What is Cerebral Palsy?

Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. CP is the most common motor disability in childhood. Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles. CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles.

The symptoms of CP vary from person to person. A person with severe CP might need to use special equipment to be able to walk, or might not be able to walk at all and might need lifelong care. A person with mild CP, on the other hand, might walk a little awkwardly, but might not need any special help. CP does not get worse over time, though the exact symptoms can change over a person’s lifetime.

All people with CP have problems with movement and posture. Many also have related conditions such as intellectual disability; seizures; problems with vision, hearing, or speech; changes in the spine (such as scoliosis); or joint problems (such as contractures).

Types of Cerebral Palsy

Doctors classify CP according to the main type of movement disorder involved. Depending on which areas of the brain are affected, one or more of the following movement disorders can occur:

• Stiff muscles (spasticity)
• Uncontrollable movements (dyskinesia)
• Poor balance and coordination (ataxia)

There are four main types of CP:

Spastic Cerebral Palsy

The most common type of CP is spastic CP. Spastic CP affects about 80% of people with CP.

People with spastic CP have increased muscle tone. This means their muscles are stiff and, as a result, their movements can be awkward. Spastic CP usually is described by what parts of the body are affected:

• Spastic diplegia/diparesis―In this type of CP, muscle stiffness is mainly in the legs, with the arms less affected or not affected at all. People with spastic diplegia might have difficulty walking because tight hip and leg muscles cause their legs to pull together, turn inward, and cross at the knees (also known as scissoring).
• Spastic hemiplegia/hemiparesis―This type of CP affects only one side of a person’s body; usually the arm is more affected than the leg.
• Spastic quadriplegia/quadriparesis―Spastic quadriplegia is the most severe form of spastic CP and affects all four limbs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.

Dyskinetic Cerebral Palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies)

People with dyskinetic CP have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk. The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected and the person has a hard time sucking, swallowing, and talking. A person with dyskinetic CP has muscle tone that can change (varying from too tight to too loose) not only from day to day, but even during a single day.

Ataxic Cerebral Palsy

People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something.

Mixed Cerebral Palsy

Some people have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.

 

Early Signs

The signs of CP vary greatly because there are many different types and levels of disability. The main sign that a child might have CP is a delay reaching motor or movement milestones (such as rolling over, sitting, standing, or walking). Following are some other signs of possible CP. It is important to note that some children without CP also might have some of these signs.

In a Baby Younger Than 6 Months of Age

• His head lags when you pick him up while he’s lying on his back
• He feels stiff
• He feels floppy
• When held cradled in your arms, he seems to overextend his back and neck, constantly acting as if he is pushing away from you
• When you pick him up, his legs get stiff and they cross or scissor

 

In a Baby Older Than 6 Months of Age

• She doesn’t roll over in either direction
• She cannot bring her hands together
• She has difficulty bringing her hands to her mouth
• She reaches out with only one hand while keeping the other fisted

In a Baby Older Than 10 Months of Age

• He crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg
• He scoots around on his buttocks or hops on his knees, but does not crawl on all fours

Tell your child’s doctor or nurse if you notice any of these signs. 

Screening and Diagnosis

Diagnosing CP at an early age is important to the well-being of children and their families. Diagnosing CP can take several steps:

Developmental Monitoring

Developmental monitoring (also called surveillance) means tracking a child’s growth and development over time. If any concerns about the child’s development are raised during monitoring, then a developmental screening test should be given as soon as possible.

Developmental Screening

During developmental screening a short test is given to see if the child has specific developmental delays, such as motor or movement delays. If the results of the screening test are cause for concern, then the doctor will make referrals for developmental and medical evaluations.

Developmental and Medical Evaluations

The goal of a developmental evaluation is to diagnose the specific type of disorder that affects a child.

Treatments and Intervention Services

There is no cure for CP, but treatment can improve the lives of those who have the condition. It is important to begin a treatment program as early as possible.

After a CP diagnosis is made, a team of health professionals works with the child and family to develop a plan to help the child reach his or her full potential. Common treatments include medicines; surgery; braces; and physical, occupational, and speech therapy. No single treatment is the best one for all children with CP. Before deciding on a treatment plan, it is important to talk with the child’s doctor to understand all the risks and benefits.

