Cerebral Palsy

Description

If your baby has trouble learning to roll over, sit, crawl or walk, see your pediatrician. Delays in development and problems controlling movement or posture may be early signs of cerebral palsy (CP), a group of chronic disorders that stem from abnormalities or damage to the brain.

Diagnosis. Doctors may use physical examination, medical history and diagnostic imaging tools to determine if your child has cerebral palsy.

Physical exam: The doctor evaluates your child's muscle tone and reflexes and may want to watch him or her walk, crawl, sit and lie down. Sometimes if the child is less than one year old, the doctor may want to wait a few months and see if specific problems with movement start to happen. The doctor may also check for other conditions linked to CP (i.e., mental impairment, seizures, vision problems, etc.)
Medical history: Give the doctor your child's complete medical history. This helps rule out other disorders that can cause movement problems (i.e., genetic or muscle diseases, metabolism disorders and tumors of the nervous system).
Diagnostic imaging tools: The doctor may want to use specialized tests such as magnetic resonance imaging (MRI), computed tomography (CT scan) or ultrasound to see a picture of your child's brain. There is no specific blood test or imaging study that can make the diagnosis of cerebral palsy.

Risk Factors / Prevention

Cerebral palsy begins before, during or after birth in the first years of life. Premature babies and others with low birth weight are at greater risk for it. Infection, head injury and other factors can cause CP, but most of the time no one knows why it happens.

Symptoms

Cerebral palsy affects the central nervous system and changes the tone of muscles. It takes mild, moderate and severe forms and generally does not get progressively worse. Symptoms vary and may include:

Tight muscles (increased tone), causing spasms and rigidity.
Loose muscles (low tone), making limbs weak and floppy.
Impaired reflexes, coordination and balance.

Some people with CP also have mental impairment (i.e., retardation or learning disabilities); seizures; vision difficulties; shortened limbs; curvature of the spine (scoliosis); dental problems; complete or partial hearing loss; or problems with joints (i.e., contracture). There is no cure for CP, but with early treatment, most children improve their capabilities significantly.

When a child is about 2 years old, the doctor may be able to diagnose the type of CP he or she has. There are four main types:

Spastic: In spastic CP, the most common form, there is increased muscle tone/tightness. Legs, arms and back are stiff and contracted, making movement difficult. If both legs are affected (spastic diplegia), tight muscles in the hips and legs cause legs to turn inward and cross at the knees when walking. If only one side of the body is affected (spastic hemiplegia), the arm is often more severely affected than the leg. If all four limbs and the trunk are affected (spastic quadriplegia or total body involved), the muscles of the mouth and tongue may also be affected.
Athetoid: (dyskinetic): In athetoid CP there is low muscle tone/looseness, leading to uncontrolled movements of the entire body. It may be difficult to sit straight or walk.
Ataxic: A rare form, ataxic CP affects balance and depth perception. There is poor coordination, unsteady walking and difficulty with precise movements such as using a pen or buttoning a shirt.
Mixed: In mixed CP, there are symptoms of both spastic and athetoid CP. Some muscles are tight and others are loose. There is both stiffness and involuntary movements.

Treatment Options

Sometimes people with cerebral palsy need help from their families throughout their lives. If your child has CP, you may want to work with a treatment team of health care professionals to identify and meet the child's individual needs. The goal is to help your child reach his or her potential and maximize independence. Treatment teams often include:

Orthopaedic surgeons to treat problems with bones, muscles, tendons, nerves or joints.
Physical therapists to improve movement and strength.
Occupational therapists to teach skills required for daily living (i.e., eating and dressing).
Speech and language specialists to treat communication problems.
Social workers to help locate community assistance and education programs.
Psychologists to help patients and families cope with stress and/or behavioral therapists to foster social and emotional development.
Other medical specialists such as eye doctors, neurologists and nutritionists.

Non-surgical treatments for cerebral palsy include:

Physical therapy. Physical therapy (PT) may begin immediately after diagnosis to help your child learn skills like sitting, walking or using a wheelchair. It may also help improve muscle strength, balance and coordination; and prevent muscles from shortening. Stretching muscles may help prevent contracture. Sometimes PT may involve activities like swimming and horseback riding to tone muscles.
Braces, splints and casts. Using braces, splints or casts may improve joint mobility and stability, prevent contracture and improve hand or leg function. Braces can compensate for muscle imbalance.
Botox. This drug can be injected into spastic muscles to loosen them up. It is especially helpful in children younger than 5 and when used together with casting.
Medications. Medications may control or prevent seizures or muscle spasms, ease muscle stiffness or reduce abnormal movements.
Mechanical aids. Special machines like computerized communication devices or simple aids like velcro-fastened shoes or crutches may help a child overcome impairments.

Coping strategies. Parents of children with cerebral palsy or other disabilities often feel guilt and/or grief about the child's condition. Some tips to help parents cope:

Learn all you can about CP. You may want to join a family support group or get help from professionals. Stay informed about new treatments and technologies.
Work with professionals at your child's school to develop an individualized plan that meets his or her needs and abilities.
Love and encourage your child. Family support and personal determination are important factors in achieving long term goals. Treat your child like a normal kid. Go places and have fun. Be patient, and keep hoping for improvement.
Get help from family and friends. Caring for a child with CP is hard work. Teach others how to do it so you can take breaks.

Treatment Options: Surgical

If contractures are severe, a child with CP may need surgery to lengthen affected muscles. Surgery may also help if tightly contracted muscles cause stress to joints and lead to deformities or dislocations. Some children with CP need surgery to correctly position their arms or legs, or to correct curvature of the spine. Other surgical options for spasticity management include selective dorsal rhizotomy and intrathecal baclofen pumps. These procedures are usually done by neurosurgeons.

June 2004