Cerebral palsy is a group
of problems that affects body movement and posture. It is related to a brain
injury or to problems with brain growth. It is one of the most common causes of
lasting disability in children. Cerebral palsy occurs in about 2 to 2.5 out of
every 1,000 people.1
Cerebral palsy causes
reflex movements that a person can't control and muscle tightness that may
affect parts or all of the body. These problems can range from mild to severe.
Mental retardation,
seizures, and vision and hearing problems can
occur.
Learning that your child has cerebral palsy is not easy,
and raising a child who has it can be very hard. But the more you know, the
better you can care for and provide for your child.
What causes cerebral palsy?
Cerebral palsy is
caused by a brain injury or problem that occurs during pregnancy, birth, or
within the first 2 to 3 years of a child’s life. Cerebral palsy can be caused
by:
Problems from being born too early (premature
birth).
Not getting enough blood, oxygen, or other nutrients
before or during birth.
A serious head injury.
A
serious infection that can affect the brain, such as
meningitis.
Some problems passed from
parent to child (genetic conditions) that affect brain
development.
In many cases, the exact cause of cerebral palsy is not
known.
What are the symptoms?
Everyone with cerebral
palsy has problems with body movement and posture. But the physical problems
are worse for some people than for others. Some people with cerebral palsy have
only a slight limp or a hard time walking. Other people have little or no
control over their arms and legs or other parts of the body, such as the mouth
and tongue, which can cause problems with eating and speaking. People with
severe forms of cerebral palsy are more likely to have other problems, such as
seizures or mental retardation.
Babies with severe cerebral palsy
often have problems with their posture. Their bodies may be either very floppy
or very stiff. Birth defects, such as a spine that doesn't have the normal
shape, a small jawbone, or a small head, sometimes occur along with cerebral
palsy.
The brain injury or problem that causes cerebral palsy
does not get worse over time. But new symptoms may appear, or symptoms may
change or get worse as your child gets older. This is why some babies born with
cerebral palsy do not show clear signs of it right away.
How is cerebral palsy diagnosed?
Most of the time,
doctors will diagnose cerebral palsy based on a child's medical history. Your
doctor will ask about your child’s growth and about any problems you may have
noticed. You may be asked to answer questions about your child’s development.
The doctor may also do a physical exam.
Tests, such as a
CT scan or an
MRI of your child’s head, may also be done. Or the
doctor may look at
ultrasound pictures of the brain. These tests can help
the doctor find out the cause of cerebral palsy.
It can take
several months to several years to find out if a child has cerebral palsy. If
your child has a severe form of cerebral palsy, a doctor may be able to
pinpoint the problem within the first few weeks of your child’s life. But
parents are often the first to notice that their baby does not have the
abilities and skills that are common in other children in the same age group.
These
developmental delays can be early signs of cerebral
palsy.
How is it treated?
Cerebral palsy can't be cured,
so your child will probably need lifelong treatment. But treatments can help
deal with symptoms, prevent problems, and make the most of your child’s
abilities. Physical therapy is one of the most important treatments. Medicines,
surgery, and special equipment such as a walker can also help.
What can you do to cope?
Meeting the daily needs
of a family member with cerebral palsy can be very hard. If your child has
cerebral palsy, seek family and community support. It may help to join a
support group or to talk with other parents who have a child with special needs
so you don't feel alone. You may also find counseling useful. It may help you
understand and deal with the wide range of emotions that you may feel when your
child has cerebral palsy. Your child will need help too. Providing emotional
support for your child can help him or her deal with having cerebral
palsy.
Cerebral palsy
(CP) is a result of injury to or abnormal development of the brain. In many
cases, the exact cause of CP is not known. The damage or abnormality may occur
during pregnancy, birth, or within the first 2 to 3 years of life.
Possible causes of CP during pregnancy or birth can be related to
genetic problems, infections or health problems in the
mother or fetus during pregnancy, or complications related to labor and
delivery. Any of these problems can affect how a fetus grows or deprive a fetus
or newborn of needed blood, oxygen, or nutrients. Health problems in a newborn,
such as untreated low blood sugar, can also cause brain damage that leads to
CP.
Possible causes of CP related to an early birth (premature birth) are related to the brain's development. Babies born too early are
at risk for bleeding in the brain (intraventricular hemorrhage, or IVH). A
condition called periventricular leukomalacia, or PVL, which reflects injury to
the white matter of the brain, is also more likely in babies born prematurely
than in those born at full term. Both IVH and PVL put a baby at risk for
cerebral palsy.
Possible causes of CP within the first 2 or 3 years of life are usually related to brain
damage from a serious illness, such as
meningitis; a brain injury, such as from an accident
or fall; or not enough oxygen getting to the brain tissue, such as from a
near-drowning incident.
Even when the condition is present at birth,
the signs of
cerebral palsy (CP) may not be noticed until a child
is between 1 and 3 years of age. This is due to the way children develop and
mature. Doctors and parents may not recognize that a baby's movements are
irregular until they become more pronounced as a child grows. These babies and
young children may retain
newborn reflexes and fail to reach age-appropriate
developmental milestones. Parents and caregivers usually are the first to
notice that a baby has
developmental delays that may be early signs of
CP.
When CP is severe, signs are often noticed at birth or shortly
thereafter. But some early signs of severe CP vary according to the
specific type of CP present.
Common signs
of severe CP that may be noticed shortly after birth include:
Problems sucking and swallowing.
A
weak or shrill cry.
Unusual positions. Often the body is either
very relaxed and floppy or very stiff. When held, babies may arch their backs
and extend their arms and legs. These postures are different from and more
extreme than those that sometimes occur in babies with
colic.
Some problems related to CP become more evident over time
or develop as a child grows. These may include:
Smaller muscles in affected arms or legs. Nervous
system problems prevent movement in affected arms and legs. Inactivity affects
muscle growth.
Abnormal sensations and perceptions. Some people
with CP feel pain when touched lightly. Even everyday activities, such as
brushing teeth, may hurt. Abnormal sensations can also make it difficult to
identify common objects by touch, such as feeling the difference between a soft
foam ball and a hard baseball.
