Cerebral palsy

Cerebral palsy
US Navy 081028-N-3173B-027 Cmdr. John King assesses the reflexes of a Cerebral Palsy patient at the Arima District Health Facility as part of the humanitarian-civic assistance mission Continuing Promise (CP) 2008.jpg
A child with cerebral palsy
Classification and external resources
Specialty Pediatrics
ICD- 10 G80
ICD- 9-CM 343
OMIM 603513 605388
DiseasesDB 2232
MedlinePlus 000716
eMedicine neuro/533 pmr/24
Patient UK Cerebral palsy
MeSH D002547

Cerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood. Signs and symptoms vary among people. Often, symptoms include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, vision, hearing, swallowing, and speaking. Often babies with cerebral palsy do not roll over, sit, crawl, or walk as early as other children of their age. Difficulty with the ability to think or reason and seizures each occurs in about one third of people with CP. While the symptoms may get more noticeable over the first few years of life, the underlying problems do not worsen over time. [1]

Cerebral palsy is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. [1] [2] Most often the problems occur during pregnancy; however, they may also occur during childbirth, or shortly after birth. Often the cause is unknown. Risk factors include preterm birth, being a twin, certain infections during pregnancy such as toxoplasmosis or rubella, exposure to methylmercury during pregnancy, a difficult delivery, and head trauma during the first few years of life, among others. [1] About 2% of cases are believed to be due to an inherited genetic cause. [3] A number of sub-types are classified based on the specific problems present. For example, those with stiff muscles have spastic cerebral palsy, those with poor coordination have ataxic cerebral palsy, and those with writhing movements have athetoid cerebral palsy. Diagnosis is based on the child's development over time. Blood tests and medical imaging may be used to rule out other possible causes. [1]

CP is partly preventable through immunization of the mother and efforts to prevent head injuries in children such as through improved safety. There is no cure for CP; however, supportive treatments, medications, and surgery may help many individuals. This may include physical therapy, occupational therapy, and speech therapy. Medications such as diazepam, baclofen, and botulinum toxin may help relax stiff muscles. Surgery may include lengthening muscles and cutting overly active nerves. Often external braces and other assistive technology are helpful. Some affected children can achieve near normal adult lives with appropriate treatment. While alternative medicines are frequently used there is no evidence to support their use. [1]

CP is the most common movement disorder in children. [4] It occurs in about 2.1 per 1,000 live births. [5] Cerebral palsy has been documented throughout history with the first known descriptions occurring in the work of Hippocrates in the 5th century BCE. Extensive study of the condition began in the 19th century by William John Little, after whom spastic diplegia was called "Little disease". [6] William Osler first named it "cerebral palsy" from the German "zerebrale Kinderlähmung" (cerebral child-paralysis). [7] A number of potential treatments are being examined, including stem cell therapy. However, more research is required to determine if it is effective and safe. [1]

Video explanation covering the three primary categories of cerebral palsy—spastic, dyskinetic, and ataxic.

Signs and symptoms

Cerebral palsy is defined as "a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain." [8] While the central feature of CP is a disorder with movement, difficulties with thinking, learning, feeling, communication and behavior often occur along with cerebral palsy. [8] Of those with CP, 28% have epilepsy, 58% have difficulties with communication, at least 42% have problems with their vision, and 23–56% have learning disabilities. [9]

Cerebral palsy is characterized by abnormal muscle tone, reflexes, or motor development and coordination. There can be joint and bone deformities and contractures (permanently fixed, tight muscles and joints). The classical symptoms are spasticity, spasms, other involuntary movements (e.g., facial gestures), unsteady gait, problems with balance, and/or soft tissue findings consisting largely of decreased muscle mass. Scissor walking (where the knees come in and cross) and toe walking (which can contribute to a gait reminiscent of a marionette) are common among people with CP who are able to walk, but taken on the whole, CP symptomatology is very diverse. The effects of cerebral palsy fall on a continuum of motor dysfunction, which may range from slight clumsiness at the mild end of the spectrum to impairments so severe that they render coordinated movement virtually impossible at the other end of the spectrum.

