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Cerebral Palsy

Alternate Names

  • CP

Definition

Cerebral palsy, which is also called CP, is a motor impairment due to an injury to the brain before it is fully mature. These motor problems are initially seen in the first few years of the child's life and generally don't worsen over time.

What is going on in the body?

Cerebral palsy is a motor impairment caused by an injury to the brain. The brain damage usually occurs before birth. However, at times it can occur during delivery or even after the child is born.
There are four major types of cerebral palsy:
  • spastic CP, which involves permanent stiffness and contracture of the muscles
  • athetoid, or dyskinetic, CP, which causes slow writhing movements
  • ataxic CP, which is rare and affects the balance and depth perception
  • mixed forms of CP, which include characteristics of the other three types of CP
At one time, CP was thought to be caused by the infant getting too little oxygen during birth. More recent studies suggest that most cases come from problems during pregnancy and not during delivery.

Risks

What are the causes and risks of the disease?

The brain damage that causes CP can occur before birth, during labor and delivery, or in the first few years of life. Common causes include the following:
  • brain infections, such as meningitis or encephalitis
  • head injuries from accidents or child abuse
  • newborn jaundice
  • Rh incompatibility between the mother and fetus
  • severe oxygen deprivation during labor or delivery
  • stroke in the fetus or newborn, caused by clotting problems
  • TORCH infections in the mother during pregnancy
However, in many, if not most, cases, the cause is not known.
Following are some of the risk factors for cerebral palsy:
  • breech birth, in which the baby is delivered feet first
  • complicated labor and delivery
  • hypothyroidism, mental retardation, or seizures in the mother
  • low APGAR score, which is a measurement of the baby's health taken right after delivery after one minute and five minutes respectively
  • low birth weight and premature birth
  • multiple births, such as twins
  • nervous system abnormalities, such as a small brain
  • seizures in the newborn
  • vaginal bleeding or protein in the mother's urine during the third trimester of pregnancy

Prevention

What can be done to prevent the disease?

Cerebral palsy is not always preventable. The following recommendations may prevent some cases of CP:
  • good prenatal care
  • measures to prevent child abuse
  • phototherapy treatment for infants with newborn jaundice
  • RhoGAM injections after pregnancies and miscarriages for women who are Rh negative
  • rubella immunizations before pregnancy for women who are not already immune to German measles
  • use of appropriate car seats for infants and children

Diagnosed

How is the disease diagnosed?

The diagnosis of cerebral palsy begins with a medical history and physical exam. The healthcare professional will look for signs of muscle problems related to nervous system injury. Delays in normal development will also be assessed.
It may take time for the diagnosis to become clear. Some signs of CP may change over time. Some signs may appear after the diagnosis has been made.
The healthcare professional may order the following tests to rule out other disorders, or to look for the cause of the CP:
  • cranial CT scan
  • cranial MRI
  • EEG
  • ultrasound of the brain

Long Term Effects

What are the long-term effects of the disease?

CP can affect different areas of the brain. There can be many long-term effects from brain injury involving many areas of functioning.
People with CP may have various limitations in activity due to movement problems. Learning disabilities or mental limitations may impair the person's ability to live independently. Some individuals with CP will need lifelong assistance for activities of daily living.
The imbalance of muscle tone and strength can result in skeletal problems. The child may develop scoliosis, or curvature of the spine. The joints may lose their ability to bend, and the hip joints may dislocate easily.

Other Risks

What are the risks to others?

Cerebral palsy is not contagious and poses no risk to others.

Treatments

What are the treatments for the disease?

Cerebral palsy cannot be cured. Treatment is geared toward improving the individual's functional abilities and quality of life.
  • Behavioral therapy can help reinforce behaviors that maximize abilities and skills.
  • Early intervention programs can help younger infants and their parents maximize development.
  • Educational planning should start before the child reaches school age.
  • Medicines, such as baclofen (i.e, Kemstro) or methocarbamol (i.e., Robaxin), can help to relax muscles.
  • Some healthcare professionals are using injections of botulinum toxin, type A (i.e., Botox) to help reduce the effects of muscle spasm.
  • Occupational therapy can help the child with self-care and other activities of daily living.
  • Physical therapy can help develop basic movement skills.
  • Speech therapy can help with speech and language impairments.
  • Orthotics (braces) and splints of various types are frequently used.
  • Surgery on muscles, bones, joints, or the nervous system can improve motor skills.
Children with CP should be helped to lead as normal a life as possible. Sports for children with disabilities provide instruction and opportunity to participate in team activities.

Side Effects

What are the side effects of the treatments?

Medicines used to treat CP may cause allergic reactions, stomach upset, or drowsiness. Surgery may cause bleeding, infection, or a reaction to anesthesia.

After Treatment

What happens after treatment for the disease?

Most children with CP need some type of assistance or treatment for life. Severely affected children may need intense, around-the-clock care for the rest of their lives.

Monitor

How is the disease monitored?

Continuous monitoring by the caregivers and healthcare providers helps identify problems early. This allows treatment to be started at the earliest time to maximize function and quality of life. Any new or worsening symptoms should be reported to the healthcare provider.

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