What is Cerebral Palsy?
What is Cerebral Palsy?Cerebral palsy is the name given to a category of neurological disorders caused by abnormal brain development or injury to the brain resulting in damaged motor abilities. Cerebral palsy is the most frequently diagnosed motor disability in children.
Cerebral palsy severity depends on the extent of the brain damage incurred. Some people with cerebral palsy may not be able to walk at all, requiring mobility aids such as wheelchairs, crutches, walkers, or other movement devices; these people may require lifetime assistance. Other people with mild cerebral palsy may have an uncoordinated walk but do not need mobility assistance. Cerebral palsy does not usually worsen; however, as a person matures, their symptoms could change.
Everyone affected by cerebral palsy has movement or posture difficulties. Additionally, people might experience intellectual challenges, seizures, hearing and vision problems, speech complications, problems with the curvature of the spine (scoliosis), or joint problems. Long-term treatment for cerebral palsy may include physical therapy, medication, and possibly surgery.
Types of Cerebral Palsy
TypesCerebral palsy is classified according to the affected area, how it affects movement and muscle tone, and the severity of cerebral palsy. Muscle tone, described as being increased (hypertonia) or decreased (hypotonia), is controlled by signals from brain nerves directing the muscles to contract.
- Spastic cerebral palsy is the most common type of cerebral palsy affecting between 70-80% of those with cerebral palsy. Spastic cerebral palsy is caused by damage to the motor cortex. A person's muscles may feel stiff and tight, limiting how easily they can move their joints. Some people move with difficulty, while others cannot move at all.
- Dyskinetic cerebral palsy is often caused by damage to the basal ganglia section of the brain. Different types of dyskinetic cerebral palsy result from injuries to different structures within the basal ganglia; these include dystonia, athetosis, and chorea.
- Ataxic cerebral palsy. Ataxia is the least common type of cerebral palsy. Ataxia means being without coordination or order. Only 6% of people with cerebral palsy have this form of the disorder. It is characterized by shaky movements that are jerky and disorganized and affects a person's balance. People with ataxia are unsteady and shaky because their sense of balance and depth perception is affected.
Signs & Symptoms of Cerebral Palsy
SymptomsSigns and symptoms of cerebral palsy differ from person to person. It can affect the entire body, just one or two limbs, or only one side of the body. Cerebral palsy is a congenital disorder – a condition that is present at birth. The first physical symptoms of cerebral palsy will appear early in childhood, marked by rigid or floppy limbs and involuntary movements.
- Quadriplegia (type of bilateral cerebral palsy). All four limbs are affected; in some cases, the trunk of the body, the face, and the mouth are affected.
- Diplegia (type of bilateral cerebral palsy). Both legs are affected. The arms may be affected but to a lesser degree than the legs.
- Hemiplegia (type of unilateral cerebral palsy). Only one side of the body is affected –one arm and one leg.
- Hypertonia. This disorder causes increased muscle tone, making moving the arms and legs difficult. Muscles receive direction from the brain which regulates when the muscles should contract. In hypertonia, damage has occurred in the deep region of the brain called the basal ganglia causing neurodevelopmental abnormalities like cerebral palsy.
- Spasticity. Spasticity is a type of hypertonia, which means increased muscle tone. It causes painfully stiff muscles that can make moving difficult or not possible at all.
- Dystonia. This type of cerebral palsy causes a person to have twisting, repetitive movements that can be painful.
- Athetosis. This type of cerebral palsy is characterized by slow, continuous, involuntary, twisting movements that are present at rest and made worse by movement.
- Chorea. People experience involuntary brief, quick, irregular, and erratic movements. People with mild chorea display movements that appear fidgety and clumsy. People with severe chorea experience wild, violent, and involuntary movements.
Most signs of cerebral palsy will involve movement problems and coordination difficulties. The more serious the cerebral palsy, the more severe the symptoms. Other symptoms can include difficulty with speech, eating, and developmental problems.
Though symptoms of cerebral palsy do not typically get worse over time, physical therapy is crucial to avoid muscle shortening and rigidity problems.
Movement
- Spasticity. This is the most common movement symptom of cerebral palsy. Muscle movement is stiff and awkward. They may be too stiff or too limp.
- Rigidity. Stiff muscles with normal reflexes.
- Ataxia. Lack of balance and coordination.
- Tremors. Awkward, involuntary movements and jerky motions.
- Writhing. Thrashing about, slow movements.
- Favoring one side of the body. Using only one hand to reach for things, dragging one leg while crawling.
- Difficulty walking. Walking on toes, wide gait, crouched over, walking with knees crossing, other walking problems.
- Motor skills. Difficulty picking things up or buttoning clothes.