Skin irritation. Drooling is common when facial and
throat muscles are affected. Drooling irritates the skin, particularly around
the mouth, chin, and chest.
Dental problems. Children who have difficulty
brushing their teeth have increased risk of developing cavities and gum disease
(gingivitis). Seizure medicines may also contribute toward developing gum
disease.
Accidents. Falls and other accidents are a risk,
depending on muscle control, joint stiffness, and general physical strength.
Also, CP-related seizures can cause accidental injuries.
Infections and long-term illnesses. Adults with CP
are at a higher risk for heart and lung disease. For example, severe CP causes
problems with eating. If food is inhaled into the lungs, the risk of lung
infection (pneumonia) increases.
All people with
cerebral palsy (CP) have some problems with body
movement and posture, but many babies do not show signs of CP at birth. Parents
and caregivers may notice the
first signs of CP, such as the baby not rolling over,
sitting, crawling, or walking at the expected ages.
Signs of CP
may become more obvious as the child grows. Some developmental problems may not
appear until after a baby's first year. The brain injury that causes CP does
not get worse over time, but its effects can appear, change, or become more
severe as the child gets older.
The specific effects of CP depend
on its type and severity, the level of mental impairment, and whether other
complications develop or other medical conditions are present.
The
type of CP present and how much of the body that is affected will determine a
child's mobility.
Most people with CP have forms of
spastic cerebral palsy. This can affect the whole body
but may only affect parts of the body in some children. For example, a child
with spastic cerebral palsy may develop symptoms mostly in one leg or one side
of the body. Most children usually learn ways to accommodate for their
handicaps. Some people can live on their own, and others live and work in
situations that provide some level of assistance. When both legs are affected,
children can move around with the help of a scooter board (a device used to
self-propel while lying down), modified stroller, wheelchair, or other special
equipment.
Total body cerebral palsy causes the most severe
problems. Severe spastic CP and athetoid (dyskinetic) CP are types of total
body CP. Many of those affected are not able to take care of themselves, either
because of severe physical disabilities or
mental retardation. But some people can live on their
own with the help of family members and/or health care aides.
Complications, such as
seizures, and other long-term physical effects of CP
can be difficult to predict until a child is between 1 and 3 years of age. But
sometimes such predictions are not possible until a child reaches school age
when learning, communication skills, and other abilities can be measured. The
amount of help and supervision needed depends on the number and severity of
problems.
The severity of mental impairment, if any, is a strong
predictor of daily functioning. About 75% of people with CP have some degree of
cognitive impairment.2 About
60% have mental retardation (ranging from mild to severe), and the rest often
function normally but have some type of
learning disability.2
Other medical conditions, such as vision or hearing
problems, are often associated with CP. Sometimes these conditions are known
right away, and in other cases they are not detected until a child gets
older.
Also, just like people with normal physical development,
people with CP have
social and emotional concerns throughout their lives.
Because their physical limitations may add to these concerns, people with CP
need the awareness and consideration of others.
Of all children
diagnosed with cerebral palsy, 90% live to adulthood (beyond 20 years
old).3 A more precise life expectancy can be estimated
by evaluating the type of CP present, its severity, and the impact of any
conditions that are often related to CP. Most adults with the mild or moderate
form—and some with the severe form—live independently and have jobs.
Opportunities for independent living and employment for adults with CP have
improved. These opportunities are a result of better home support services and
advances in technology, such as computers to assist with speech, powered
wheelchairs, and other devices.
Between 40%
and 50% of all children who have
cerebral palsy (CP) are born
prematurely.1 The risk of a
baby having CP increases as the birth weight decreases. A baby who is born
prematurely usually has a low birth weight, less than
5.5 lb (2.5 kg), but full-term
babies can also have low birth weights. Multiple-birth babies are more likely
than single-birth babies to be born early or with a low birth weight.
Low-birth-weight, premature babies are more likely than full-term,
normal-weight babies to have had developmental problems during fetal growth
that can injure the brain. It is estimated that about 80 out of 100 children
with CP had a disruption in the normal development of parts of their brain
during fetal growth.4 For example, a condition called
periventricular leukomalacia, or PVL, which reflects injury to the white matter
of the brain, is more likely in babies born prematurely than in those born at
full term.
Babies born to teen mothers or to mothers age 35 and
older have a higher risk for cerebral palsy.
Also, a fetus's risk
for developing a brain abnormality or injury that leads to CP increases when
the mother has certain problems during her pregnancy, which may include:
Infections in the mother's
uterus or birth canal (vagina). These
infections may cause
inflammation in the
placenta (chorioamnionitis), which can disrupt the
normal growth of a fetus's brain and may contribute to getting periventricular
leukomalacia (PVL).5
Exposure to certain
medicines, such as thyroid hormones or estrogen.
Use of alcohol,
illegal drugs, and some prescription medicines (such as
methotrexate).
Other problems, such as bleeding in the uterus
during the sixth to ninth month of pregnancy, large amounts of protein in the
urine (proteinuria), or high blood sugar levels.
Risk factors for cerebral palsy at birth
In rare
cases, some babies develop CP as a result of complications during the mother's
pregnancy or at birth. Risk factors include:
Premature birth. Premature babies are at
increased risk for developing bleeding in the brain (intraventricular
hemorrhage, or IVH), which may result in CP.
Difficult or prolonged
labor. Brain infection or physical trauma (such as from the use of forceps or
other instruments, which is rare) are all risks associated with a problem birth
that can increase a baby's risk of developing CP. A lack of oxygen, although it
occurs less commonly, also increases a baby's risk. But CP can itself cause a
baby to have a difficult birth because of body movement and posture problems
related to the condition.
Placenta abruptio. The placenta usually separates from
the wall of the uterus several minutes after the birth of the baby. If it
separates before the baby is born, the baby loses the blood and oxygen supply
from the mother, which increases the risk of developing
CP.
Infections in the mother's uterus or vagina, such as
strep infections, that transfer to the baby during
birth. Cerebral palsy can result if the infection reaches the baby's brain.
Risk factors after birth
Risk factors for
developing CP just after birth or within the first 2 or 3 years of life are
related to brain damage and include:
A serious illness, such as severe
jaundice,
meningitis, or
lead poisoning (very rare). Early signs of concern
include breathing problems, low levels of thyroid hormone (thyroxine),
seizures, and low blood sugar levels (hypoglycemia). Babies born prematurely or
with a low birth weight are susceptible to these illnesses.
Serious
head injury from an accident or fall. This includes injury to a baby from
shaking, throwing, or other force (shaken baby syndrome, also called intentional head injury or IHI).
Lack
of oxygen to brain tissues, such as the result of a brain tumor or a
near-drowning incident.
Having some kinds of blood-clotting or
genetic problems.
Call 911 or other emergency services if your child with
cerebral palsy (CP):
Is having problems
breathing.
Chokes during feeding and you are not able to dislodge
the food.
Call a doctor immediately if:
You are pregnant and you get or suspect you
have
rubella or signs of some other infection; have been
exposed to harmful substances, such as strong chemicals or radiation; or you
have consumed alcohol or used drugs.
If you have a child diagnosed with CP, call your doctor if
your child has:
A seizure (if it is the first time, call your
doctor or seek care immediately).
Constipation that is not relieved
by home treatment.
Skin irritation that is not getting better,
starts to bleed or weep fluid, or causes pain.
Feeding problems
that are not relieved by home treatment, such as:
A pattern of coughing and choking during
feeding. If food is inhaled into the lungs, it increases the risk of developing
pneumonia.
Chewing difficulty along with
weight loss or complaints of being hungry.
Frequent accidents that threaten your child's
safety.
Other signs of
complications, such as bladder control problems,
bleeding gums, or an increase in joint stiffness.
Watchful Waiting
Pay attention to whether your child is reaching
early developmental milestones. Report your
observations to your doctor at regularly scheduled
well-child visits or any time you have concerns.
Watchful waiting is not appropriate if your child has
been diagnosed with cerebral palsy and develops complications. See your child's
doctor.
If you have cerebral palsy and you are pregnant, talk
with a doctor about how CP can affect your pregnancy and delivery.
Who To See
Health professionals who can diagnose and treat people
with cerebral palsy include:
Pediatricians (some pediatricians
specialize in developmental disabilities).
Doctors use caution in diagnosing CP too early
because some babies who have
motor skill abnormalities soon after birth never
develop CP.
Sometimes symptoms may not appear until the nervous
system matures with the continual growth of the brain, nerves, and muscles. It
can take up to a few years before doctors determine whether a baby with body
movement and posture (motor) problems has CP.
Cerebral palsy is
diagnosed based on observations of a baby's or young child's physical
development delays or irregularities, medical history, a physical exam,
screening tests, and other tests, such as MRI. Specifically, these tests
include:
Asking questions about the child's
medical history, including details about the mother's
pregnancy.
Developmental delays are often reported by parents or
observed by a doctor during routine
well-baby checks. These visits are also an opportunity
for doctors to watch your baby and ask details about his or her sensory and
motor skills, especially those that are expected to occur
during the first year or
second year.
A
physical exam to look for signs of CP. During a
physical exam, a doctor evaluates whether a child retains
newborn reflexes longer than normal, which can be an
indication of CP. Postures and basic muscle function, hearing, and vision are
usually also assessed.
Screening tests. Your doctor will
recommend developmental questionnaires and other tests to help determine the
extent of developmental delays and whether they should be further
evaluated.
Taken together, results of these tests can point toward
a diagnosis of CP.6
If diagnosis is
unclear, additional tests may be done to evaluate the brain and possibly rule
out other conditions. Sometimes, results from these tests can also be useful in
evaluating the severity of CP. Tests may include:
After CP
is diagnosed, a child will also be screened for
other medical conditions that can occur with cerebral
palsy, such as:
Other developmental delays in addition to
those that have already been identified. Developmental abilities will be
assessed periodically to find out whether new symptoms, such as speech and
language delay, appear as a child's nervous system matures.
Seizures. An
electroencephalography (EEG) is used to check for
abnormal activity in the brain if a child has a history of
seizures.
Problems with feeding and swallowing.
Vision
or hearing problems.
Psychological evaluation, for any behavioral
problems.
Most of the time, a doctor can predict many of the
long-term physical effects of CP when a child is between 1 and 3 years old. But
sometimes such predictions are not possible until a child reaches school age
when learning, communication skills, and other abilities can be measured. The
amount of help and supervision needed depends on the number of problems and how
bad the problems are.
Some children need repeated testing that
may include:
X-rays, to check for loose or
dislocated hips. Children with CP are usually X-rayed
several times between ages 2 and 5. A child will also have an X-ray any time he
or she complains of hip pain or has other signs of dislocated hips, such as
unusual leg or knee movements. Spinal X-rays also are done to look for curves
in the child's spine (scoliosis).
Gait analysis, which
helps identify problems and guide treatment decisions.
Additional tests may be needed, depending on the child's
symptoms or other conditions that are present.
Cerebral palsy
(CP) cannot be cured. But a variety of treatments can help people with CP to
maximize their abilities and physical strength, prevent
complications, and improve their quality of life. The
brain injury or problem that causes CP does not get worse over time. But new
symptoms can appear or become worse over time because of how a child grows and
develops.
Specific treatment varies by individual and changes as
needed if new issues develop. In general, treatment focuses on measures that
maintain or improve a person's quality of life and overall health.
Initial treatment
Physical therapy is
an important treatment that begins soon after a child is diagnosed and often
continues throughout his or her life. This therapy also may begin before a
definite diagnosis is made, depending on the child's symptoms.
In some cases,
orthopedic surgery (for muscles, tendons, and joints)
or
selective dorsal rhizotomy (cutting nerves of affected
limbs) for contracture or other mobility problems is performed soon after
diagnosis on a baby or very young child with severe problems.
Often the biggest problem for parents is fear of the unknown. Learning about CP
can help you to understand the condition and be familiar with some of the
challenges and joys of raising a child with cerebral palsy. Being informed can
help give you a sense of control about how best to help your child. For more
information, talk to your doctor or see the Other Places to Get Help section of
this topic.
Ongoing treatment
Ongoing treatment for cerebral
palsy (CP) focuses on continuing and adjusting existing treatments and adding
new treatments as necessary. Although the brain injury that causes CP does not
get worse over time, some of its effects can appear for the first time, change,
or become more severe as a child gets older.
Regular visits with
your child's doctor and specialists are important for monitoring your child's
condition. These visits may include tests, such as
questionnaires to evaluate whether new developmental
milestones are being achieved as expected, or periodic blood tests to find out
about the effects of medicine your child may be taking. Your child should also
have regular eye, hearing, and speech evaluations.
Other tests may
be done to find out whether common problems related to cerebral palsy have
developed. These problems can then be treated as they appear.
Ongoing treatment for cerebral palsy may include:
Physical therapy. This is usually an
important part of ongoing treatment for CP and can help your child become as
mobile as possible. It may also help prevent the need for surgery. If a child
has surgery, intense physical therapy may be needed for 6 months or more.
Monitoring of any medicines being taken, to help control symptoms
and prevent complications. Medicines may include
antispasmodics or
injectable antispasmodics to help relax muscles and
reduce spasms,
anticonvulsants to help treat seizures, or
anticholinergics to help manage uncontrollable body
movements (dystonic cerebral palsy) or frequent drooling.
Orthopedic surgery (for muscles, tendons, and joints)
or
selective dorsal rhizotomy (cutting nerves of affected
limbs) to try to prevent problems with bones and related muscles, ligaments,
and tendons.
Special devices and equipment, such as braces, casts,
and splints. The specific types used depend on a child's needs. For example, a
child may get a cast after surgery or as a means to restrict movement in one
area to strengthen muscles and tendons in another part of the body.
Ongoing treatment for CP may also include:
Biofeedback. This therapy may be useful as part of
physical therapy or on its own. During biofeedback sessions, people with CP
learn ways to control their affected muscles. Some people find this technique
helpful in reducing muscle tension. Biofeedback does not help everyone with
CP.
Massage therapy and
hatha yoga. These therapies are designed to help relax
tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga
breathing exercises are sometimes used to try to prevent lung infections. More
research is needed to determine the health benefits of these therapies for
people with CP.
Therapies to stimulate learning and sensory
development. Babies and young children may benefit from stimulation or
neurodevelopmental therapies. Some of these therapies also help people of other
ages. These therapies cannot repair damaged parts of the brain. But they may be
able to stimulate undamaged parts of the brain.
You may hear about a wide range of
controversial treatments. Some of these may cause
harm. Do not be afraid to talk to your doctor about any type of treatment you
are considering for your child.
Each person with CP has unique
strengths and areas of difficulty. But most people with CP need ongoing help
with:
Feeding and eating. Cerebral palsy can
affect jaw control and interfere with the ability to chew, suck, and swallow.
Special utensils, such as plates that stick to a surface; properly positioning
your child at meals; and serving soft or semi-solid foods, such as oatmeal, may
be helpful.
Using the toilet. Some people with
cerebral palsy have stiff hip joints or similar problems that make using a
toilet difficult. Others do not have dependable bladder control. Training from
an occupational therapist and special undergarments are common ways to help
treat this condition.
Bowel elimination. People with CP often
become constipated, making stool difficult to pass. Stool softeners and mild
laxatives are frequently used for this problem. For more information, see the
topics
Constipation, Age 11 and Younger or
Constipation, Age 12 and Older.
Bathing and grooming. People with cerebral palsy who do not have control of
their hands or arms usually are unable to groom themselves. Others can be
taught some level of self-grooming through regular practice.
Dressing. Provide clothing and shoes that are easy to put on and
take off, such as those that zip or button in the front (not the back) or that
have large buttons, ties, or Velcro fasteners.
Dental care. Cerebral palsy can affect the jaw muscles, make teeth improperly
positioned and prone to decay, and cause sensitivity in the mouth and tongue.
Also, many people with CP find it difficult to use a toothbrush. You can help
your child by providing special equipment, such as a mechanized teeth-cleaning
water spray or electric toothbrush; buying toothpaste for sensitive gums; and
making sure he or she has regular dental cleanings.
Skin care.
Drooling is common in people with CP, and it can cause skin irritation around
the chin, mouth, and chest. You can help protect skin by blotting rather than
wiping drool, using absorbent cloths to cover the chest, and applying lotions
or cornstarch to areas that are prone to irritation.
Speaking. Some people with CP have problems with the
muscles in their jaws and mouth as well as hearing loss. These problems, alone
or in combination, can make it difficult for them to form words. Try to speak
slowly, look directly at your child, and use pictures or objects as you talk.
Also, read with your child a lot and use picture books to help your child
express himself or herself.
Keeping active. Your child needs to
move his or her limbs to help keep muscles strong and joints flexible. Have him
or her move and play as much as possible. Involve other family members too. Ask
the doctor, physical therapist, or other parents for ideas.
Safety. People with CP are prone to falls and other
accidents, especially if they are affected by
seizures. You can take general safety measures at
home—such as having heavy, sturdy furniture or not polishing floors—to help
your child avoid accidents. Also, use common sense and care around sharp
objects, and never leave a person with CP alone while he or she is
bathing.
Behavioral therapy, in which a counselor helps a child
learn better ways to communicate, may be a part of ongoing treatment. It is
most often used to help school-age children with CP learn better ways to
interact with others, especially their peers.
Working with others
involved with your child's care, understanding your child's needs and rights,
and taking care of yourself and other family members are all important parts of
ongoing treatment for people with cerebral palsy. These strategies
include:
Researching and understanding your child's
educational rights. In the United States, disabled
children are eligible for free early treatment programs and equal access to
public education. You also have the right to be fully informed about
educational decisions concerning your child. Contact your state and local
education departments for detailed information about these accommodations. In
addition,
vocational training may benefit some teens and young
adults.
Working with your child's teachers, school administrators,
special learning consultants, and school boards to develop the best educational
plan for your child. A cooperative team approach helps your child realize his
or her potential.
Supporting your child emotionally. Your child's
needs will change over time. As children grow and become more aware of their
physical limitations, they need to be able to talk about their feelings and how
they are treated. It is sometimes easier for them to talk with someone who is
not a family member. Ask your doctor about whether emotional
counseling might benefit your child. Also, involve
your child as much as possible when making decisions about his or her health
care.