Intervention Services

Both early intervention and school-aged services are available through our nation’s special education law—the Individuals with Disabilities Education Act (IDEA). Part C of IDEA deals with early intervention services (birth through 36 months of age), while Part B applies to services for school-aged children (3 through 21 years of age). Even if your child has not been diagnosed with CP, he or she may be eligible for IDEA services.

Causes and Risk Factors

CP is caused by abnormal development of the brain or damage to the developing brain that affects a child’s ability to control his or her muscles. There are several possible causes of the abnormal development or damage. People used to think that CP was mainly caused by lack of oxygen during the birth process. Now, scientists think that this causes only a small number of CP cases.

The abnormal development of the brain or damage that leads to CP can happen before birth, during birth, within a month after birth, or during the first years of a child’s life, while the brain is still developing. CP related to abnormal development of the brain or damage that occurred before or during birth is called congenital CP. The majority of CP (85%–90%) is congenital. In many cases, the specific cause is not known. A small percentage of CP is caused by abnormal development of the brain or damage that occurs more than 28 days after birth. This is called acquired CP, and usually is associated with an infection (such as meningitis) or head injury.

 

 

………………………………………………………………

Causes and Risk Factors of Cerebral Palsy

Cerebral palsy (CP) is caused by abnormal development of the brain or damage to the developing brain that affects a child’s ability to control his or her muscles. There are several possible causes of the abnormal development or damage. People used to think that CP was mainly caused by lack of oxygen during the birth process. Now, scientists think that this causes only a small number of CP cases.

The abnormal development of the brain or damage that leads to CP can happen before birth, during birth, within a month after birth, or during the first years of a child’s life, while the brain is still developing.

Congenital CP

CP related to abnormal development of the brain or damage that happened before or during birth is called congenital CP. The majority of CP (85%–90%) is congenital. In many cases, the specific cause is not known.

Risk Factors for Congenital CP

Some things increase the chance that a child will have CP. These are called risk factors. It is important to remember that having a risk factor does not mean that a child will have CP. Some of the risk factors for congenital CP are:

• Low birth weight―Children who weigh less than 5 1/2 pounds (2,500 grams) at birth, and especially those who weigh less than 3 pounds, 5 ounces (1,500 grams) have a greater chance of having CP. 
• Premature birth―Children who were born before the 37th week of pregnancy, especially if they were born before the 32nd week of pregnancy, have a greater chance of having CP. Intensive care for premature infants has improved a lot over the past several decades. Babies born very early are more likely to live now, but many have medical problems that can put them at risk for CP. 
• Multiple births―Twins, triplets, and other multiple births have a higher risk for CP, especially if a baby’s twin or triplet dies before birth or shortly after birth. Some, but not all of this increased risk is due to the fact that children born from multiple pregnancies often are born early or with low birth weight, or both. 
• Assisted reproductive technology (ART) infertility treatments―Children born from pregnancies resulting from the use of some infertility treatments have a greater chance of having CP. Most of the increased risk is explained by preterm delivery or multiple births, or both; both preterm delivery and multiple births are increased among children conceived with ART infertility treatments. 
• Infections during pregnancy―Infections can lead to increases in certain proteins called cytokines that circulate in the brain and blood of the baby during pregnancy. Cytokines cause inflammation, which can lead to brain damage in the baby. Fever in the mother during pregnancy or delivery also can cause this problem. Some types of infection that have been linked with CP include viruses such as chickenpox, rubella (german measles), and cytomegalovirus (CMV), and bacterial infections such as infections of the placenta or fetal membranes, or maternal pelvic infections. 
• Jaundice and kernicterus― Jaundice is the yellow color seen in the skin of many newborns. Jaundice happens when a chemical called bilirubin builds up in the baby’s blood. When too much bilirubin builds up in a new baby’s body, the skin and whites of the eyes might look yellow. This yellow coloring is called jaundice. When severe jaundice goes untreated for too long, it can cause a condition called kernicterus. This can cause CP and other conditions. Sometimes, kernicterus results from ABO or Rh blood type difference between the mother and baby. This causes the red blood cells in the baby to break down too fast, resulting in severe jaundice.
• Medical conditions of the mother―Mothers with thyroid problems, intellectual disability, or seizures have a slightly higher risk of having a child with CP. 
• Birth complications―Detachment of the placenta, uterine rupture, or problems with the umbilical cord during birth can disrupt oxygen supply to the baby and result in CP. 

