi-specialist care team. 

Medications that can lessen muscle tightness might be used to improve functional abilities, treat pain and manage complications related to spasticity or other cerebral palsy symptoms. For example:

• Muscle or nerve injections
• Oral muscle relaxants
• Medication to reduce drooling — possibly Botox injections into the salivary glands

A variety of therapies play an important role in treating cerebral palsy:

• Physical therapy to improve strength, flexibility, balance, motor development and mobility
• Braces or splints might be recommended to help with function, such as improved walking, and stretching stiff muscles
• Occupational therapy to gain independence in daily activities and routines in the home, the school and the community 
• Adaptive equipment recommended for your child can include walkers, quadrupedal canes, seating systems or electric wheelchairs
• Speech and language therapy can help improve speech or to learn to communicate in other ways, such as sign language or voice synthesizer
• Speech therapists can also address difficulties with eating and swallowing
• Recreational therapy, such as therapeutic horseback riding or skiing, can help improve motor skills, speech and emotional well-being

Where there are severe contractures or deformities, surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity.