Cerebral palsy (CP) is a condition that affects a person’s ability to move, maintain their balance and posture, and stay attentive. CP is caused by abnormal development of the brain, often before birth. It is the most common type of movement disability in childhood. Cerebral refers to the brain, while palsy refers to the muscles’ weakness or problems using them. Usually appearing in early childhood, symptoms include exaggerated reflexes, floppy or rigid limbs, and involuntary movements. If a person with such symptoms does not respond well to physical therapy or other therapeutic treatments, they might need surgery.

A person’s symptoms of CP can range from mild to severe. Severe CP may include the need for extensive physical therapy and mobility equipment in order to walk, while someone with mild CP might walk without any difficulty. Typically, the severity of these symptoms does not increase over time. People also might suffer from intellectual disability, seizures, vision or hearing problems, changes to their spine (such as scoliosis), or joint problems (such as contractures).

For the majority of children, life expectancy is between 30 and 70 years. Those with the longest life expectancies will likely have better medical care, more mobility and adaptive equipment and greater autonomy. There is no cure for cerebral palsy, and it lasts a lifetime.

Cerebral palsy is a condition determined by the extent and location of a person’s (typically child) abnormalities. Doctors classify cerebral palsy into one of three categories:

· Spastic (having stiff muscles),

· Athetoid (having convulsive movements),

· Ataxic (having spells of dizziness) plus any other symptoms, such as weakness or paralysis. For example, hemiparesis means that one side of the body is weakened while quadriplegia means all four limbs are affected.

Spastic cerebral palsy, the most common of the disorders, causes people to have stiff muscles and uncoordinated movements.

Spastic hemiplegia/hemiparesis is a condition that typically affects the arm and hand of one side of the body, but can also include the leg. Children are often delayed in walking due to tight heel tendons, and the leg and arm on the affected side are usually shorter and thinner. Some children may develop an abnormal curvature of their spine — scoliosis. Children can sometimes need braces or a walker. A child with spastic hemiplegia may have seizures or speech delays, but typically has normal intelligence.

The most serious form of cerebral palsy is spastic quadriplegia/quadriparesis. It will typically have a moderate-to-severe intellectual disability and is caused by widespread brain damage or significant malformations. Children will often have severe stiffness in the limbs but a floppy neck. They will usually be unable to walk. Speaking and being understood can be difficult because of the frequent inability to coordinate movement around the vocal cords. Seizures are often hard to control as they might occur very frequently.

Athetoid (Dyskinetic) cerebral palsy is a disorder found in children, characterized by slow and uncontrollable writhing or jerky movements of the muscles. Hyperactivity in the facial muscles can make some children grimace. They find it difficult to sit up straight, walk, talk, or control their breathing. However, intelligence is seldom impaired.

Ataxic cerebral palsy is a disorder that affects equilibrium and depth perception. Children with ataxic CP often have poor coordination and walk unsteadily while crossing their feet. They also have difficulty with quick or precise movements, such as writing or buttoning a shirt, or they struggle to control voluntary movements like reaching for a book.

Mixed types of cerebral palsy refer to symptoms that don’t correspond to any single type of CP but are a mix of various symptoms. For example, a child with mixed cerebral palsy may have some muscles that are too tight and others that are too relaxed. This creates a mix of stiffness and floppiness.

Some of the other conditions that are associated with cerebral palsy are muscular dystrophy, spina bifida, epilepsy, and intellectual disabilities.

As many as four out of five children with CP have impaired hearing, more so than the general population. Some experience partial or complete hearing loss, often because of jaundice or lack of oxygen to the developing brain during pregnancy.

Poor communication skills make it difficult to communicate effectively, which can often be interpreted as a sign of cognitive impairment. This can be very frustrating for children with CP who have average intelligence or higher, especially since many of them have difficulty with walking and other physical abilities.

As a complication of cerebral palsy, some people may experience incontinence (leaking urine). This can be caused by a lack of control over the muscles that maintain urinary bladder closure.

People with CP experience abnormal sensations, feelings, or behaviors. Some individuals report experiencing pain or difficulty feeling simple sensations like touch. Children with CP may face difficulties with spatial and auditory information.

People with CP often have a higher risk of heart and lung disease, pneumonia (often from inhaling bits of food into the lungs), and infection.

Malnutrition can be extremely harmful for individuals with CP, especially young children. Swallowing or feeding difficulties may make it difficult to acquire proper nutrition and maintain weight.

Inactive Children with Cerebral Palsy. Restrictions from movement impairments make it difficult for children with CP to participate in sports and other activities that are strenuous enough to develop and maintain strength. Inactive adults who experience disability see an increase in the severity of their disease as well as decreased overall health and wellness.

While cerebral palsy is typically diagnosed by a physician, here are some common signs. Although it’s rare for a child to be diagnosed with cerebral palsy until the age of four or five, if a child’s symptoms are mild and don’t present until later, it can be hard to diagnose them.

