Cerebral Palsy (CP) is a group of neurological disorders that permanently affects muscle coordination and body movement. Cerebral Palsy involves non-progressive damage and impairment of motor functions to the developing brain, traditionally considered so until the age of 2 years.
The motor disorder (i.e., muscle coordination and body movement) is caused by an injury or non-progressive malformation of the brain that occurs in the developing foetus (traditionally considered so until the age of 2 years) or during infancy. It affects muscle control and tone, posture, balance, fine and gross motor skills, and oral motor functioning. Persons with Cerebral Palsy may suffer from chronic and acute pain, experienced most commonly in joints such as knees and ankles, hips, upper and lower back.
Most children with Cerebral Palsy are capable of walking, with approximately 10% requiring an aid to walk, and 30% using a wheelchair. Further, 1 in 5 people with Cerebral Palsy have difficulties in communication.
Cerebral Palsy can be broadly classified into 3 categories based on the part of the body it affects, the type of movement it affects and the severity of the effects.
Some people display symptoms that do not correspond to any single aforementioned type of Cerebral Palsy. The most common type of Mixed Cerebral Palsy is spastic-dyskinetic, wherein children may have some muscles that are too tight, whilst others that are too relaxed.
Cerebral Palsy is caused by damage or abnormal development of the cerebral cortex, the part of the brain that is responsible for directing muscle movement. This may occur during pregnancy, childbirth or postpartum. Cerebral Palsy can be congenital (from birth) or acquired.
Various types of brain damage has been observed in persons with Cerebral Palsy:
The signs and symptoms of Cerebral Palsy appear early on during infancy even though specific diagnosis may be delayed until the child is two years old or later. Children with Cerebral Palsy often display developmental delays, marked by slow progress in achieving developmental milestones such as learning to walk, sit or crawl.
The signs and symptoms of Cerebral Palsy can vary from one child to the next. Even in one individual, the symptoms may even change over time. Cerebral Palsy may also result in a certain level of Intellectual Disability among some people. Children with Cerebral Palsy may exhibit an impaired ability to handle objects during everyday activities, along with abnormal physical perception and seizures. In addition, persons with Cerebral Palsy may experience hearing or vision loss, as well as issues in communication.
Further, persons with Cerebral Palsy display a wide variety of symptoms including:
However, it should be noted that not all children who display these signs and symptoms have Cerebral Palsy.
Cerebral Palsy is mostly diagnosed in children during the first 2 years of their life. However, in certain situations where a child exhibits mild symptoms of Cerebral Palsy, it may not be easy for a doctor to reach a reliable diagnosis before the age of 4 – 5 years.
Techniques that enable doctors to study the brain including neuro-imaging methods such as magnetic resonance imaging (MRI), cranial ultrasound, computed tomography (CT) scan, electro-myogram (EMG) and electro-encephalogram (EEG), can be used to diagnose Cerebral Palsy.
Unfortunately, there is no single test available to confirm Cerebral Palsy definitively. Lab tests can recognise other disorders that cause similar symptoms to those related to Cerebral Palsy. Even though the symptoms can change over a period of time, Cerebral Palsy is non-progressive in nature. Doctors may require regular visits and a series of tests to monitor and evaluate the child’s development and motor skills. This would also help the doctor to rule out other conditions that result in symptoms similar to Cerebral Palsy.
It is recommended to seek expert consultation from:
A diagnosis of Cerebral Palsy in a child can be overwhelming. You may find it helpful to hear from other parents – for example, through Parent Support Groups. Learning from their experiences can be a reassuring way to adapt to the diagnosis.
Once Cerebral Palsy is diagnosed and the type is determined, health care professionals can design an appropriate treatment plan to enhance and sustain the capabilities of a child with Cerebral Palsy. A customised treatment plan to tackle the fundamental issues that affect the child’s quality of life is important. Therapeutic options such as physical therapy, occupational therapy, recreational therapy and language and speech therapy are recommended for children with Cerebral Palsy.
Oral medications such as diazepam, baclofen, dantrolene sodium, and tizanidine are often used as the first line of treatment to help relax contracted, overactive or stiff muscles.
In case stiffness and spasticity are severe enough to stifle mobility or make it painful to move, an orthopedic surgery may be recommended. Orthopedic surgeries may also be undertaken to improve the gait or the appearance of how persons with Cerebral Palsy walk.
If the more conservative therapies and treatments fail to relieve a child with Cerebral Palsy from chronic pain and severe spasticity, selective dorsal rhizotomy, a surgical procedure that involves cutting the nerves is recommended.
Given the right support, a child with Cerebral Palsy can learn to lead a fulfilling life and make a valuable contribution to society. As a parent of a child with Cerebral Palsy, you play an important role in helping your child reach his/her full potential. There are a number of interventions you can make at home, but you may also need to seek out professional advice and specialist support.
