Overview

Cerebral palsy is a group of neurological disorders that impact movement and posture, stemming from brain damage that typically occurs during fetal development.

Symptoms usually manifest in infancy or early childhood and can range from very mild to severe. Children with cerebral palsy may exhibit exaggerated reflexes, floppiness in the arms, legs, and trunk, or spasticity, which involves stiff muscles. Other symptoms include abnormal posture, involuntary movements, unsteady walking, or a combination of these issues.

Symptoms

Signs and symptoms generally appear during infancy or preschool years and vary greatly between individuals. Disability can be on one side of the body or affect the whole body.

Movement and Coordination Problems:

• Impaired muscle coordination
• Involuntary movements
• Abnormal or exaggerated reflexes
• Slow and writhing movements
• Reduced movements at joints
• Spastic paralysis
• Floppiness or rigidity in the trunk and limbs
• Unsteady walking
• Abnormal posture
• Problems with swallowing
• Excessive drooling
• Difficulty in speaking
• Eye muscle imbalance

Neurological Disorders:

• Hearing and vision problems
• Abnormal touch and pain sensations
• Intellectual disabilities
• Mental disorders
• Urinary incontinence

Causes

Cerebral palsy is caused by irregular brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. Often the cause isn’t known. Many factors can lead to changes in brain development, including:

• Gene changes that result in genetic conditions or differences in brain development.
• Maternal infections that affect an unborn baby.
• Stroke, which interrupts blood supply to the developing brain.
• Bleeding into the brain in the womb or as a newborn.
• Infant infections that cause swelling in or around the brain.
• Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical trauma.
• Lack of oxygen to the brain related to a hard labor or delivery, although this cause is less common than previously thought.

Early Signs of Cerebral Palsy

If you have concerns about your child’s behaviors, developmental path, or symptoms, talk to your pediatrician immediately. Doctors screen and test babies, but they also rely on parents’ observations. Look out for some of the earliest signs of cerebral palsy in babies to get the earliest diagnosis possible:

• Your child is missing developmental milestones, like holding up their head, rolling, or sitting.
• Their arms, legs, or neck feel unusually floppy or abnormally stiff and tense.
• The legs or arms are stiff and cross over each other.
• Your child favors one side of the body over the other.
• They push away from you when picked up.

Diagnosis of Cerebral Palsy

A child might not be diagnosed right away when symptoms of cerebral palsy are mild. The symptoms can go undetected for years. Most children are diagnosed as toddlers, but some people never get diagnosed until they are adolescents or adults.

Developmental Observations

Doctors perform developmental screenings at well-baby visits to determine if the child is growing and developing appropriately. They observe and evaluate to check for developmental delays, which could indicate cerebral palsy. Developmental screenings include a review of milestones, such as using the hands, sitting up, and making sounds in response to language. Pediatricians typically do these screenings at 9, 18, and 24 or 30 months.

Imaging Tests

Specific testing is more conclusive than observation of developmental milestones. Imaging tests and scans help physicians diagnose cerebral palsy and rule out other conditions. The most common tests ordered when considering a diagnosis of cerebral palsy include:

• Cranial Ultrasound: Captures images of the brain using sound waves, preferable in the first month of life as it is the least invasive neuroimaging technique.
• CAT Scan: A special X-ray machine takes pictures of the baby’s brain, skull, and vessels in the brain.
• MRI: Uses magnetic fields to take detailed pictures of the infant’s brain and spine, often requiring sedation to keep the infant still during the scan.

Other Tests

Numerous other tests and evaluations aid in the diagnosis of cerebral palsy or associated conditions, including:

• Blood tests to check for genetic and metabolic abnormalities
• Speech and language testing
• Hearing testing
• Vision testing
• Oral motor tests, including feeding and swallowing evaluations
• Neurological evaluations, including neuromuscular testing
• Tests of cognitive functioning
• Gait testing to evaluate walking problems
• Physical and occupational therapy evaluations

Types and Severity of Cerebral Palsy

Doctors diagnose the type and severity of cerebral palsy based on symptoms and the area of the body affected. Spastic cerebral palsy, the most common type, causes muscle stiffness and can be categorized as diplegia, hemiplegia, or quadriplegia to describe symptoms in the legs, on just one side of the body, or all over the body. The Gross Motor Function Classification System (GMFCS) is used to diagnose the severity of cerebral palsy, ranging from I to V, with V being the most severe and most impaired.

