Cerebral Palsy

About: 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.
Cerebral palsy may be classified by the type of movement problem (such as spastic or athetoid cerebral
palsy) or by the body parts involved (hemiplegia, diplegia, and quadriplegia). Spasticity refers to the inability
of a muscle to relax, while athetosis refers to an inability to control the movement of a muscle. Infants who
at first are hypotonic wherein they are very floppy may later develop spasticity. Hemiplegia is cerebral palsy
that involves one arm and one leg on the same side of the body, whereas with diplegia the primary
involvement is both legs. Quadriplegia refers to a pattern involving all four extremities as well as trunk and
neck muscles. Another frequently used classification is ataxia, which refers to balance and coordination
problems. The motor disability of a child with CP varies greatly from one child to another; thus
generalizations about children with cerebral palsy can only have meaning within the context of the subgroups
described above. For this reason, subgroups will be used in this book whenever treatment and outcome
expectations are discussed. Most professionals who care for children with cerebral palsy understand these
diagnoses and use them to communicate about a child's condition.
Spastic Cerebral Palsy
Spastic Cerebral Palsy is the most common diagnosis. If your child’s CP is “spastic,” her muscles are rigid
and jerky, and she has difficulty getting around. There are three types of spastic Cerebral Palsy:
• Spastic diplegia — Your child’s leg and hip muscles are tight, and his legs cross at the knees, making
it difficult to walk. This kind of movement is frequently referred to as “scissoring.”
• Spastic hemiplegia — Only one side of your child’s body is stiff. Her arms or hands might be more
affected than her legs. On the affected side, her arm and leg may not develop normally. She may also
require leg braces.
• Spastic quadriplegia — The severest of the three, spastic quadriplegia means that your child is more
likely to have mental retardation if diagnosed as quadriplegia. His legs, arms, and body are affected.
It will be difficult for him to walk and talk, and he may also experience seizures.
Athetoid Dyskinetic Cerebral Palsy
Athetoid dyskinetic is the second most frequently diagnosed type of Cerebral Palsy. Your child will have
normal intelligence, but her body will be totally affected by muscle problems. Her muscle tone can be weak
or tight, and she might have trouble walking, sitting, or speaking clearly. She may also have trouble
controlling her facial muscles and therefore drool.
Ataxic Cerebral Palsy
This is the least diagnosed type of Cerebral Palsy. Your child will have trouble tying his shoes, buttoning his
shirt, cutting with scissors, and doing other tasks that require fine motor skills. He might walk with his feet
farther apart than normal and have trouble with his balance and coordination. Your child may also suffer
from “intention tremors,” a shaking that begins with a voluntary movement. For example, your child may
reach for a toy, and then his hand and arm will start to shake. As he gets closer to the toy, the tremor worsens.

Hypotonic Cerebral Palsy

Unlike with other types of CP, you will notice that your baby has muscle control problems early in life. Her
head seems floppy, and she will not be able to control it when sitting up. Her motor skills will be
developmentally delayed.
It is suspected that this type of Cerebral Palsy is caused by brain damage or malformations that occur while a
baby’s brain is still developing.
Mixed Cerebral Palsy
If your child does not “fit” into one of the above diagnoses, your doctor will consider him “mixed.” This is
quite common.
Congenital Cerebral Palsy
If your child is diagnosed with congenital Cerebral Palsy, be aware that this is not a “type” of palsy, but
rather it is a term meaning “birth defect.” In other words, your child’s doctor is saying that he developed
Cerebral Palsy during development. It is not a condition that your child inherited from you or your husband
or partner. And it is not caused by a medical error.
Erb’s Palsy
If any type of Cerebral Palsy can be attributed to a birthing accident, it is Erb’s palsy (brachial plexus palsy).
According to the National Institute of Neurological Disorders and Stroke:
Although injuries can occur at any time, many brachial plexus injuries happen when a baby’s
shoulders become impacted during delivery and the brachial plexus nerves stretch or tear.
If your baby has Erb’s palsy, he will have no muscle control in his arm; the arm will be limp and have no
feeling.
Based on the nerve area that is affected, there are four types of Erb’s Palsy:
• Avulsion — the nerve completely separates from the spine.
• Rupture — the nerve is torn throughout but not from the spine.
• Praxis/stretch — the nerve is damaged but not torn and could heal on its own.
• Neuroma — scar tissue from an injury puts pressure on the nerve.

Causes: The common cerebral palsy causes are premature delivery, malnutrition, bacterial or viral infection
at the time of birth, low birth weight, injury caused to head or brain due to a fall or accident and
hemorrhages.

Pathophysiology: Cerebral palsy is caused by an insult to the immature brain; the period during which the
insult can occur ranges from any time before birth up to the postnatal period. (Some classify cerebral palsy as
an insult to the brain before age 3 years.) After the immediate postnatal period, cerebral palsy often has an
identifiable cause (eg, hypoxic-ischemic encephalopathy), which should be noted. The cerebral insult alters
muscle tone, muscle stretch reflexes, primitive reflexes, and postural reactions. Other associated symptoms
may be involved secondary to the neurologic insult (eg, mental retardation, vision and hearing problems,
seizures), but they are not part of the definition of cerebral palsy.

The etiology of the cerebral insults includes vascular, hypoxic-ischemic, metabolic, infectious, toxic,
teratogenic, traumatic, and genetic causes. The pathogenesis of cerebral palsy involves multifactorial causes,
but much is still unknown. Different pathogenetic mechanisms of cerebral palsy have been associated with
preterm and term births. In many cases, a cause cannot be accurately determined. Some believe that a pre-
existing condition in some fetuses causes early birth and neurologic problems, as opposed to the prematurity
itself causing cerebral palsy.

Treatment: 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.