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Cerebral Palsy (CP)

What is cerebral palsy?

Cerebral palsy (CP) is a broad term that describes a group of nonprogressive brain (neurological) disorders that cause the loss of normal motor function. It is a lifelong condition that affects the communication between the brain and the muscles. CP affects body movement, muscle control, muscle coordination, reflex, posture, and balance. It may result from several problems, such as:

  • Lack of oxygen to the brain

  • Genetic conditions

  • Infections

  • Bleeding in the brain

  • Severe cases of jaundice

  • Head injury

Sometimes children with CP may also have other conditions, such as seizures, visual loss, or intellectual disability. But these are not features of CP. CP only refers to the motor dysfunction.

What causes cerebral palsy?

Many cases of CP have unknown causes. The disorder occurs when there is abnormal development or damage to areas in the brain that control motor function. Risk factors for CP include the following:

  • Prematurity

  • Inflammation of the placenta or amniotic fluid due to an infection (chorioamnionitis)

  • Blood clotting disorders

  • Very low birthweight (especially in babies weighing less than 3.3 lbs.)

  • Viruses

  • Chemical or substance abuse during pregnancy

  • Infection

  • Bleeding in the brain

  • Injury

  • Complications of labor and delivery. (This is a much rarer cause of CP than most people believe. It only seems to cause about 5% to10% of cases.)

What are the symptoms of cerebral palsy?

The following are the most common symptoms of CP. But each child may experience symptoms differently. The child may have muscle weakness, poor motor control, or shaking (spasticity) of the arms or legs. Muscle stiffness in the form of stiff legs or clenched fists may also be seen. CP is classified according to the kind of motor function the child may have, including the following:

  • Spastic diplegia (di means 2). Spasticity of the legs in most cases, but sometimes the arms. Diplegia is also called paraplegia.

  • Spastic quadriplegia or tetraplegia (quad or tetra means 4). Spasticity involving all arms and legs.

  • Spastic hemiplegia (hemi means half). Spasticity affecting one half, or one side, of the body (such as the right arm and right leg).

  • Spastic double hemiplegia. Spasticity in both sides of the body. But the amount of spasticity is different when comparing the right side to the left side.

  • Athetoid (or dyskinetic). Movement that can’t be controlled (involuntary), is purposeless, usually twisting, and rigid.

  • Ataxic. This affects balance, leading to an unsteady gait. It also affects fine motor coordination. This makes it difficult to do things such as writing.

Children with CP may have additional problems, including the following:

  • Seizures

  • Vision, hearing, or speech problems

  • Learning disabilities and behavior problems

  • Intellectual disability

  • Respiratory problems

  • Bowel and bladder problems

  • Bone abnormalities including scoliosis, a sideways curvature of the spine

Babies with CP are often slow to reach developmental motor milestones, such as learning to roll over, sit, crawl, or walk. They may also have certain reflexes present that normally disappear in early infancy. The symptoms of CP may seem like other conditions. Always see your child's healthcare provider for a diagnosis.

How is cerebral palsy diagnosed?

The diagnosis of CP is made with a physical exam. During the exam, your child’s healthcare provider takes a full prenatal and birth history of your child. The diagnosis of CP is not usually made until a child is at least 6 to12 months old. This is the time when the child should be achieving developmental milestones, such as sitting, standing, walking, with hand and head control. Diagnostic tests may include the following:

  • Neurological exam. This evaluates reflexes and brain and motor function.

  • MRI. This test uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of body structures and organs, such as the brain. This imaging test is commonly used to evaluate CP.

  • Feeding studies. These tests use X-rays or videos to see what happens from the time food enters your child’s mouth until after your child swallows.

  • Electroencephalogram (EEG). This evaluates electrical activity in the brain.

  • Gait lab analysis. This evaluates your child’s walking pattern.

  • CT scan. This imaging test uses a combination of X-rays and computer technology to make horizontal images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • Genetic studies. These tests evaluate for conditions that have a tendency to run in families.

  • Metabolic tests. These tests evaluate the absence or lack of a specific enzyme (for example, amino acids, vitamins, carbohydrates) that are needed to maintain the normal chemical function of the body.