Treatment for Cerebral Palsy

Treatment depends upon the type and severity of cerebral palsy and is typically managed by a multidisciplinary team of medical professionals. Treatment goals are individualized to a child’s needs and may include:

• Manage medical conditions
• Manage and control pain
• Assist with behavior and social interactions
• Promote independence
• Assistance with eating, bathing, and dressing
• Optimize mobility
• Help with education and learning

Medications

Certain medications help children with cerebral palsy control symptoms by relaxing muscles and treating associated conditions like epilepsy and seizures. Common medications include:

• Baclofen
• Anticonvulsants
• Botox
• Stool softeners
• Sleep aids

Surgery

Surgery can help reduce muscle spasticity, increase flexibility, and improve function. However, surgery is not suitable for every child and carries risks. Common surgical procedures include:

• Osteotomy: Shapes and realigns bones to improve joint mobility and reduce pain.
• Tendon Lengthening: Reduces tension in tight tendons to correct joint or gait problems.
• Spinal Surgery: Corrects curvature in the spine to relieve pain and improve walking.

Complementary and Alternative Treatment Options

Complementary and alternative medicine (CAM) is another modality many parents choose to approach treatment more holistically and naturally.

The most common types of CAM treatments for cerebral palsy patients include:

• Energy Therapy. Energy therapy involves manipulating a child’s energy fields to promote energy flow in the body and aid in well-being.
• Movement Therapy. Movement therapy teaches body movements that help promote spiritual, physical, emotional, and mental balance.
• Mind and Body Techniques. Mind and body techniques include massage, acupuncture, hypnotherapy, guided meditation, guided imagery, yoga, breathing exercises, and more.
• Aqua Therapy. Aqua therapy (also known as aquatic or water therapy) promotes physical function and control and improves muscle tone, confidence, and independence.

Therapies

Different forms of therapy can provide physical, mental, social, and academic benefits. Common therapies include:

• Physical Therapy: Helps with balance, posture, muscle strengthening, and mobility.
• Occupational Therapy: Improves function in daily activities.
• Speech and Language Therapy: Helps children communicate more effectively through various strategies and tools.

Innovations in Cerebral Palsy Treatment

Ongoing research aims to improve the management and potential cure for cerebral palsy. Areas of research include:

• Early diagnosis. Researchers are getting closer to being able to identify infants who will develop cerebral palsy. Earlier diagnosis allows for interventions that can significantly limit disability.
• Systemic hypothermia. One important early intervention involves cooling the infant’s brain to slow or reverse brain damage that causes cerebral palsy.
• Constraint-induced therapy. CIT is a promising new therapy that constrains a child’s stronger limb. This forces the weaker limb to build strength.
• Functional electrical stimulation. FES uses electrical currents to stimulate muscles and hopefully restore some movement.
• Botox. Injections of botulinum toxin may help control spastic muscles.

Prevention

Preventive measures include:

• Make sure you’re vaccinated. 
• Take care of yourself. 
• Seek early and continuous prenatal care. 
• Avoid alcohol, tobacco and illegal drugs.

Complications

Possible complications of cerebral palsy include:

• Contracture
• Malnutrition
• Mental health conditions
• Heart and lung disease

Conclusion

Cerebral palsy is a complex neurological disorder that impacts movement and posture due to brain damage typically occurring before birth. The condition presents a wide range of symptoms, from mild to severe, and requires individualized diagnosis and treatment.

Early intervention is crucial, involving developmental screenings and advanced imaging techniques. While there is no cure, therapies such as physical, occupational, and speech therapy, along with medications and sometimes surgery, can significantly improve quality of life.