Speech, tongue, and jaw movement
- Delayed or impaired speech development
- Difficulty eating, chewing, and sucking
- Problems swallowing
- Excessive drooling
Developmental delays
- Delays in motor skills such as crawling, sitting up, and walking
- Learning and intellectual difficulties
- Delays in growth – smaller than normal size
Other medical problems
- Epilepsy (seizures)
- Hearing problems
- Eye problems – impaired vision and involuntary eye movements
- Unusual pain or touch perceptions
- Bladder or bowel problems such as constipation or incontinence
- Mental health issues including emotional or behavioral problems
If you suspect, there are inconsistencies with your baby's growth or reaching developmental milestones, seeking medical help from a pediatric neurology specialist who cares for children with neurological disorders is imperative.
Knowing the signs and symptoms of cerebral palsy and being educated on the available treatments will greatly increase your child's opportunity to lessen some of the detrimental symptoms of this disorder.
What Causes Cerebral Palsy?
CausesCerebral palsy is a congenital disorder that causes children to be born with abnormal development or damage to the motor function part of the brain; this damage usually happens prior to birth but can occur at birth or in early infancy. In some cases, the cause of cerebral palsy is unknown.
However, known factors that could lead to problems in the developing brain include:
- Gene mutation. Certain gene mutations can cause genetic disorders or problems in brain development.
- Mothers contracting infections during pregnancy. Some infections can cause birth defects or developmental problems in the brain.
- Fetal stroke. An obstruction of blood flow to the baby's developing brain can cause a stroke in vitro.
- Brain bleeds. Babies can experience bleeding into their developing brains while in the womb.
- Infants contracting infections. Some infections can cause inflammation in and around the brain.
- Traumatic brain injury. This type of injury can be sustained from an automobile accident, a fall, or physical abuse.
- Insufficient oxygen. A baby can have oxygen obstructed during delivery (asphyxia), though this is an uncommon cause of cerebral palsy.
Risk Factors for Cerebral Palsy
Risk FactorsRisk factors for cerebral palsy include infections that a mother may get during pregnancy or exposure to toxic chemicals or drugs. Babies that contract an infection while in the womb can develop inflammation, damaging the development of the brain.
Risk factors include:
- Cytomegalovirus. This is a common virus that causes flu-like symptoms. Birth defects are possible if the mother has an initial infection of this sort while she is pregnant.
- German measles (rubella). This viral infection is preventable with a vaccination. It is a known cause of congenital disabilities if a woman contracts this infection while pregnant.
- Herpes. This viral infection can be passed from the mother to the child during pregnancy. It can affect both the womb and the placenta.
- Syphilis. This sexually contractable bacterial disease can be passed from the mother to the baby and can cause congenital disabilities or difficulties.
- Heart & lung problems. Heart disease, lung disease, and breathing disorders are common for people with cerebral palsy.
- Toxoplasmosis. This parasitic infection comes from having contact, by way of food or soil, with the contaminated feces of infected cats.
- Zika virus infection. This mosquito-borne infection causes significant developmental birth defects and affects fetal brain growth.
- Intrauterine infections. This includes infections to the placenta or the fetal membranes.
- Toxic exposure. Toxic chemicals such as methylmercury, lead, arsenic, pesticides, and other toxins are known to cause congenital disabilities and developmental abnormalities in the womb.
- Acquired cerebral palsy. This disorder develops 28 days or later after a baby is born. Approximately 20% of people with cerebral palsy have acquired cerebral palsy. The most common causes for this type of cerebral palsy are:
- Problems with blood circulation to the baby's developing brain can cause blood clots and a fetal stroke
- Sickle cell anemia
- Neonatal infections
- Injuries to the head causing brain damage
- Premature birth. A premature baby is a baby born before its full gestation period is completed – before the due date. Premature babies are at risk for many serious health complications such as cerebral palsy. Precautionary measures should be followed to avoid having a baby born too soon.
- Substance abuse. Common risk factors for cerebral palsy include alcohol, drugs, and smoking.
Prevention
PreventionThere are no ways to prevent cerebral palsy; however, precautions can be followed to reduce the risk. For people who have a family history of congenital disorders, genetic counseling could help answer some important questions about family planning. Keeping all prenatal care appointments is another important step to ensuring the health of an unborn baby.
Some ways to improve your baby's chance of not developing cerebral palsy include:
- Vaccinations. Stay up-to-date with vaccinations, including COVID-19. Getting vaccinated for rubella before becoming pregnant could help prevent fetal brain damage, which is a serious side effect of rubella.
- Get in shape. Avoiding infections during pregnancy can start with a healthy body.
- Prenatal care. Keeping all scheduled appointments, taking prenatal vitamins prescribed by your child's doctor, eating healthy, and getting enough sleep can decrease the risk of your baby experiencing unnecessary fetal distress.
