What is Cerebral Palsy?

Cerebral Palsy is a disorder of movement, muscle tone or posture that is caused by damage that occurs to the immature, developing brain, most often before birth.

Cerebral palsy refers to various types of neurological conditions that affect the motor movement, muscle coordination and posture of a person. Besides that, in some cases, the hearing, vision, and sensation are affected too and the patient might have to go through emotional and behavioural challenges. Cerebral Palsy could also bring about changes in the spine and problems in the joints.

Cerebral Palsy is an umbrella term for a group of symptoms and disabilities in a person due to neurological damage, therefore it occurs with varying degrees of severity. Some patients have the ability to walk, while others may need assistance. There are cases where patients have cognitive and intellectual disabilities, but in most cases, these abilities are not compromised and the patient might show normal or near-normal intellect. And in a few cases, the patient might have to deal with epilepsy, blindness or deafness.

Cerebral Palsy Causes

It is caused by an abnormality or disruption in brain development, usually before a child is born. There are some factors which can lead to problems with brain development include:

• Mutations in genes

• Maternal Infections that affect the developing fetus

• Fetal stroke, a disruption of blood supply to the developing brain

• Infant Infections

• Traumatic Head Injury

• Lack of oxygen

Most common causes of cerebral palsy are:

• If the white matter of the fetus’ brain is damaged, usually due to injury during gestation.

• Abnormal brain development could occur if the mother has an infection or any disease during pregnancy

• During labour and delivery, the child could undergo stress which could lead to a lack of oxygen in the brain

• Intracranial haemorrhage i.e bleeding in the brain which could be caused when the baby has a stroke while inside the womb

• Jaundice being untreated- In certain cases, a child is born with jaundice, should this condition go untreated it could lead to cerebral palsy

• Mutation: During development, the child could undergo gene mutation or it could be hereditary

• In rare cases, CP happens because something goes wrong during a child's birth.

• If the developing brain undergoes brain damage due to a car accident, child abuse or if the mother takes a fall.

• If the mother ingests toxins during her pregnancy

• Brain damage in infancy or early childhood can also lead to CP. For example, a baby or toddler might suffer damage from lead poisoning, bacterial meningitis, poor blood flow to the brain, being shaken as an infant (shaken baby syndrome), being in a car accident

Cerebral Palsy Symptoms

• Variations in muscle tone

• Stiff muscles with normal reflexes

• Lack of muscle coordination

• Tremors or involuntary movements

• Slow, writhing movements

• Seizures

Types of Cerebral Palsy

1. Spastic CP

This is the most commonly occurring form of CP, i.e in 70% of the patients. People with spastic CP mainly have stiff muscles, therefore limiting the movement. Symptoms of spastic CP include:

• Delayed development in the movement of body parts

• Abnormal body movements.

• Limited range of movement

• Stiffness in the muscles

• Mostly affects the upper and lower limbs, and therefore difficulty when it comes to movement,

Based on the part of the body or the muscles that have been affected spastic CP is further classified into three types:

• Spastic hemiplegia: In this case, muscle stiffness only occurs at one side that is the left or right side. It may be limited to a few body parts like an arm, a hand or just a leg or all three at the same time. Therefore, only one side of the body will have hindered development. The intelligence of the patient is rarely affected but he or she may have occasional seizures.

• Spastic diplegia: In this case, the lower part of the body is affected, i.e the lower limbs, while the upper body does not show any signs of muscle inhibition. Patients with spastic diplegia have their legs crossed at the knees, also known as scissoring. Patients with this type of disorder can walk provided that they have some assistive devices like walkers or wheelchairs.

• Spastic quadriplegia: In this case, the muscles all over the body are affected. In such cases, the cognitive ability of the patient is compromised. Patients with this condition have a hard time doing simple activities like walking and movement of their limbs.

2. Ataxic Cerebral Palsy

In this case, the cerebellum of the brain is injured and therefore, the patient has poor muscle coordination. Due to this, the muscles are overly relaxed, making the arms and legs appear floppy.

The appearance of the patients with this condition is compared to that of a rag doll. The intelligence and cognitive abilities of patients with ataxic CP are not affected. In fact, some of them have good communication skills, but in some cases, patients show signs of cluttering. This is the least common type of CP.

Symptoms include:

• Improper muscle coordination

• Having no control over the movement of the head, which could be dangerous for children. 

• Delayed development of motor functions when compared to others of the same age

• Experiencing difficulty in breathing.

• Looseness in the ligaments and joints giving the patient a floppy appearance

• Poor depth perception and improper body balance

• Impaired mobility and difficulty in walking, usually have an unsteady gait

• Fatigue

• Unable to stand or sit without proper assistance.

• Difficulty with movements that require precision like writing, tying shoelaces or buttoning the shirt.

• Tremors, and shaky movements that are difficult to control.

3. Dyskinetic Cerebral Palsy

In this case, the patient has very less control over the movement of the muscles.  A person with dyskinetic CP has changing muscle tones, i.e it switches between too tight to too loose on the same day or might change on a day-to-day basis.

The symptoms include,

• Dystonia; repetitive twisting motions.

• Athetosis, writhing movements i.e, arms and legs move uncontrollably or may show jerky movements. 

• Improper posture

• Painful movements.

• Too much activity on the muscles all over the body, including the face and mouth, means the children have a tendency to drool as well as difficulty in swallowing or talking.

• Trouble hearing, breathing, and also with muscle coordination near the mouth.

• Intelligence and cognitive abilities are rarely compromised. 

4. Mixed Cerebral Palsy

In these cases, as the name suggests, patients have symptoms for two or more of the above-mentioned types. Most of the time, it is a mix of spastic CP and dyskinetic CP. For example, a child may have stiff muscles in some parts of the body like in spastic CP and then jerky movements in other parts of the body like in dyskinetic CP.

Cerebral Palsy Diagnosis

The paediatrician will evaluate the child’s signs and symptoms, review the child’s medical history, and conduct a physical evaluation. The doctor may refer a child to a pediatric neurologist.

MRI: It is done to produce detailed 3-D or cross-sectional images of a child’s brain.

Cranial Ultrasound: It is performed during infancy and it uses high-frequency sound waves to obtain images of the brain.

EEG: It is done to determine if he or she has epilepsy, which often occurs in people with cerebral palsy.

If a child is diagnosed with cerebral palsy and some other tests associated with the disorder are also done:

• Vision Impairment

• Hearing Impairment

• Speech delays

• Intellectual Disabilities

• Other Developmental delays

• Movement disorders

Cerebral Palsy Treatment

Children and adults with cerebral palsy require long-term care with a medical care team. The team may include:

• Paediatrician or physiatrist

• Pediatric neurologist

• Orthopaedic surgeon

• Physical therapist

• Occupational therapist

• Speech-language pathologist

• Developmental therapist

• Mental health specialist

• Recreation therapist

• Social worker

• Special education teacher

Medicines that can lessen the tightness of muscles may be used to improve functional abilities. Therapies are given to a person with cerebral palsy to enhance functional abilities.