Babies born with severe CP often have an irregular posture; their bodies may be either very floppy or very stiff. Birth defects, such as spinal curvature, a small jawbone, or a small head sometimes occur along with CP. Symptoms may appear or change as a child gets older. Some babies born with CP do not show obvious signs right away.[ citation needed] Classically, CP becomes evident when the baby reaches the developmental stage at 6 to 9 months and is starting to mobilise, where preferential use of limbs, asymmetry, or gross motor developmental delay is seen. [10]

Drooling is common among children with cerebral palsy, which can have a variety of impacts including social rejection, impaired speaking, damage to clothing and books, and mouth infections. [11]

An average of 55.5% of people with cerebral palsy experience lower urinary tract symptoms, more commonly excessive storage issues than voiding issues. Those with voiding issues and pelvic floor overactivity can deteriorate as adults and experience upper urinary tract dysfunction. [12]

Children with CP may also have sensory processing issues. [13]


Speech and language disorders are common in people with cerebral palsy. The incidence of dysarthria is estimated to range from 31% to 88%, [14] and around a quarter of people with CP are non-verbal. [15] Speech problems are associated with poor respiratory control, laryngeal and velopharyngeal dysfunction, and oral articulation disorders that are due to restricted movement in the oral-facial muscles. There are three major types of dysarthria in cerebral palsy: spastic, dyskinetic (athetosis), and ataxic.[ citation needed]

Early use of augmentative and alternative communication systems may assist the child in developing spoken language skills. [15] Overall language delay is associated with problems of intellectual disability, deafness, and learned helplessness. [16] Children with cerebral palsy are at risk of learned helplessness and becoming passive communicators, initiating little communication. [16] Early intervention with this clientele, and their parents, often targets situations in which children communicate with others so that they learn that they can control people and objects in their environment through this communication, including making choices, decisions, and mistakes. [16]


In order for bones to attain their normal shape and size, they require the stresses from normal musculature. Osseous findings will, therefore, mirror the specific muscular deficits in a given person with CP. The shafts of the bones are often thin (gracile) and become thinner during growth. When compared to these thin shafts ( diaphyses), the centres ( metaphyses) often appear quite enlarged (ballooning). With a lack of use, articular cartilage may atrophy, leading to narrowed joint spaces. Depending on the degree of spasticity, a person with CP may exhibit a variety of angular joint deformities. Because vertebral bodies need vertical gravitational loading forces to develop properly, spasticity and an abnormal gait can hinder proper and/or full bone and skeletal development. People with CP tend to be shorter in height than the average person because their bones are not allowed to grow to their full potential. Sometimes bones grow to different lengths, so the person may have one leg longer than the other.[ citation needed]

Children may develop scoliosis before the age of 10 - estimated prevalence of scoliosis in children with CP is between 21% and 64%. Scoliosis can be corrected with surgery, but CP makes surgical complications more likely, even with improved techniques. [17]

Pain and sleep

Pain is common and may result from the inherent deficits associated with the condition, along with the numerous procedures children typically face. [18] Pain is associated with tight or shortened muscles, abnormal posture, stiff joints, unsuitable orthosis, etc. There is also a high likelihood of chronic sleep disorders secondary to both physical and environmental factors. [19] Chronic pain is under-recognized in children with cerebral palsy, [20] even though 3 out of 4 children with cerebral palsy experience pain. [21]


Those with CP may have difficulty preparing food, holding utensils, or chewing and swallowing due to sensory and motor impairments. An infant with CP may not be able to suck, swallow or chew. [22] Children with CP may have too little or too much sensitivity around and in the mouth. [22] Fine finger dexterity, like that needed for picking up a utensil, is more frequently impaired than gross manual dexterity, like that needed for spooning food onto a plate. [23][ non-primary source needed] Grip strength impairments are less common. [23][ non-primary source needed]

Children with severe cerebral palsy, particularly with oropharyngeal issues are at risk of undernutrition. [24]

Associated disorders

Associated disorders include "intellectual disabilities, seizures, muscle contractures, abnormal gait, osteoporosis, communication disorders, malnutrition, sleep disorders, and mental health disorders, such as depression and anxiety". [25] In addition to these, "functional gastrointestinal abnormalities contributing to bowel obstruction, vomiting, and constipation" may also arise. Adults with cerebral palsy may suffer from "ischemic heart disease, cerebrovascular disease, cancer, and trauma" moreso than a non-affected population. [26] Obesity in people with cerebral palsy in particular is considered to be a risk factor for multimorbidity. [27] Other medical issues can be mistaken for being symptoms of cerebral palsy, and so may not be treated correctly. [28]

Related conditions can include seizures, apraxia, dysarthria or other communication disorders, eating problems, sensory impairments, intellectual disability, learning disabilities, urinary incontinence, fecal incontinence, and/or behavioural disorders.[ citation needed]