The National Institute of Neurological Disorders and Stroke (NINDS) defines cerebral palsy as “a group of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination.”
In simple terms, this category of disorders impacts children’s movement and muscle coordination by affecting the area of the brain responsible for these actions, which is the cerebral cortex, ultimately as a result of some level of brain damage.
Sometimes referred to as just CP for short, if you break down the term cerebral palsy, “cerebral” references the brain and “palsy” references an impaired motor function, if not complete loss of motor control.
Types of Cerebral Palsy
As cerebral palsy is a group of neurological disorders initiated within a child’s brain, there are many different types of CP that are included in this category of conditions ultimately resulting in a cerebral palsy diagnosis.
Some of the most common types of CP are:
- Spastic cerebral palsy. The most common type, spastic CP involves muscle stiffness and awkward movements.
- Hemiplegic cerebral palsy. Hemiplegic CP only affects one arm and hand. In rare cases, it may impact a leg.
- Athetoid cerebral palsy. Sometimes called dyskinetic cerebral palsy or athetoid dyskinetic cerebral palsy, athetoid cerebral palsy creates uncontrollable movements of the arms and legs, as well as varying muscle tones.
- Ataxic cerebral palsy. This type of CP results in problems with walking and coordination, primarily due to issues with depth perception and balance.
- Congenital cerebral palsy. Congenital CP is diagnosed when a baby’s brain either doesn’t develop normally or suffers damage prior to birth.
- Hypotonic cerebral palsy. Children diagnosed with hypotonic cerebral palsy have reduced muscle tone, so they have difficulties with head control and are often described as “floppy.”
- Mixed cerebral palsy. If the CP isn’t distinctly one type, the doctor may diagnose it as mixed cerebral palsy, or a combination of two or more of the other CPs.
While each has its own unique definition and diagnosis, all of the disorders contained within the CP category have the basic characteristics of this condition created by the initial brain damage, which include abnormal muscle tone, spastic muscle movement (sometimes referred to as spasticity), and a variety of other muscle and movement related issues.
Symptoms of Cerebral Palsy
The symptoms displayed by a child with cerebral palsy vary depending on two factors:
- The type of cerebral palsy, and
- Its severity, or the level of damage to the child’s brain.
However, some of the most common symptoms displayed by children with CP include:
- Muscle stiffness or tightness
- Abnormal muscle tone (which may include muscle tone that is unusually rigid and tense or muscle tone that is unusually weak)
- Random, involuntary muscle movements
- Spasticity of the muscles (muscle spasms, commonly seen with spastic CP and athetoid CP)
- Weakness in the arms and/or legs
- Problems with movements requiring fine motor skills (such as when engaged in activities like picking a coin up off a table, or buttoning a pair of pants or shirt)
- Balance and coordination issues
- Wide-based gait
- Exaggerated muscle reflexes
- Excessive drooling
- Problems speaking
- Hearing issues
Depending on the actual diagnosis and how much brain damage exists, a child diagnosed with CP may also have cognitive problems, such as an intellectual disability or some level of mental retardation.
Furthermore, some of these cerebral palsy symptoms are noticeable at birth, whereas others don’t appear for months, sometimes years later, leaving this condition undiagnosed until problems and symptoms associated with CP eventually present themselves.
Again, it depends on the level of brain damage as to how pronounced the CP symptoms will appear and what level of difficulty the child will have as a result.
Fortunately, people with cerebral palsy often find relief from some of these symptoms when they undergo physical therapy, movement therapy utilizing the Anat Baniel Method, or some of the other common types of CP therapy.
Cerebral Palsy Causes and Prevalence
The cause of cerebral palsy is oftentimes unknown, but it sometimes occurs as a result abnormal development when the fetus is in the womb. Other times, it’s believed to be caused by injury to the brain. This injury could occur prior to the birth, during the birthing process, or after the child is born.
As far as prevalence, with all of the types of cerebral palsy combined, this set of disorders is actually the number one childhood disability. According to the Centers for Disease Control and Prevention (CDC), CP afflicts one in every 323 children.
Further, a majority of the children diagnosed with CP (77.4 percent) have what is called spastic cerebral palsy, which is a type of CP characterized by spastic, jerky movements in addition to muscle and joint stiffness.
National Cerebral Palsy Awareness Month occurs every March in an effort to bring more attention to this particular disorder, as well as to help educate families of children and people with cerebral palsy as to what their treatment options are, such as physical therapy, occupational therapy, and constraint-induced movement therapy, or even a surgery like selective dorsal rhizotomy if the condition is severe.
This month is also a great time for parents to learn more about the ins and outs of this particular condition, getting answers to their questions like:
- How the brain damage is caused (and whether it is a result of medical malpractice);
- When the brain damage occurs (before the child’s birth, during the birth process, or after the child’s birth);
- What problems and symptoms to watch out for when determining whether their child may have cerebral palsy;
- Whether it affects the child’s life expectancy rates;
- What the difference is between different types of CP (like spastic and athetoid); and
- What they can do to help their child deal with muscle spasticity, movement issues, or brain-based responses, like problems associated with speaking or intellect.
