Cerebral palsy is a disorder of movement, muscle tone or posture caused by damage to the developing brain before or after birth. Signs will usually develop during the first 3 years. Cerebral palsy causes impaired movement including a reduced range of motion, it may also cause problems with epilepsy, swallowing, eye muscle imbalance, blindness or deafness (see full list of symptoms below).
Symptoms can vary greatly from child to child. They are usually not obvious at birth, but will become more noticeable over the first 3 years of the child’s life.
Movement and coordination problems can include:
- Variations in muscle tone e.g. too stiff or too floppy (hypertonia), muscle shortening and muscle rigidity may worsen if not treated.
- Rigidity: stiff muscles with normal reflexes
- Ataxia: lack of muscle coordination
- Tremors, shaking hands, or involuntary movements
- Athetosis: slow, writhing movements
- Delays in reaching motor skills milestones, e.g. sitting up alone, crawling etc.
- Favouring one side of the body, e.g. reaching with only one hand, etc. Cerebral palsy may only affect ones side of the body or one limb, although it can affect the whole body.
- Difficulty walking, e.g. a crouched gait, a scissors-like gait with knees crossing, etc.
- Excessive drooling
- Problems with swallowing
- Difficulty with sucking or eating
- Delays in speech development or difficulty speaking
- Difficulty with precise motions, e.g. picking up a spoon, etc.
- Easily dislocated hips
- Sleep problems
- Learning disabilities may be common in about half of the children.
People with cerebral palsy may also have or develop:
- Abnormal touch or pain perceptions.
- Psychiatric conditions e.g. depression (depression symptoms in child) Social isolation can become a huge problem.
- The brain disorder causing cerebral palsy won’t change with time, but may contribute to other neurological conditions.
- Contracture, due to severe muscle tightening, this can inhibit bone growth and result in joint deformities, dislocation or partial dislocation.
- Malnutrition due to swallowing and feeding difficulties.
- Co-existing conditions may also be present e.g. autism, ADHD
- Lung disease and breathing disorders.
- Osteoarthritis due to pressure on joints or abnormal alignment of joints.
- Osteopenia – fractures due to low bone density, due to lack of mobility, nutritional shortcomings and antiepileptic drug use.
Please speak to your GP if you have any concerns about your child’s health or development.
There are four main types of cerebral palsy
1. Hypotonia cerebral palsy – the muscles are stiff and tight (especially when trying to move them quickly), making it difficult to move and reducing the range of movement that’s possible
2. Dyskinetic cerebral palsy – the muscles switch between stiffness and floppiness, causing random, uncontrolled body movements or spasms
3. Ataxic cerebral palsy – when a person has balance and co-ordination problems, resulting in shaky or clumsy movements and sometimes tremors
4. Mixed cerebral palsy – when a person has symptoms of more than one of the types mentioned above
Other terms you may hear used that refer tot he parts of the body affected by cerebral palsy:
- Hemiplegia – one side of the body is affected.
- Diplegia – two limbs are affected
- Monoplegia – one limb is affected
- Quadriplegia – all four limbs, usually the whole body, are affected.
The 5 Levels of Severity in Cerebral Palsy
Level I – Fully independent, can perform most physical activities normally with only slight problems in balance or coordination.
Level II – Trouble balancing on uneven surfaces, requires use of railings when climbing stairs, but can walk independently for the most part; minimal ability in running and jumping.
Level III – Requires devices such as crutches or a wheelchair; may be able to climb stairs using railing.
Level IV – Ability to walk is severely affected, most likely using wheelchair to get around.
Level V – Significant restrictions in voluntary control; cannot walk, sit or stand independently.
Cerebral palsy is caused by an abnormality or disruption in brain development but the exact trigger isn’t known.
Factors that may lead to problems include:
- Mutations in genes.
- Maternal infections, maternal blood pressure problems.
- Fetal stroke.
- Infant infections.
- Traumatic head injuries e.g. car accident, fall, etc.
- Lack of oxygen to the brain (asphyxia).
- Premature birth, multiple pregnancy, breech birth, complicated labour or delivery.
- Low birth weight.
- Rh blood type incompatibility.
If you’re concerned about your child’s development, as I’ve said please speak to your GP or the doctor at your child’s development check-up. They can refer you to specialist team to check for symptoms of cerebral palsy.
Examination and checks:
- Check your child’s medical history and development
- Check your child for symptoms of cerebral palsy
- Check for any problems during your pregnancy, during the birth or soon after the birth
- An assessment of your child’s movements and learning abilities may also be carried out.
- Brain scans may be recommended e.g. cranial ultrasound scan, MRI scan, CT scan.
- Other tests may include: EEG, EMG (electromyogram), blood tests.
Treatments for cerebral palsy
There’s currently no cure for cerebral palsy, but treatments include:
- Physiotherapy – techniques such as exercise and stretching to help maintain physical ability and hopefully improve movement problems.
- Speech therapy to help with speech, communication, and swallowing difficulties.
- Occupational therapy – to help with carrying out everyday tasks.
- Medication for muscle stiffness and other difficulties.
- Surgery, if necessary, to treat movement or growth problems.
A team of healthcare professionals will work with you to come up with a treatment plan that meets your or your child’s needs. It is very important for you and your child that you are included in this treatment plan and as your child grows that they are included also.
It is not uncommon to develop feelings of guilt and anger, pain and loss, when your child has a disabilty. We tend to blame ourselves for everything that has happened, for everything our child may be losing out on, etc. Please stop, this isn’t heping you, your mental health or your child. Your child will pick up on this. It is better to be proactive and ask for help if you are feeling like this. You aren’t alone here there are wonderful support groups available online and in person. Please join one. You can catch #ABLEHOUR every Thursday night 8pm GMT on twitter. You can read more about helping yourself as a parent of a disabled child in my blog here.