What is the importance of early childhood intervention for a child diagnosed with Cerebral Palsy?
Early detection and intervention is extremely important. It helps to ensure that children with Cerebral Palsy function better and are successfully integrated into society. As Cerebral Palsy may also be the consequence of a genetic disorder, the parents can seek genetic counseling. Early diagnosis also means that plans for treatment of congenital malformations, and other medical conditions, along with developmental, educational, and vocational services can be made in time. Early intervention consists of a program of therapies, exercises and activities, designed to specifically help your child. These can be carried out at home, as well as through specialist interventions.
What kind of care can I provide at home?
The best place for your child to grow is in his/her own home surrounded by family, where he/she can be nurtured with appropriate and non-judgmental stimulation. As a parent of a child with Cerebral Palsy, you play an important role in helping your child reach their full potential. You and your child will have many accomplishments.
What interventions are made for a child diagnosed with Cerebral Palsy?
Different kinds of therapy can help children with Cerebral Palsy to achieve their maximum potential in growth and development. As soon as it is diagnosed, a child can begin therapy for movement, and other areas that need help, such as learning, speech, hearing, and social and emotional development. Depending on his/her symptoms, a person may need any of the following:
Should I enrol my child in a special education program?
Your child has a legal right to education. These laws also protect your rights as a parent to be fully informed about or to challenge educational decisions concerning your child.
Whether to send your child to a mainstream or special school is a personal decision, based on your child’s special education needs and your personal preferences.
Whatever you decide, it is important to be involved with your child’s education. If your child is in a mainstream school, he or she may need an adapted curriculum and may sometimes be required to attend special classes.
You should try and enrol your child in classes with other children of the same age. Think of ways you can stimulate your child’s thinking skills without making tasks too difficult. Remember, it is okay for your child to sometimes fail. Keeping the child’s positive image of himself/herself alive is essential, and will help him/her to succeed in life.
Adolescents with Cerebral Palsy have the same needs as everyone else. Cerebral Palsy is a non-progressive condition, but due to its neurological nature, adolescents may find it difficult to apply skills from one situation to another. The adolescents must be taught appropriate inputs, such as how to adapt their movement and understand and control their growing adult body. This will enable them to continue developing skills throughout adult life.
You can help your child develop healthy relationships by teaching appropriate social skills and behaviour. Peer acceptance and self-esteem are affected by how well your adolescent child addresses these issues. You may also want to start planning your child’s future work and living arrangements.
Here are some tips:
Many adults with Cerebral Palsy function well in society. They often have regular jobs and take part in community activities. Some might need assistance in caring for themselves. As parents, you should encourage his/her interests, such as in art, theatre, music or literature.
Many people who have Cerebral Palsy live independently as adults or in group homes/apartments with support services. But most group homes and community centres require a basic level of self-sufficiency, such as being able to eat, dress, and bathe independently. Occupational therapists can assist in these transitions.
An adult with Cerebral Palsy benefits greatly from working outside the home and having social activities. Unfortunately, prejudice against persons with Cerebral Palsy often bars them from the mainstream workplaces. Employers often make assumptions about what a person with challenges can and cannot do, when in reality they have a wide range of abilities. Vocational training helps many young adults learn how to work in many settings, such as stores, restaurants, and hotels. Day-to-day challenges are likely to increase as an adult with Cerebral Palsy ages, with some individuals being able to continue working by adjusting work schedules, using assistive equipment, or resting more frequently.
As people with Cerebral Palsy grow older, they face a new set of challenges including conditions such as depression and hypertension. It is important that both caregivers and providers be aware of the increased chance of these conditions, and screen appropriately and regularly for them.
For more information, visit the section on Persons with Challenges.
There is no cure for Cerebral Palsy, but interventions, including treatment, therapy, special equipment, and, in some cases, surgery can help children with Cerebral Palsy.
With the exception of a few cases of severe Cerebral Palsy, most children with the condition are expected to live well into adulthood.
Some conditions that accompany Cerebral Palsy are seizures, problems with vision, hearing or speech, changes in the spine, joint problems or Intellectual Disability. Because of the Cerebral Palsy, they may also have hypertension, incontinence, bladder dysfunction and difficulty in swallowing.
Persons with Cerebral Palsy are three to four times more likely to have depression. The level of emotional support, and how one copes with the stress can both have a significant impact on his/her mental health.
We would like to extend our sincere gratitude to Dr. Sudha Sreedharan who reviewed this content and whose suggestions and guidance proved immensely valuable.
The following references were used to compile the above information: http://yourcpf.org/what-is-cp/  http://yourcpf.org/cause-and-timing/  http://yourcpf.org/what-is-cp/