Cerebral Palsy as a Co-Occurring Condition
Children afflicted with CP often have additional health conditions with which to contend.
For instance, in a 2014 study published in the journal Developmental Medicine & Child Neurology, it was revealed that 41 percent of the 451 kids studied had also been diagnosed with epilepsy, a condition characterized by seizures. The rate was even higher (61 percent) for children who were either unable to walk or had limited walking ability due to the CP.
Seizures can be particularly troubling to parents, based largely on their spastic nature. When they witness their child’s muscles tighten and their movement becomes tense and jerky, it can be frightening for them to see, especially if the child’s condition is severe and they’re unable to speak once the seizure subsides.
This study also found that 6.9 percent of the children with CP had autism spectrum disorder. That number increased to 18.4 percent when the type of CP was non-spastic in nature. This is much higher than the general prevalence of autism, which is somewhere between one and two percent according to the CDC.
Elevated Medical Costs Associated with Cerebral Palsy
Children with cerebral palsy tend to have much higher medical expenses than children without CP.
For instance, a study of 9,927 children on Medicaid found that medical expenses are around $15,047 higher for children with CP when compared to children who don’t have this condition. That amount triples to $41,664 for children with CP combined with an intellectual disability.
In total, the lifetime costs of caring for a child with CP are estimated to be in excess of $1.15 million. For children living beyond the age of 18, which is a reasonable life expectancy in less severe cases of cerebral palsy, that amount can be much higher.
Cerebral Palsy Diagnosis
According to data provided by the CDC, “cerebral palsy (CP) is the most common motor disability in childhood.” Affecting roughly four children per every 1,000 born, this condition occurs more often in boys than girls. Additionally, spastic CP is the most common diagnosis, afflicting 77.4 percent of children with CP.
Many different types of medical professionals can diagnose cerebral palsy, including the child’s pediatrician in addition to specialists like pediatric physiatrists and pediatric rehabilitation doctors. Generally, identifying and diagnosing CP occurs in three stages:
- Developmental monitoring: Watching the child to see if any visible physical or mental delays or differences exist. This is critical because the CDC notes that most children are diagnosed with CP before the age of 2.
- Developmental screening. If a delay or difference is detected, the child is then screened to determine if further testing needs to be completed. Typically, screening occurs when the child is 9 months, 18 months, and 24 months of age.
- Developmental and medical evaluation.
In the event CP is suspected, the doctor may decide to:
- perform a physical exam;
- refer the child for a brain scan via magnetic resonance imaging (MRI), x-ray computed tomography (CT Scan), or cranial ultrasound;
- conduct genetic or metabolic testing; or
- perform an electroencephalogram (EEG).
If the child is diagnosed with cerebral palsy, further testing may be conducted to determine the extent of its severity. The doctors may look into areas such as the child’s speech abilities, hearing, vision, and intellectual abilities.
Cerebral Palsy Treatment
There is no known cure for cerebral palsy at this time, but there are many different treatment options that can help people diagnosed with this condition better manage it. It is a multi-faceted disease, so an effective treatment plan often involves a number of different therapists and medical professionals.
Some of the most common forms of CP treatment include:
- Physical therapy. The patient performs exercises designed to help improve balance and coordination. This type of therapy also aids in enhancing muscle tone.
- Occupational therapy. Helps people with CP perform day-to-day activities related to home and work.
- Recreation therapy. Involves the patient engaging in recreational activities like sports and the arts. This type of therapy provides mental benefits like reduced anxiety and social isolation effects, while also providing physical benefits related to strength and flexibility.
- Speech and language therapy. If the patient has difficulty communicating, this therapy can help him or her develop effective communication methods.
- Medication. Certain prescription medications can help ease some of the symptoms associated with CP, such as those related to spastic movements and drooling.
- Orthotics and other movement aids. If there are walking difficulties, the person with CP can enjoy greater mobility with the help of devices such as braces, splints, canes, walkers, and wheelchairs.
If the CP is severe, surgery may be recommended. Some surgeries are used to lengthen muscles and tendons or create better musculoskeletal alignment, whereas others assist with providing a level of pain control. Some CP patients have also found relief with complementary and alternative therapies such as yoga and acupuncture.
Additional treatment modes may be recommended if there are other medical issues present, such as those that occur more often in persons with CP. These include issues related to seizures, acid reflux, frequent urinary tract infections, and dental issues.
A cerebral palsy diagnosis doesn’t have to mean a lifetime of pain and suffering. With treatment options such as these, in addition to the continual testing done by researchers to find more effective treatment methods, people with CP can and do live long and happy lives.