Cerebral palsy

Published by Bupa's Health Information Team, September 2010.

This factsheet is for parents of children who have cerebral palsy or people who would like information about it. However, for simplicity we will refer to 'your child' throughout.

Cerebral palsy is a condition that affects speech, movement, posture and co-ordination. Symptoms are usually first seen in children before they are two, and vary widely in severity.

About cerebral palsy

Cerebral palsy isn't a specific illness; it's a term that describes motor (movement) disorders caused by damage to your child's brain. It isn't a progressive condition, so the damage doesn't gradually get worse. However, the manifestations may change throughout your child's life as his or her nervous system matures. This means the symptoms may change over time.

Cerebral palsy affects about one in 400 children, but each child is affected differently.

With support from nurses, carers and other specialists from an early age, your child can learn to manage his or her symptoms so as to be as independent as possible.

Types of cerebral palsy

There are four types of cerebral palsy which cause different problems with movement.

• Spastic cerebral palsy
• Dyskinetic (dystonic or athetoid) cerebral palsy
• Ataxic cerebral palsy
• Hypotonic cerebral palsy

Sometimes, one type is seen initially and then, as your child grows, another type becomes dominant. For example, your child may be hypotonic (floppy) soon after birth but may later develop more spasticity (stiffness).

In some children, it can be difficult to be sure whether the condition is cerebral palsy or a progressive neurological disorder. This means it may be some years before the diagnosis can be made with confidence.

It's important to remember that the condition varies between individuals and your child may show a mixture of different types of motor disability.

Spastic cerebral palsy
This is the most common type of cerebral palsy. Spasticity is the medical term for a certain type of increased muscle tone which makes muscles stiff and affects movement. Difficulties moving limbs may make walking harder for your child but if his or her cerebral palsy is mild, this may only affect certain activities such as running. He or she may also have difficulties forming words when speaking.

Spastic cerebral palsy can affect different areas of your child's body.

• Hemiplegia means one side of your child's body is affected.
• Diplegia means your child's legs are affected.
• Triplegia means three of your child's limbs are affected.
• Quadriplegia means all four your child's limbs are affected.

Dyskinetic (dystonic or athetoid) cerebral palsy
This causes slow, involuntary muscle movements and abrupt twitches that may be repetitive. Athetoid cerebral palsy can make speaking difficult because your child may find it hard to control his or her tongue, breathing and vocal cords. Your child may also have hearing problems.

Ataxic cerebral palsy
This can affect your child's co-ordination and balance, making it difficult for him or her to judge body position in relation to surrounding objects. It also weakens muscles and causes tremors. Your child may have difficulty walking steadily.

Hypotonic cerebral palsy
Hypotonia is the medical term for low muscle tone and causes floppiness. A hypotonic child therefore doesn't sit unaided until much later in his or her development and will have difficulty learning to walk.

Symptoms of cerebral palsy

The severity of symptoms varies greatly between children, from barely noticeable clumsiness to such severe problems with movement that your child may need a wheelchair.

Common symptoms include difficulty and delay with movement, balance and coordination, muscle stiffness, involuntary and uncontrolled movements, and shakiness. These symptoms are often noticed in the first months and years of life. In addition to motor problems, your child may have other neurological impairments including learning difficulties and epilepsy.

These symptoms aren't always a result of cerebral palsy but if your child has them, see your GP.

Complications of cerebral palsy

If your child has severe cerebral palsy, he or she may have another condition such as epilepsy, learning difficulties or sensory disturbances such as sight or hearing changes. Your child may need special assistance with daily activities and education.

Problems with movement can limit how your child learns about his or her surroundings and environment, which can limit learning opportunities and may affect development.