Doctors will order a series of medical tests to evaluate the child’s motor skills. During regular visits, the doctor will monitor their development, growth, muscle tone, age-appropriate motor control and coordination, in order to rule out other disorders that could cause similar symptoms. CP is not progressive; if a child is continuously losing motor skills, the problem more likely has something to do with a genetic or muscle disease, metabolism disorder or tumors in the nervous system — but there are exceptions to every rule!

It’s important to know that in some cases, CP can be caused by other conditions that also have similar symptoms. Lab tests are required to identify these additional causes and make a diagnosis.

Neuroimaging techniques, such as an MRI, that allow doctors to look into the brain can detect abnormalities that could mean a treatable movement disorder. Neuroimaging methods include:

A type of ultrasound used for young babies with high-risk conditions is called cranial ultrasound. It is the least intrusive imaging technique for infants, but it cannot capture as much as computed tomography or magnetic resonance imaging. Computed tomography uses x-rays to create images that show the brain’s structure and areas of damage.

MRI uses a computer, a magnetic field, and radio waves to create anatomical pictures of the brain’s tissues and structure. MRI can show the location and type of damage and offers finer levels of detail than CT scans.

Using a set of electrodes to detect electrical activity in the brain, an electroencephalogram (EEG) may show changes that could help identify epilepsy.

Metabolic disorders can take a long time to diagnose, because they sometimes do not present with symptoms. For example, some metabolic disorders can cause brain abnormalities or malformations that will show up on an MRI.

Other factors can also cause symptoms that resemble CP or can contribute to the development of CP. For example, coagulation disorders (which cause excessive or unclotting blood) can lead to prenatal or perinatal strokes that harm the brain and produce symptoms of CP, most commonly hemiparetic CP. Referrals to specialists such as a child neurologist, developmental pediatrician, ophthalmologist, or otologist often aid in a more accurate diagnosis and help doctors develop an appropriate treatment plan.

Though many children go on to enjoy near-normal adult lives if their disabilities are properly managed, the best chance does not occur without early intervention and treatment.

There is not one therapy that works with every individual with cerebral palsy. Once the diagnosis is made, and the type of CP is determined, a team of health care professionals will work with the child and his or her parents to identify specific impairments and needs, and then develop an appropriate plan to address the core disabilities that affect quality of life.

Physical therapy is usually necessary when diagnosed with CP. Specific exercises, such as strength training programs, and specific activities can maintain or improve muscle strength, balance and motor skills, prevent contractures and use orthotic devices to help with mobility.

Occupational therapists focus on optimizing upper body function, improving posture, and making the most of a child’s mobility. They work with patients to find new ways to complete everyday tasks such as dressing, going to school, and participating in day-to-day activities.

Recreational therapy encourages an individual to participate in physical activity as a way to give back to the community. Parents of children who participate in recreational therapy usually notice increased levels of confidence, speech fluency, and emotional well-being.

Speech and language therapy can help improve a child’s ability to speak, swallow food more easily, and learn new ways to communicate — with sign language or a communication board.

Some medications, like seizure drugs, can have a negative effect on dental health. Because of this, children with CP are more likely to develop gum disease and cavities. Be sure to get your kids in for dental cleanings regularly, and make sure they brush their teeth well after every meal.

Drugs such as diazepam, baclofen, dantrolene sodium and tizanidine are usually the first line of treatment for stiff muscles or spasticity. Unfortunately, some drugs can cause some side effects that may include drowsiness, changes in blood pressure or risk of liver damage. Drugs intended as mild muscle relaxants are most appropriate for children, who need only mild reduction in muscle tone or have widespread spasticity.

Botulinum toxin injection around the spine has become a common treatment for spastic movement disorders in children, including cerebral palsy. When botox is injected, it relaxes contracted muscles by inhibiting nerve cells from over-stimulating muscle. The relaxing effect of a BT-A lasts about three months. Botox injections may cause some minor discomfort or flu-like symptoms and can be mildly painful to inject, but these side effects wear off quickly. BT-A injections are most effective when combined with a stretching program including physical therapy and splinting; this is because they work best on children who have some control over their motor movements and have a limited number of muscles to treat.

Intrathecal baclofen therapy is the process of implanting a pump to deliver baclofen, a muscle relaxant, into the fluid surrounding the spinal cord. Baclofen affects nerve cells in the spinal cord, which then reduces muscle spasticity throughout the body. The pump can be adjusted if muscle tone is worse at certain times of course or night. Intrathecal baclofen pumps are most appropriate for individuals with chronic and severe stiffness across their bodies.

Assistive devices such as computer software, voice synthesizers, and picture books can greatly help some people with CP communicate more effectively. Other types of devices throughout the home or workplace can help these individuals adapt to daily activities.

Orthotic devices help compensate for muscle imbalance and increase mobility. These devices, such as braces and splints, use external force to correct muscle abnormalities and improve functionality, including sitting or walking. Other orthotics help stretch muscles or re-position joints. Braces, wedges, special chairs, and other devices can help people sit more comfortably and perform daily tasks more easily. Rolling walkers, wheelchairs, and powered scooters can be of great assistance to those who need mobility support in order to complete their day-to-day activities. Vision aids include glasses and large print books; some individuals with CP may require surgery to correct their vision problems while others may use hearing amplifiers to better hear conversation from a smartphone or tablet.