Getting proper rest, eating well, exercising, and learning
ways to cope with the challenges of raising a child with CP. You will be
better equipped to help your child when you have physical energy and emotional
strength.
Working together as a family. The entire family is
affected when one member has CP.
Helping family members cope with this situation is
important, especially for siblings. You can help prevent other children from
having unrealistic fears and concerns, feeling left out, or becoming
overwhelmed.
Most children with cerebral palsy live to adulthood and
have a somewhat shorter than normal life span. But a lot depends on the type of
CP and how it affects your child's health.
Many adults get jobs if
they have good support from their family and community. You can enroll your
teen in
occupational therapy as part of a gradual preparation
for independent living. Helping your child be independent
requires patience and resourcefulness on your part. Expect some frustrating
setbacks or obstacles. Your child may need extra help and encouragement to
prepare for added expectations and responsibilities.
Treatment if the condition gets worse
Although the
brain injury that causes cerebral palsy (CP) does not get worse over time, some
of its effects can appear for the first time, change, or become more severe as
a child's nervous system grows and develops.
Common problems related to cerebral palsy may develop, become more severe, or
lead to
complications. Treatment varies by the individual and
type of problem but generally can include medicine, surgery, specialized
therapies, and orthopedic equipment.
Medicines
Medicines can help treat effects that
some people experience with CP, such as muscle spasms or seizures.
If severe muscle spasms develop,
antispasmodic pills may be given. These pills include
diazepam (Valium), dantrolene (Dantrium), and baclofen (Lioresal). Or, less
commonly, intrathecal baclofen (ITB) may be given. For this, a small pump is
placed under the skin of the abdomen. This pump releases baclofen into the
fluid around the spinal cord. ITB may be more helpful than the pill at
relieving spasms, but it is harder to do than pills and has some risks (such as
infection where the pump is implanted).
Injectable antispasmodics, such as
botulinum toxin (Botox), are sometimes used. This
medicine can be given with a needle directly into an affected muscle. Botulinum
toxin may be more useful than antispasmodic pills for the treatment of CP. But
in rare cases, severe side effects can occur.
If seizures become a
problem,
anticonvulsants such as carbamazepine (Tegretol) are
used. Anticholinergics, such as glycopyrrolate (Robinul)
help a minority of people with CP who have uncontrollable body movements
(dystonic cerebral palsy) or drool frequently.
Surgery Types of surgery include:
Orthopedic surgery to loosen tight
muscles, tendons, and joints, particularly on the hips, knees, and
ankles.
Selective dorsal rhizotomy to cut nerves on the limbs
that are most affected by movements and spasms to allow more flexibility and
control.
A doctor evaluates symptoms, age, and the person's
general state of health when considering whether to recommend surgery. A
thorough checkup is needed to help the doctor determine which muscles and
nerves are affected and what type of surgery would best treat the condition. A
gait analysis may be included, to evaluate the person's walking
patterns.
Physical therapyPhysical therapy is often used as part of ongoing
treatment, but its focus may change after surgery or for problems that are new
or getting worse. After surgery, specialized physical therapy may be needed for
6 months or longer.
Biofeedback may be useful as part of physical therapy
or on its own. Although biofeedback does not help everyone with CP, some people
who use the technique learn how to control their affected muscles or reduce
muscle tension.
Special devices and equipment Many people with CP benefit from using something to
maintain or improve joint mobility, help strengthen muscles and relax
overactive (spastic) muscles, and assist with daily activities. Such devices
and equipment may include orthotics, casts, standers, special seats, walkers,
wheelchairs, special shoes, and other individualized methods to help with
specific problems.
Individualized therapies may also be needed
depending on the specific need that develops.
Occupational therapy helps adults adapt
to their limitations and live as independently as possible.
Speech therapy helps control the mouth muscles. This therapy can be of great
benefit to children with speech or eating problems. Speech therapy often starts
before the child begins school and continues throughout the school
years.
Nutritional counseling may help when dietary needs are
not met because of problems with eating certain foods.
Both
massage therapy and
hatha yoga are designed to help relax tense muscles,
strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises
are sometimes used to try to prevent lung infections. More research is needed
to determine the health benefits of these therapies for people with
CP.
Therapies to stimulate learning and sensory development may
benefit babies and young children. Some also help people of other ages. These
therapies cannot repair damaged parts of the brain. But they may be able to
stimulate undamaged parts of the brain.
Behavioral therapy helps
some school-age children with CP learn better ways to communicate with others.
You may hear about a wide range of
controversial treatments, some of which may cause
harm. Do not be afraid to talk to your doctor about any type of treatment you
are considering for your child.
The cause of
cerebral palsy (CP) sometimes is not known. But links
have been identified between CP and certain conditions during pregnancy, birth,
and early childhood. Some of these can be prevented, and some cannot.
Family members working together with
doctors can use home treatment to provide the best possible care for a baby or
young child with
cerebral palsy (CP).
Education and support for parents and family members
Learn about the condition. Often the biggest
problem for parents is fear of the unknown. Learn about the condition so you
are best able to help your child. You may find local or national cerebral palsy
organizations helpful, especially in dealing with the impact of daily emotional
and lifestyle issues. Talk with your doctor or call your local hospital for
suggestions. For more information, see the Other Places to Get Help section of
this topic.
Learn about your child's educational rights.Educational rights for disabled children are mandated
by law in the United States. These laws include free early treatment programs,
equal access to public education, and protection of the parents' rights to be
fully informed about or disagree with educational decisions concerning their
child. Contact your state and local education departments for specific
information about these accommodations. In addition,
vocational training may benefit some teens and young
adults.
Work with teachers and school officials. Work
with your child's teachers, school administrators, special learning
consultants, and school boards to develop the best educational plan for your
child. A cooperative team approach helps your child realize his or her
potential.
Provide emotional support. The needs of a child
with CP change over time. As children grow and become more aware of their
physical limitations, they need to be able to talk about their feelings and how
they are treated. It is sometimes easier for them to talk with someone who is
not a family member. Ask your doctor about whether emotional
counseling would benefit your child. Also, include
your child when making decisions about his or her health care.