Causes of cerebral palsy

Damage to your child's brain during pregnancy, birth, or just after birth, causes cerebral palsy. It's often not clear why this happens. However, there are a number of possible factors that may cause such brain damage, including:

• getting an infection early in pregnancy
  
• getting an infection such as meningitis when your child is born
  
• premature birth or complications during birth
  
• cerebral (brain) bleeding - this is more common if your child is premature or one of a multiple birth (eg twins, triplets)
  
• changes in your child's brain as it's developing
  
• an inherited (genetic) cause - this is rare
  
• maternal iodine deficiency - this is rare in the UK but common in less developed countries

Researchers are currently trying to find the exact causes of cerebral palsy so that it may be preventable in the future.

Diagnosis of cerebral palsy

If you think your child is having problems with movement, see your GP who will ask about your child's symptoms and examine him or her. Your GP may also ask you about your child's medical history.

Your GP may refer your child to a paediatrician (a doctor who specialises in child health). Most children who have cerebral palsy are diagnosed around the age of two, but the condition can be diagnosed at any age. The paediatrician will monitor your child as he or she develops and grows to rule out similar conditions before making a diagnosis. Tests, such as blood tests, a CT (computerised tomography) scan or an MRI (magnetic resonance imaging) scan, may be done to rule out other conditions. This may, however, depend on your child's age. Speak to your GP for more information.

Treatment of cerebral palsy

There is no cure for cerebral palsy, but with the right support your child can become as independent as possible.

Non-medical treatment

Often a multidisciplinary team of professionals working in different areas of health and social care are involved in the assessment and care of your child. This varies according to your local services. During the assessment stage, a detailed evaluation of your child's abilities is made. This includes an assessment of his or her movement, capabilities, vision, hearing and daily activities.

A detailed management plan can then be developed specific to your child's needs and capabilities. Some of the people who may be involved in your child's assessment and care are listed below.

• Your GP can give general advice and may help put you in contact with support services.
• A physiotherapist (a health professional who specialises in movement and mobility) will have a key role in helping your child. The physiotherapist will monitor and record your child's progress, teaching them how to control head movements, roll over, crawl and walk as much as possible. The physiotherapist will also help to reduce abnormal movements and give advice on equipment that may help your child's mobility. As your child grows older, physiotherapy will focus on helping him or her to be independent and adapt to his or her changing circumstances to take on increasing challenges. When your child is transferred to adult services, the physiotherapist will continue to help reduce symptoms, such as mobility challenges, as they arise.
• An occupational therapist will assess how much cerebral palsy affects your child's life and recommend specific activities or equipment that will help him or her adapt to difficulties and maximise his or her independence.
• A speech and language therapist (a health professional who specialises in identifying and managing speech and swallowing problems) will help to identify and manage any problems your child has with communication. This may include teaching languages using sign or symbols or other communication aids.
• A social worker from your local authority can help provide advice on practical and financial matters.
• A paediatric neurologist (a health professional who specialises in disorders of the central nervous system in children) may be involved in the initial diagnosis of cerebral palsy and ongoing monitoring if your child has epilepsy.
• An educational psychologist can help to manage any learning difficulties your child may have. This could involve visits to his or her school to assess progress.

Setting specific goals in the management of cerebral palsy, which are agreed by you and the team of healthcare professionals can help your child get the best care and support.

Medicines

An injection of botulinum toxin A is sometimes used to relieve muscle stiffness in children with spastic cerebral palsy. This is often given to older children who walk on tip-toes and have very tight calf muscles and tendons. It can also be used in arms and hands if your child's fist is permanently clenched.

Surgery

If your child has spastic cerebral palsy, a back operation called dorsal rhizotomy may help. Nerves in the lower back can be cut to help relieve spastic muscles, but this is a complicated procedure and is only carried out in specific circumstances, usually after other treatments (including physiotherapy and botulinum toxin) have not worked. The operation may not improve mobility in some children and once it's done, it can't be reversed. It may also have serious complications.

Another surgical treatment is tendonectomy, where tendons are cut to relieve stiffness.

Your paediatrician can advise you about surgery and if it's a suitable treatment for your child.

Living with cerebral palsy

Caring and supporting a child with cerebral palsy can be challenging. Ask your doctor for advice about managing your child's condition. Charity and patient groups can also provide advice and support.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.