 

Preventing CP

In many cases, the cause or causes of congenital CP aren’t fully known, which means that currently little can be done to prevent it. CP related to genetics is not preventable. However, there are actions people can take before and during pregnancy, as well as after birth that might help reduce the risk of developmental problems, including CP.

Taking steps to help ensure a healthy pregnancy can help prevent developmental problems, including CP. Acquired CP often is related to an infection or injury, and some of these cases can be prevented.

Before Pregnancy

• Be as healthy as possible before pregnancy. Make sure that any infections in the mother are treated and health conditions are in control, ideally before pregnancy occurs.
• Get vaccinated for certain diseases (such as chickenpox and rubella) that could harm a developing baby. It is important to have many of these vaccinations before becoming pregnant.
• If assistive reproductive technology (ART) infertility treatments are used to get pregnant, consider ways to reduce the chance of a multiple pregnancy (twins, triplets, or more), such as transferring only one embryo at a time.

During Pregnancy

• Learn how to have a healthy pregnancy.
• Get early and regular prenatal care, both for your health and for that of your developing baby.
• Wash your hands often with soap and water to help reduce the risk of infections that might harm your developing baby.
• Contact your health care provider if you get sick, have a fever, or have other signs of infection during pregnancy.
• A flu shot is your best protection against serious illness from the flu. A flu shot can protect pregnant women and their unborn babies, both before and after birth. Flu shots have not been shown to cause harm to pregnant women or their babies.
• If there is a difference in the blood type or Rh incompatibility between mother and baby it can cause Jaundice and kernicterus. Women should know their blood type and talk to their doctor about ways to prevent problems. Doctors can treat the mother with Rh immune globulin (“Rhogam”) when she is 28 weeks pregnant and again shortly after giving birth to prevent kernicterus from occurring.
• Talk to your doctor about ways to prevent problems if you are at risk for preterm delivery. Research has shown that taking magnesium sulfate before anticipated early preterm birth reduces the risk of CP among surviving infants.

After the Baby is Born

• Learn how to help keep your baby healthy and safe after birth.
• Any baby can get jaundice. Severe jaundice that is not treated can cause brain damage, called kernicterus. Kernicterus is a cause of CP that potentially can be prevented. Your baby should be checked for jaundice in the hospital and again within 48 hours after leaving the hospital. Ask your doctor or nurse about a jaundice bilirubin test. In addition, steps can be taken to prevent kernicterus that is caused by Rh blood type incompatibility between the mother and baby.
• Make sure your child is vaccinated against infections that can cause meningitis and encephalitis, including Haemophilus influenzae type B (HiB vaccine) and Streptococcus pneumoniae (pneumococcal vaccine).
• Take steps to prevent injuries:
  • Buckle your child in the car using an infant or child car seat, booster seat, or seat belt (according to the child’s height, weight, and age).
  • Make living areas safer for children by using window guards to keep young children from falling out of open windows and using safety gates at the top and bottom of stairs.
  • Make sure the surface on your child’s playground is made of a shock-absorbing material, such as hardwood mulch or sand.
  • Carefully watch young children at all times around bathtubs, swimming or wading pools, and natural bodies of water. Adults watching kids near water should avoid distracting activities like using a computer or handheld device, reading, or talking on the phone.
  • Make sure your child wears a helmet for activities like riding a bike.
  • Never hit, throw, shake, or hurt a child.

 

 

……………………………………………………………………………………………………………………………………………………………

 

 

 

 

 

Screening and Diagnosis of Cerebral Palsy

Diagnosing cerebral palsy (CP) at an early age is important to the well-being of children and their families. Diagnosing CP can take several steps:

• Developmental Monitoring
• Developmental Screening
• Developmental and Medical Evaluations

Developmental Monitoring

Developmental monitoring (also called surveillance) means tracking a child’s growth and development over time. At each well-child office visit, the doctor monitors the child’s development. The doctor does this by asking parents if they have any concerns about their child’s development, taking or updating the child’s developmental history, and watching the child during the exam to see how he or she moves.