Take care of yourself. Get proper rest, eat well,
exercise, and learn
ways to cope with the challenges of raising a child with CP. You will be
better equipped to help your child when you have physical energy and emotional
strength.
Help each other. The entire family is affected
when one member has CP.
Helping family members cope with this situation is
important, especially for siblings. You can help prevent other children from
having unrealistic fears and concerns, feeling left out, or becoming
overwhelmed.
Helping with daily routines
Each person with CP
has unique strengths and areas of difficulty. But most people with CP need
ongoing help with:
Feeding and eating. Cerebral palsy can
affect jaw control and interfere with the ability to chew, suck, and swallow.
Special utensils, such as plates that stick to a surface; properly positioning
your child at meals; and serving soft or semi-solid foods, such as oatmeal, may
be helpful.
Using the toilet. Some people with
cerebral palsy have stiff hip joints or similar problems that make using a
toilet difficult. Others do not have dependable bladder control. Special
undergarments and training by an
occupational therapist are common ways to help treat
this condition.
Bowel elimination. People with CP often become
constipated, making stools difficult to pass. Stool softeners and mild
laxatives are frequently used for this problem. For information about
preventing and treating constipation, see the topics
Constipation, Age 11 and Younger or
Constipation, Age 12 and Older.
Bathing and grooming. People with cerebral palsy who do not have control of
their hands or arms usually are unable to groom themselves. Others can be
taught some level of self-grooming through regular practice.
Dressing. Provide clothing and shoes that are easy to put on and
take off, such as those that zip or button in the front (not the back) or that
have large buttons, ties, or Velcro fasteners.
Dental care. Cerebral palsy can affect the jaw muscles, make teeth improperly
positioned and prone to decay, and cause sensitivity in the mouth and tongue.
Also, many people with CP find it difficult to use a toothbrush. You can help
your child by providing special equipment, such as a mechanized teeth-cleaning
water spray or electric toothbrush; buying toothpaste for sensitive gums; and
making sure he or she has regular dental cleanings.
Skin care.
Drooling is common in people with CP, which can cause skin irritation around
the chin, mouth, and chest. You can help prevent skin irritations and protect
your child's skin by blotting rather than wiping drool, using absorbent cloths
to cover the chest, and applying lotions or corn starch to areas that are prone
to irritation.
Speaking. Some people with CP have
problems with the muscles in their jaws and mouth as well as hearing loss.
These problems, alone or in combination, can make it difficult to form words.
Try to speak slowly, look directly at your child, and use pictures or objects
as you talk. Also, read with your child a lot, and use picture books to help
your child express himself or herself.
Keeping active. Your child
needs to move his or her limbs to help keep muscles strong and joints flexible.
Have him or her move and play as much as possible. Involve other family members
too. Ask the doctor, physical therapist, or other parents for
ideas.
Safety. People with CP are prone to falls and other
accidents, especially if they are affected by
seizures. You can take general safety measures at
home—such as having heavy, sturdy furniture or not polishing floors—to help
your child avoid accidents. Also, use common sense and care around sharp
objects, and never leave a person with CP alone while he or she is bathing.
Preparing for independence
You and your family and
friends can help your child reach his or her highest potential. Focus on his or
her strengths. And build
self-esteem by helping your child learn to do things
by himself or herself. For more information see:
As your
child approaches the teen years and young adulthood, be aware of his or her
changing needs.
Teens and adults with CP need
emotional support and understanding. Family members
and other supportive friends and family can help them deal with the daily
challenges of having CP.
Gradually prepare your child with CP for
independent living. Usually teens have learned to use
their talents and strengths. But they may need extra help and encouragement to
prepare for added expectations and responsibilities.
Teens and
young adults with CP may also need more guidance than other people their age in
developing intimate relationships.
Parents must also recognize that they will need to change
their own routines as their child with CP grows and develops. For example,
parents may not be able to continue caring for a severely affected child who is
growing tall and heavy. Parents also need to plan ahead for the time when their
grown child with CP is not under their care. For more information, see the
Other Places to Get Help section of this topic.
Adulthood
Most children with cerebral palsy live
to adulthood and have a somewhat shorter than normal life span. But a lot
depends on the type of CP and the degree of problems. Preparing your child for
adulthood takes careful planning. It also requires patience and resourcefulness
on your part. Do not abandon your efforts because of frustrating setbacks or
obstacles.
Encourage independent living skills. A time
may come when you or other family members can no longer assist your child with
CP at the accustomed level.
Complications of cerebral palsy may develop and affect quality of life. Also, some forms of CP are
more severe and require special assistance. For these reasons, planning for an
adult's current and future health care needs is important.
Occupational therapy and similar programs may be
helpful. Most adults with CP are employed, despite moderate to severe physical
disability. In the United States, laws protect the rights of disabled people to
find and hold employment (among other rights). Learn about the provisions of
the Americans with Disabilities Act (ADA) of 1990. For more information about
the ADA, see the Other Places to Get Help section.
Older adults
with CP may need extra help preparing for retirement.
Antispasmodics are the most common medicines used for
people with CP. Antispasmodics can help relax tight muscles and reduce muscle
spasms. Most antispasmodics are taken orally and include:
Diazepam (such as
Valium).
Baclofen (Lioresal).
Dantrolene sodium
(Dantrium).
Although these medicines are given as a pill to swallow
(oral medicine), baclofen can also be given using a method called intrathecal
baclofen (ITB). For this, a small pump is placed under the skin of the abdomen.
This pump releases baclofen into the fluid around the spinal cord. ITB may be
more helpful than taking a pill at relieving severe spasms. But it is harder to
do than pills and has some risks (such as infection where the pump is
implanted).
Injectable antispasmodics, which are
injected directly into stiff or spasmatic muscles, are sometimes used to help
them relax. These medicines typically remain effective for about 3 to 8 months,
depending on the type used. Injectable antispasmodics used for treating CP
include:
Anticonvulsants are used as treatment for people with
CP who have seizures. Most commonly used anticonvulsants include:
Gabapentin
(Neurontin).
Lamotrigine (Lamictal).
Oxcarbazepine
(Trileptal).
Topiramate (Topamax).
Zonisamide
(Zonegran).