- Avoid certain foods & drinks. Avoid drinking beverages containing caffeine. Pregnant women should avoid eating tuna fish and other large ocean fish that are known to contain unhealthy levels of mercury, which causes birth defects. Pregnant women should avoid drinking alcohol, smoking tobacco, or taking illegal drugs which can cause harm to an unborn baby.
Complications
ComplicationsCerebral palsy results in motor skill problems and physical disorders that usually become noticeable in the first year of life. Cerebral palsy can affect the muscles on one side or part of the body or throughout a person's entire body.
Complications are usually related to the long-term effects of abnormal muscle tone (spasticity or dystonia) and decreased mobility on a growing musculoskeletal system. This usually includes:
- Contracture. Muscles can tighten and shorten the muscle tissue resulting from constant spasticity. Contracture can affect bone growth resulting in malformed joints or dislocation of joints. These malformations include scoliosis (curvature of the spine), hip dislocation, or other bone abnormalities.
- Malnutrition. Feeding and swallowing problems exist for some people with cerebral palsy. This especially poses a problem for infants when trying to feed. Their impaired ability to feed properly can lead to poor nutrition, impaired growth, and weakened bones. In severe cases of cerebral palsy, some children and adults could require a feeding tube to allow for proper nutrition.
- Mental health issues. People with cerebral palsy are prone to depression because of social isolation and the challenges they face because of their physical disability. In addition, children with cerebral palsy also exhibit behavioral problems.
- Osteoarthritis. Painful, degenerative bone disease can occur in the joints and is caused by abnormal alignment or joint pressure from muscle spasticity.
- Osteoporosis. Low bone density may result from poor nutrition, lack of mobility, and prolonged use of anti-epileptic drugs.
- Additional complications. Chronic pain and breakdown of the skin (bed sores) can occur from being immobile. Sleep, intestinal, and oral health problems are common for people with cerebral palsy.
- Seizures. A brain injury causes cerebral palsy; brain injuries increase the chance for abnormal brain activity to occur, resulting in a seizure.
- Vision problems. Vision problems are common for people with cerebral palsy. One in 10 children with cerebral palsy are blind, and 75-90% have some sort of visual impairment. Vision damage (cortical visual impairment) occurs in the occipital lobe in the back of the brain, where visual information is interpreted.
- Hearing problems. Children with cerebral palsy often experience some level of hearing impairment. Between 15-25% of children with cerebral palsy are affected by some sort of hearing problem. Two kinds of hearing loss affect children with cerebral palsy: conductive hearing loss and sensorineural hearing loss.
- Conductive hearing loss. Sounds are unable to pass from the outer ear to the inner ear because of an obstruction of a bone abnormality or a buildup of fluid or wax.
- Sensorineural hearing loss. The nerve pathways connecting the inner ear to the brain have been damaged. High-pitched or faint sounds are unable to be heard.
- Speech problems (dysarthria). Many children affected with cerebral palsy have a condition called dysarthria, which affects the muscles of the mouth, making speech difficult; people affected have trouble controlling their lips and tongues.
- Learning disabilities. Since cerebral palsy affects the normal development of certain parts of the brain, learning disabilities associated with these sections are common. For instance, children with cerebral palsy may be impacted by short attention spans, fine motor skill difficulties, perceptual and language difficulties, and difficulties in planning and organizing.
- Behavioral problems. Behavioral problems become more challenging as people with cerebral palsy mature. Children have difficulty fitting into peer groups because of strong emotional responses to certain situations. Teenagers may be prone to depression and anxiety problems. Adults may experience depression as they age and find difficulties trying to fit into society. It is estimated that 25% of people with cerebral palsy experience behavioral issues. Most of these cases involve people who experience epilepsy episodes, intellectual disabilities, and severe pain.
Trust NewYork-Presbyterian for Cerebral Palsy Care
NewYork-Presbyterian retains the most experienced neurologists, physiatrists (rehabilitation medicine doctors), and neurosurgeons who lead the path to treating pediatric neurological conditions like cerebral palsy. Our pediatric neurological team is an authority on the most advanced approaches and least invasive treatments available to our young patients.
The world-renowned expert pediatric neurologists at NewYork-Presbyterian offer neurological care for disorders and conditions like cerebral palsy. The most advanced pediatric surgeons, neurologists, and neurosurgeons from Columbia University and Weill Cornell Medicine have joined together with NewYork-Presbyterian to create the most comprehensive brain and spine care for patients from infants to adults. Know the symptoms and treatments available for your child's cerebral palsy.
Call one of the expert pediatric neurologists at NewYork-Presbyterian today.