Cerebral palsy (CP)

Cerebral palsy (CP) refers to a set of conditions impacting balance, movement, and muscle tone. The term “cerebral” points to brain involvement, while “palsy” indicates muscle-related challenges or weakness.

CP originates from issues in the brain area managing muscle movement. It can occur due to underdevelopment or damage to this brain region during birth or early infancy.

Most individuals with CP are born with it, termed “congenital” CP. However, it can also develop after birth, known as “acquired” CP.

People with CP may experience varying degrees of muscle control difficulties, ranging from mild to severe, affecting mobility. Some may encounter speech impairments, intellectual disabilities, or have normal intelligence levels.

What are the Different Types of Cerebral Palsy?

CP is categorized into four main types, based on movement characteristics:

CP is categorized into four main types, based on movement characteristics:

1. Spastic cerebral palsy:
   • The most common form, characterized by stiff or tight muscles, or spasms.
   • Subtypes include:
     • Spastic diplegia: Mainly affecting leg muscles, causing walking difficulties.
     • Spastic hemiplegia: Affects one side of the body, possibly leading to limb shortening and curvature of the spine.
     • Spastic quadriplegia: Affects all limbs, torso, and facial muscles, often accompanied by seizures and speech issues.
2. Dyskinetic cerebral palsy:
   • Involves fluctuating muscle tone, resulting in uncontrolled movements.
   • Subtypes include:
     • Athetoid: Slow, writhing movements.
     • Choreoathetoid: Aimless, uncontrollable movements.
     • Dystonic: Abnormal muscle tone.
3. Ataxic cerebral palsy:
   • Rare condition causing coordination and balance problems, leading to instability and tremors.
4. Mixed CP:
   • Combines symptoms of multiple CP types, commonly spastic and dyskinetic forms.

What Causes Cerebral Palsy?

The precise causes of CP are not always identifiable, but several factors can contribute, such as:

• Brain bleeding during prenatal, birth, or postnatal stages.
• Insufficient blood flow to crucial organs.
• Seizures during or shortly after birth.
• Certain genetic conditions.
• Traumatic brain injuries.

What Are the Signs and Symptoms of CP?

CP manifests in a broad spectrum of symptoms, ranging from mild to severe. Often, delays in achieving developmental milestones related to muscle use could indicate CP. These milestones encompass actions like rolling over, sitting up, standing, and walking. However, it’s important to note that not all delays in milestones necessarily signify CP.

Symptoms may surface at birth or emerge gradually over time. In infants younger than six months, observable signs may include:

• The baby’s head falling backward when picked up from sleeping on their back.
• Stiffness or floppiness in their body.
• Extending the back and neck when cradled, almost as if pushing away.
• Stiffening and crossing of the legs, resembling a “scissor” motion when picked up.

For babies older than six months, warning signs might include:

• Inability to roll over.
• Difficulty bringing hands together or to the mouth.
• Reaching with only one hand while the other remains in a fist.

For babies older than ten months, watch for:

• Crawling by pushing off with one hand and leg while dragging the other side of the body.
• Alternative crawling methods like scooting or knee hopping.
• Inability to stand without support or crawl if older than one year.

While some babies are diagnosed with CP shortly after birth, others may not receive a diagnosis until later in childhood.

How Is Cerebral Palsy Diagnosed?

During routine check-ups, doctors monitor your baby’s developmental progress and assess if they’re achieving milestones on time. They observe your baby’s movements to determine if they fall within the normal range and inquire about any concerns you may have.

Diagnosis may be challenging, especially in younger infants, as subtle changes may be less apparent. Most children with CP are diagnosed by age two, although milder cases may not be identified until later, around four or five years old.

What Tests Are Used for Cerebral Palsy Diagnosis?

When CP is suspected, doctors may refer you to specialists such as neurologists or developmental pediatricians. These specialists conduct physical examinations, observe your child’s movements, review their medical history, and consider parental observations.

Tests to aid in diagnosis may include:

• Blood tests to rule out other conditions.
• Imaging tests such as CT scans or MRI scans to visualize the brain.
• Ultrasound for young infants, offering images of the brain without radiation exposure.
• EEG to detect seizure activity, which can be associated with CP.

Once a diagnosis is confirmed, treatment options such as physical therapy and muscle training can be explored. Although there’s no cure for CP, early intervention can help manage symptoms and improve quality of life.

Am I at Risk of Having a Child With CP?

Certain maternal conditions during pregnancy, exposure to infections, or complications during childbirth can increase the likelihood of CP in newborns. These include pregnancies with multiples, health issues like seizures or thyroid problems, or exposure to toxins or infections such as rubella, Zika, or bacterial meningitis.

Sources:

1. CDC: Cerebral Palsy (CP), “Screening and diagnosis of cerebral palsy.”
2. Gillette Children’s Specialty Healthcare: Cerebral Palsy.
3. National Institute of Neurological Disorders and Stroke: Cerebral Palsy, “Cerebral palsy: Hope through research.”
4. American Academy of Pediatrics: Cerebral Palsy.
5. March of Dimes: Cerebral Palsy, “Developmental milestones for baby.”
6. Mayo Clinic Health Library: Cerebral Palsy.
7. Nemours Foundation: “Cerebral palsy.”