Anticholinergics help a minority of people with CP who
have uncontrollable body movements (dystonic cerebral palsy) or who drool
frequently. These include:
Benztropine mesylate.
Carbidopa-levodopa
(Sinemet).
Glycopyrrolate (Robinul).
Procyclidine
hydrochloride (Kemadrin).
Trihexyphenidyl hydrochloride.
Stool softeners and mild laxatives may help treat
constipation, which is a common complaint of people with CP.
What To Think About
Medicine for cerebral palsy (CP)
targets individual needs. Unfortunately, medicine has had limited success in
treating CP, especially the types that involve involuntary movements (athetoid
type of dyskinetic cerebral palsy).
Botulinum toxin may be more useful than antispasmodic pills for treating
CP.
Some medicines used to treat CP have serious side effects. For
example, dantrolene sodium (Dantrium) can cause liver damage, so frequent blood
tests are needed while taking this medicine. And in rare cases, the use of
botulinum toxin is related to severe side effects, such as trouble breathing or
swallowing.
Some doctors believe that the most commonly used
medicines to treat CP (diazepam [such as Valium], baclofen [Lioresal], and
dantrolene [Dantrium]) should not be given to growing children. They are
concerned that the side effects from these medicines can cause problems for
children that are more severe than the tight muscles and muscle spasms related
to CP. For example, one side effect of these medicines is drowsiness.
Drowsiness may interfere with a child's ability to concentrate and learn in
school. Other doctors believe that the benefits of these medicines outweigh the
risk of side effects.
Ask your doctor the following questions
about any medicine prescribed for your child:
How successful is it in treating your child's
problem?
What are the short-term and long-term side
effects?
What are the chances that the medicine will stop working?
Discuss what options are available if this happens.
How might it
affect your child's growth and development?
Surgery for people with
cerebral palsy (CP) usually involves either:
Loosening tight muscles and releasing fixed
joints, most often performed on the hips, knees, and ankles. In rare cases,
this surgery may be used for people with stiffness of their elbows, wrists,
hands, and fingers.
Cutting nerves to the limbs most affected by
movements and tightness (spasticity). This procedure reduces spasms and allows
more flexibility and control of the affected limbs and joints.
A doctor evaluates the person's symptoms, age, and general
state of health when considering whether to recommend surgery.
A
thorough checkup is needed to help the doctor determine which muscles and
nerves are affected and what type of surgery would best treat the condition. A
gait analysis is part of the exam if the person is able to walk.
For young children, surgery may be postponed if doing so will likely
prevent the need for additional surgery in the future.
Other surgeries related to cerebral palsy
Surgery for various orthopedic problems: Surgery for other
problems is sometimes needed for children with CP. These surgeries vary
depending upon the specific problems involved. For example, some children may
need surgery to correct uneven leg length, dislocation of the hip, or curves in
the spine (scoliosis).
Medicine-related surgery: A small pump is surgically implanted
under the skin in the abdomen for some people with CP. This pump is used to
deliver medicines, such as baclofen (Lioresal), directly into the fluid
surrounding the spinal cord. For more information, see
antispasmodics.
Surgery Choices
The main surgery choices for people affected by cerebral
palsy (CP) are:
Orthopedic surgery (for muscles, tendons, and joints). It's done to increase range
of motion. For example, the surgeon may lengthen a tendon, cut through muscles
or tendons, or attach a tendon to a different part of the bone.1 Surgery to treat spinal curves or to prevent or treat hip
dislocation is also done.
Selective dorsal rhizotomy (cutting nerves of affected limbs). This procedure is usually
considered only for children with severe muscle tightness in the legs.
What To Think About
Doctors do not agree about the
best age for people with cerebral palsy (CP) to have surgery.
Some surgeons believe that children less than
2 years old with CP benefit most from orthopedic surgeries because it allows
them to grow and develop more like other children.
Some doctors
believe that all surgery should wait until a child is older than age 2. And
some prefer to wait until sometime between ages 6 and 8 years. They believe
that more problems can be corrected during the same surgery if orthopedic
surgery is postponed until the child is older.
Surgery is not used nearly as often for the arms as for
the legs. Surgery on arm deformities carries more risks related to sensory
damage. Also, surgery has a more limited impact on functional abilities than on
the legs.7
Sometimes medicines or
physical therapy is used to postpone or get rid of the
need for surgery. Physical therapy is also needed for most children after
surgery. The type of therapy and special equipment needed after surgery (such
as braces, casts, and splints) depend on the child's specific needs. In
general, post-surgical physical therapy usually starts as soon as possible and
may continue for as long as 6 months.
Physical therapy is
one of the most important treatments for
cerebral palsy (CP). It usually begins soon after
diagnosis and often continues throughout life. Some people with CP may begin
physical therapy before being diagnosed, depending on their symptoms.
Special devices and equipment are needed for some people with CP to help
them with specific problems. For example:
A child who develops uneven leg length may need
to wear special shoes with a higher sole and heel on the shorter
leg.
Some people who are not able to walk without assistance may
need to use canes, crutches, walkers, or wheelchairs.
Physical
therapy and special equipment may be used together, such as for
constraint-induced movement therapy, also called shaping. This approach
encourages a child to increase movements by presenting interesting activities
or objects and giving praise and rewards when a child makes attempts to use the
less-functioning muscles.8
Occupational therapy helps adults adapt to their
limitations and live as independently as possible.
Speech therapy helps control the mouth muscles. This therapy can be of great
benefit to children with speech or eating problems. Speech therapy often starts
before the child begins school and continues throughout the school
years.
Nutritional counseling may help when dietary needs are
not met because of problems with eating certain foods.
Biofeedback may be useful as part of physical therapy
or on its own. During a biofeedback session, people with CP learn how to
control their affected muscles. Some people learn ways to reduce muscle tension
with this technique. Biofeedback does not help everyone with CP.
Both
massage therapy and
hatha yoga are designed to help relax tense muscles,
strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises
are sometimes used to try to prevent lung infections. More research is needed
to determine the health benefits of these therapies for people with CP.