Treatment of cerebral palsy

Your child’s healthcare provider will figure out the best treatment based on:

  • Your child’s age, overall health, and medical history

  • How sick your child is

  • How well your child handles certain medicines, treatments, or therapies

  • If the condition is expected to get worse         

  • Your opinion or preference

CP is a lifelong condition that is not correctable. Because of this, management includes focusing on preventing or minimizing deformities and maximizing the child's capability at home and in the community. A child is best treated with an interdisciplinary team that may include the following healthcare providers:

  • Pediatrician or family practitioner.

  • Orthopedic surgeon. A surgeon who specializes in conditions of the muscles, ligaments, tendons, and bones

  • Neurologist. A doctor who specializes in conditions of the brain, spinal cord, and nerves.

  • Neurosurgeon. A surgeon who specializes in operating on the brain and spinal cord.

  • Ophthalmologist. A doctor who specializes in eye problems.

  • Dentist.

  • Nurse.

  • Physiatrist. A doctor who specializes in physical medicine and rehabilitation.

  • Orthotist. A professional who specializes in making braces and splints

  • Rehabilitation team. For example, physical, occupational, speech therapy, audiology.

Management of CP includes nonsurgical and surgical options. Nonsurgical interventions may include:

  • Rehabilitation

  • Positioning aids (used to help the child sit, lie, or stand)

  • Braces and splints (used to prevent deformity and to provide support or protection)

  • Medications (used to help decrease spasticity in the muscles; the medications may be given by mouth or as an injection)

Surgical interventions may be used to manage the following conditions:

  • Orthopedic problems that may include managing curvatures in the back, hip dislocations, ankle and foot deformities, and contracted muscles

  • Spasticity

Long-term outlook for the child with cerebral palsy

CP is a lifelong condition that is not correctable. Because of this, management includes focusing on preventing or minimizing deformities and maximizing the child's capabilities at home and in the community. Positive reinforcement will encourage the child to strengthen his or her self-esteem and promote as much independence as possible.

The full extent of the problems is usually not fully understood right after birth. But it may be revealed as the child grows and develops.

Online Medical Reviewers:

  • Adler, Liora C., MD
  • Sather, Rita, RN

Related Services

  • Behavior Treatment Services - Provides assessment and short-term treatment for children and teens with developmental delay or disability and challenging behaviors.
  • Community Consultation Program - Provides technical assistance, training, and continuing education to schools, community and state agencies that provide services to children with learning and behavioral challenges.
  • Crisis Intervention Program - Provides services to individuals with a developmental or intellectual disability living in Monroe County with significant behavioral difficulties.
  • Pediatric Feeding Disorders Program - Provides assessment and treatment for children who have difficulty eating related to food selectivity, food refusal, and disruptive mealtime behavior.
  • Physical Disabilities Program - Provides evaluation and coordinated treatment recommendations for children with physical disabilities.

URMC Collaborations

  • Child Neurology - Assures children have the evaluation and treatment they need for seizures or other neurologic issues.
  • Dental Department - Helps children maintain good oral health.
  • Orthotics and Prosthetics
  • Pediatric Gastroenterology - Evaluates and offers suggestions for treatment for problems with slow bowel motility, constipation, or gastroesophageal reflux (GER).
  • Pediatric Neurosurgery - Provides care for children with CP who have problems with too much fluid in the brain or require a shunt to drain fluid (ventriculoperitoneal (VP) shunt). Dr. Howard Silberstein is the pediatric and adult neurosurgeon who provides care for both children and adults with cerebral palsy when needed.
  • Pediatric Orthopaedics - Monitors and treats bone and muscle issues.
  • Pediatric Sleep Medicine Service - Evaluates and treats sleep problems.
  • Physical Medicine and Rehabilitation - Provides outpatient evaluation and intense and targeted therapy programs for children and teens. Pediatric physical therapists provide evaluation and treatment of independent daily living skills and equipment needs. Pediatric occupational therapists provide evaluation and treatment of fine motor skills, handwriting, daily living skills, sensory processing, and adaptive equipment needs.
  • Speech Pathology Department - Meets the needs of children who have difficulties with speech, communication, oral-motor control, and feeding/swallowing.

Resources

Visit the Cerebral Palsy LibGuide for resources.