Many children and adolescents with CP use some form of complementary or alternative medicine. Clinical trials in some of these therapies have been inconclusive or showed no benefit, and the therapies have not been accepted in mainstream clinical practice. Although there are anecdotal reports of some benefit in some children with CP, these therapies have not been approved by the U.S. Food and Drug Administration for treating CP. These therapies include hyperbaric oxygen therapy, certain types of electrical stimulation, helping children complete certain motions multiple times a day, and specialized learning strategies. Additional dietary supplements should also be discussed with the child’s doctor because they may interact with other products or medications that the child already takes or have unwanted side effects.

Individuals with intellectual disability and CP can be diagnosed as well, which calls for a different approach to prescribing drugs to treat epileptic seizures. Doctors often prescribe medications based on the type of seizures an individual experiences, because no one drug controls every type. Some people will need a combination of two or more types of medication in order to achieve good seizure control.

Children with CP who are unable to walk and have poor bone density are more likely to get their bones broken. As a result, doctors may prescribe a family of drugs called Bisphosphonates for these children that is typically used as an anti-aging medication.

Pain can be a problem for people with CP because of their spastic muscles and the stress and strain on different parts of the body. Some individuals may also have frequent and irregular muscle spasms that cannot be predicted or medicated in advance. Diazepam can reduce the pain associated with muscle spasms, and gabapentin has been used successfully to decrease the severity and frequency of painful spasms. Botulinum toxin injections have also been shown to decrease spasticity and pain. Some children and adults are able to lessen pain by using noninvasive and drug-free interventions such as distraction, relaxation training, biofeedback, or therapeutic massage.

There are 74 studies beginning or on-going regarding the treatment of CP according to ClinicalTrials.gov as of 12/01/2022. Many of these studies involve behavioral and physical therapy. While others are focused on the uses of devices to aid the individual patient. There are only a few studies that involve actual novel drug treatment.

The U.S. is currently looking into the safety and tolerability of umbilical cord blood stem cell therapy in children with cerebral palsy. Large-scale trials are needed to determine if stem cells are safe and effective, but evidence has shown they can help repair damaged nerves and brain tissues. As scientists continue their research, they hope that it might be able to grow new neurons or nerve fibers, or improve the function of existing ones.

Orthopedic surgery is often used to correct muscle paralysis and other gait abnormalities in people with cerebral palsy. Orthopedic surgeons can lengthen muscles and tendons that are too short, improving mobility and easing pain. Children might need surgery even if it will have negative consequences on their future development because their disability currently limits the way they walk. Orthopedic surgeries may be performed at staggered stages of a child’s life; for example, when a child reaches 3–6 years of age, researchers recommend surgical procedures that lengthen the femur and tibia. Before orthopedic surgery, surgeons may request that a quantitative gait analysis be completed.

There are nerve blockages called selective dorsal rhizotomy (SDR) or dorsal rhizotomy, which help decrease chronic pain. The procedure involves cutting a few nerves at the base of the spinal cord to decrease muscle spasms. SDR is most often used to relax muscles and reduce chronic pain in one or both of the lower or upper limbs. It’s sometimes used to correct bladder continence problems. Potential side effects may include sensory loss and numbness in areas once supplied by the severed nerves.

Assistive devices such as software, voice synthesizers and picture books can help some people with Cerebral Palsy communicate more effectively. Alternatives like other types of assistive devices throughout the home or workplace can make daily activities more accessible for CP sufferers.

Orthotic devices can help with muscle imbalances and limited mobility. These devices include braces or splints and are used to correct muscle abnormalities and improve function, including sitting or walking. Other types of orthotic devices may help stretch muscles or re-position joints. Devices like wheelchair ramps, standing aids, and rolling walkers can make it easier for individuals with limited mobility to complete their daily activities. Vision aids include glasses and large print books; some people with CP may need surgery to correct their vision problems, while others may use hearing amplifiers in order to hear what is being said on mobile devices.

While CP sadly touches far too many families every day, there are exponentially more friends and family who are impacted by it. This is why raising awareness of the condition is so important: spreading the word about this condition will help break down barriers, increase research, and hopefully lead to a better world for children with CP.

Beyond knowledge or highlighting a relationship with a child, “Cerebral Palsy Awareness” includes promoting causes and knowledge about CP in a way that improves dialogue and spreads awareness of this condition. Different ways of increasing Cerebral Palsy awareness include promoting CP acceptance through awareness and perception corrections as well as through simple behavior correction. Disability etiquette and education are powerful tools for realigning perception, increasing CP awareness, and correcting behaviors.

In addition, research continues to identify the origins of cerebral palsy and what can be done on a genetic level to mitigate the disorders, even before birth.