Other treatments that vary by age or specific need include:
Therapies to stimulate learning and sensory
development. Babies and young children may benefit from these stimulation or
neurodevelopmental therapies. Some of these therapies also help people of other
ages. These therapies cannot repair damaged parts of the brain. But they may be
able to stimulate undamaged parts of the brain that the person is not currently
using.
Behavioral therapy. This type of therapy helps some
school-age children with CP learn ways to communicate with others.
Several
controversial therapies exist for CP, such as
electrical stimulation and special diets. If you are considering these types of
treatments, talk to your doctor about any related research or where to find
more information.
National Institute of Neurological Disorders and
Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone:
1-800-352-9424 (301) 496-5751
TDD:
(301) 468-5981
Web Address:
www.ninds.nih.gov
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
Centers for Disease Control and Prevention (CDC):
National Center on Birth Defects and Developmental Disabilities
(NCBDDD)
1600 Clifton Road
Atlanta, GA 30333
Phone:
1-800-232-4636 (1-800-CDC-INFO)
TDD:
1-888-232-6348
E-mail:
cdcinfo@cdc.gov
Web Address:
www.cdc.gov/ncbddd
NCBDDD aims to find the cause of and prevent birth
defects and developmental disabilities. This agency works to help people of all
ages with disabilities live to the fullest. The Web site has information on
many topics, including genetics, autism, ADHD, fetal alcohol spectrum
disorders, diabetes and pregnancy, blood disorders, and hearing loss.
March of Dimes
1275 Mamaroneck Avenue
White Plains, NY 10605
Phone:
(914) 997-4488
Web Address:
www.marchofdimes.com
The March of Dimes tries to improve the health of babies by
preventing birth defects, premature birth, and early death. March of Dimes
supports research, community services, education, and advocacy to save babies'
lives. The organization's Web site has information on premature birth, birth
defects, birth defects testing, pregnancy, and prenatal care. You can sign up
to get a free newsletter and also explore Understanding Your Newborn: An
Interactive Program for New Parents.
National Dissemination Center for Children with
Disabilities
P.O. Box 1492
Washington, DC 20013
Phone:
1-800-695-0285
Fax:
(202) 884-8441
TDD:
1-800-695-0285
E-mail:
nichcy@aed.org
Web Address:
www.nichcy.org
The National Dissemination Center for Children with
Disabilities (NICHCY) is the national information and referral center that
provides information on disabilities and disability-related issues for
families, educators, and other professionals. The focus is on children and
youth, birth to age 22.
U.S. Department of Justice: Americans with Disabilities
Act
950 Pennsylvania Avenue NW
Civil Rights Division Disability Rights Section—NYA
Washington, DC 20530
Phone:
1-800-514-0301
Fax:
(202) 307-1198
TDD:
1-800-514-0383
Web Address:
www.ada.gov
This Department of Justice Web site has links to
information about the legal rights of Americans who are in some way disabled.
Legal rights to housing, jobs, mobility, education, technology use, health
care, and recreation are described. And the Web site also has information about
the latest legal developments that affect people with disabilities.
United Cerebral Palsy
1660 L Street NW
Suite 700
Washington, DC 20036
Phone:
1-800-872-5827 (202) 776-0406
Fax:
(202) 776-0414
Web Address:
www.ucp.org
United Cerebral Palsy (UCP) is an organization that
offers family support for people with cerebral palsy. UCP publishes
newsletters, brochures, pamphlets, scientific reports, and books. UCP also
works for the rights of people with cerebral palsy. There are chapters in every
state.
Pellegrino L (2007). Cerebral palsy. In ML Batshaw et
al., eds., Children With Disabilities, 6th ed., pp.
387–408. Baltimore: Paul H. Brooks Publishing.
Liptak GS (2001). Cerebral palsy. In RA Hoekelman,
ed., Primary Pediatric Care, pp. 468–473. St. Louis:
Mosby.
Rapp CE, Torres MM (2000). The adult with
cerebral palsy. Archives of Family Medicine, 9: 466–472.
Johnston MV (2007). Cerebral palsy section of
Encephalopathies. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 2494–2496. Philadelphia: Saunders Elsevier.
Wu Y (2002). Systematic review of chorioamnionitis and cerebral palsy. Mental Retardation and Developmental Disabilities Research Reviews, 8: 25–29.
Ashwal S, et al. (2004). Practice parameter:
Diagnostic assessment of the child with cerebral palsy. Neurology, 62(6): 851–863.
Koman LA, et al. (2004). Cerebral palsy.
Lancet, 363(9421): 1619–1631.
Taub E, et al. (2004). Efficacy of constraint-induced
movement therapy for children with cerebral palsy with asymmetric motor
impairment. Pediatrics, 113(2): 305–312.
Other Works Consulted
Anttila H, et al. (2008). Effectiveness of physical
therapy interventions for children with cerebral palsy: A systematic review.
BMC Pediatrics, 8(14): 1–10.
Committee on Children with Disabilities, American
Academy of Pediatrics (1999). The treatment of neurologically impaired children
using patterning. Pediatrics, 104(5): 1149–1151.
Desch LW (2007). Technological assistance. In ML
Batshaw et al., eds., Children With Disabilities, 6th
ed., pp. 557–569. Baltimore: Paul H. Brooks Publishing.
Diamond M, Armento M (2005). Cerebral palsy section of Children with disabilities. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 2, pp. 1499–1517. Philadelphia: Lippincott Williams and Wilkins.
Moe PG, et al. (2007). Cerebral palsy section of
Neurologic and muscular disorders . In WW Hay Jr et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., chap. 23,
pp. 784–786. New York: McGraw-Hill.
Murphy NA, et al. (2008). American Academy of
Pediatrics clinical report: Promoting the participation of children with
disabilities in sports, recreation, and physical activities. Pediatrics, 121(5): 1057–1061.
Nelson KB, Chang T (2008). Is cerebral palsy
preventable? Current Opinion in Neurology, 21(2):
129–135.
Rapin, I (2005). Cerebral palsy section of Static disorders of brain development. In LP Rowland, ed., Merritt's Neurology, 11th ed., pp. 577–579. Philadelphia: Lippincott Williams and Wilkins.
Wu YW, et al. (2003). Chorioamnionitis and cerebral
palsy in term and near-term infants. JAMA, 290(20):
2677–2684.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
