Cerebral Palsy

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What is Cerebral Palsy?

The term cerebral palsy refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don’t worsen over time. Even though cerebral palsy affects muscle movement, it isn’t caused by problems in the muscles or nerves. It is caused by abnormalities in parts of the brain that control muscle movements. The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later. The early signs of cerebral palsy usually appear before a child reaches 3 years of age. The most common are a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a “scissored” gait; and muscle tone that is either too stiff or too floppy. A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse.

Is there any treatment?

Cerebral palsy can’t be cured, but treatment will often improve a child’s capabilities. Many children go on to enjoy near-normal adult lives if their disabilities are properly managed. In general, the earlier treatment begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them. Treatment may include physical and occupational therapy, speech therapy, drugs to control seizures, relax muscle spasms, and alleviate pain; surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; wheelchairs and rolling walkers; and communication aids such as computers with attached voice synthesizers.

What is the prognosis?

Cerebral palsy doesn’t always cause profound disabilities. While one child with severe cerebral palsy might be unable to walk and need extensive, lifelong care, another with mild cerebral palsy might be only slightly awkward and require no special assistance. Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.

What research is being done?

Researchers are investigating the roles of mishaps early in brain development, including genetic defects, which are sometimes responsible for the brain malformations and abnormalities that result in cerebral palsy. Scientists are also looking at traumatic events in newborn babies’ brains, such as bleeding, epileptic seizures, and breathing and circulation problems, which can cause the abnormal release of chemicals that trigger the kind of damage that causes cerebral palsy. To make sure children are getting the right kinds of therapies, studies are also being done that evaluate both experimental treatments and treatments already in use so that physicians and parents have valid information to help them choose the best therapy.

How is cerebral palsy treated?

Most of the causes of cerebral palsy do not have specific, curative treatments. However, children with cerebral palsy present many medical problems that can be treated or prevented. The initial stage of treatment involves an interdisciplinary team, consisting of a pediatrician, preferable one with experience in neurodevelopmental disorders, a neurologist (or other neurological practitioner), a mental health practitioner, an orthopedic surgeon, a physical therapist, a speech therapist, and a occupational therapist. Each member of the team has important, independent contributions to make in the care of the affected child.

The physical therapist evaluates muscle tone, strength and gait (walking).
The occupational therapist reviews the child’s ability to perform tasks of self-help and care — from feeding to manual dexterity.
The speech therapist evaluates the child’s ability to speak and understand speech.

Most children with neurological impairment have significant emotional distress and also require therapy from a mental health practitioner.

Virtually all states have federally-mandated programs for the assessment and treatment of children with cerebral palsy and other developmental conditions. In many states, these programs are termed “Regional Centers” and can be found in local phone books. Also Children’s Hospitals usually have special clinics with experience with children with cerebral palsy. Furthermore, when a child reaches the age of 3 years, the school district may become formally involved in the review of at-risk children. These programs protect children up to the age of 21 years.

At the present time there is a vacuum in the provision of medical care for adults (young and old) with cerebral palsy living in the community settings. There are a limited number of services in adult hospitals geared to the treatment of adults with cerebral palsy or developmental disabilities.