It is important for doctors to monitor the development of all children, but especially those who are at a higher risk for developmental problems due to preterm birth or low birth weight.

If any concerns about the child’s development are raised during monitoring, then a developmental screening test should be given as soon as possible.

Developmental Screening

During developmental screening a short test is given to see if the child has specific developmental delays, such as motor or movement delays. Some developmental screening tests are in the form of interviews or questionnaires completed by parents, others are tests that the doctor gives to the child. The American Academy of Pediatrics recommends that all children be screened for developmental delays during regular well-child office visits at:

• 9 months
• 18 months
• 24 or 30 months

When a child is 9 months of age, many issues involving movement can be seen easily. However, mild movement delays that were not found at the 9-month screening might be easier to see when the child is 18 months of age. By the time the child is 30 months of age, most movement delays can be found.

A developmental screening test also can be given whenever the child’s parents or doctor or others involved in the care of the child have concerns about the child’s development. If the results of the screening test are cause for concern, then the doctor will make referrals for:

• Developmental and medical evaluations

AND

• Early intervention or early childhood services

Developmental and Medical Evaluations

The goal of a developmental evaluation is to diagnose the specific type of disorder that affects a child. To evaluate movement or motor delays, the doctor will look closely at the child’s motor skills, muscle tone, reflexes, and posture, and take a careful medical history from the parents. The doctor will try to rule out other disorders that could cause similar problems.

Because many children with CP also have related developmental conditions such as intellectual disability; seizures; or vision, hearing, or speech problems, it is important to evaluate the child to find these disorders as well.

The developmental evaluation can be performed by the primary care doctor or by a specialist. Specialists who can do this type of developmental evaluation include:

• Developmental pediatricians or neurodevelopment pediatricians (doctors with special training in child development and in evaluating children developmental problems).
• Child neurologists (doctors with special training in childhood diseases of the brain, spine, and nerves).
• Pediatric physiatrists or pediatric rehabilitation doctors (doctors with special training in physical medicine and rehabilitation for children).

In addition to the developmental evaluation, additional tests can be done to look for a cause of CP. Specialists might suggest brain imaging tests, such as x-ray computed tomography (CT scan) or magnetic resonance imaging (MRI). An electroencephalogram (EEG), genetic testing, or metabolic testing, or a combination of these, also might be done.

CP generally is diagnosed during the first or second year after birth. But if a child’s symptoms are mild, it is sometimes difficult to make a diagnosis until the child is a few years older.

………………………………………………………………………………………………………………………………………………………………………………………..

Individuals with Disabilities Education Act (IDEA) Services

Español (Spanish) | Print

Both early intervention and school-aged services are available through our nation’s special education law—the Individuals with Disabilities Education Act (IDEA). Part C of IDEA deals with early intervention services (birth through 36 months of age), while Part B applies to services for school-aged children (3 through 21 years of age). Even if your child has not been diagnosed with cerebral palsy (CP), he or she may be eligible for IDEA services.

Part C of IDEA: Early Intervention for Babies and Toddlers

Early intervention services can help children from birth through 36 months of age learn new skills, whether they have been identified recently with motor and movement delays or already have a CP diagnosis. Early intervention services can start even before a CP diagnosis is made.

Depending on the child’s needs, early intervention services might include family training, counseling, and home visits; occupational, physical, or speech therapy; hearing loss services; health, nutrition, social work, and assistance with service coordination; assistive technology devices and services; and transportation.

Before Part C services start, an Individual Family Service Plan (IFSP) is developed by a team, which includes the parents and all providers who work with the child and the family. The IFSP describes the child’s present level of development, the family’s strengths and needs, the specific services to be provided to the child and the family, and a plan to transition to public school.

Part B of IDEA: Services for School-Aged Children

Services for school-aged children with developmental disabilities (3 through 21 years of age) are provided free of charge through the public school system. Among the services covered under IDEA are special education; related services such as physical, occupational, and speech therapy; and supplementary aids and services, such as adaptive equipment or special communication systems.

Before Part B services start, an Individualized Education Plan (IEP) is developed for children 3 through 21 years of age who qualify for special education services from school districts. An IEP is similar to an IFSP, but more focused on the child’s goals rather than on the family’s goals.