Cerebral Palsy

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Introduction

Cerebral Palsy

Cerebral palsy is the name for a group of lifelong conditions that affect movement and co-ordination, caused by a problem with the brain that occurs before, during or soon after birth.

This page covers:

Symptoms

When to get medical advice

Causes

Treatments

Outlook

Help and support

Symptoms of cerebral palsy

The symptoms of cerebral palsy aren't usually obvious just after a baby is born. They normally become noticeable during the first two or three years of a child's life.

Symptoms can include:

  • delays in reaching development milestones - for example, not sitting by eight months or not walking by 18 months
  • seeming too stiff or too floppy
  • weak arms or legs
  • fidgety, jerky or clumsy movements
  • random, uncontrolled movements
  • walking on tip-toes
  • a range of other problems - such as swallowing difficulties, speaking problems, vision problems and learning disabilities

The severity of symptoms can vary significantly. Some people only have minor problems, while others may be severely disabled.

Read more about the symptoms of cerebral palsy.

When to get medical advice

Speak to your health visitor or GP if you have any concerns about your child's health or development.

Symptoms like those of cerebral palsy can have a number of different causes and aren't necessarily a sign of anything serious.

Your child may be referred to specialists in child development who can do some checks and tests to see if there is a problem.

Read more about tests for cerebral palsy.

Causes of cerebral palsy

Cerebral palsy can occur if a baby's brain doesn't develop normally while in the womb, or is damaged during or soon after birth.

Causes of cerebral palsy include:

  • bleeding in the baby's brain or reduced blood and oxygen supply to their brain
  • an infection caught by the mother during pregnancy
  • the brain temporarily not getting enough oxygen (asphyxiation) during a difficult birth
  • meningitis
  • serious head injury

But in many cases, the exact cause isn't clear. 

Read more about the causes of cerebral palsy.

Treatments for cerebral palsy

There's currently no cure for cerebral palsy, but treatments are available to help people with the condition have a normal and independent a life as possible.

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 and communication, and swallowing difficulties
  • occupational therapy - where a therapist identifies problems that you or your child have carrying out everyday tasks, and suggests ways to make these easier
  • medication for muscle stiffness and other difficulties
  • in some cases, surgery 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.

Read more about treatments for cerebral palsy.

Outlook for cerebral palsy

Cerebral palsy affects each person differently and it may be very difficult to predict what the outlook will be for you or your child.

Generally speaking:

  • life expectancy is usually unaffected, but can be reduced in severe cases
  • the condition may limit your child's activities and independence, although many people go on to have full, independent lives
  • many children go to a mainstream school, but some may have special educational needs and benefit from attending a special school
  • the original problem with the brain doesn't get worse over time, but the condition can put a lot of strain on the body and cause problems such as painful joints in later life
  • the daily challenges of living with cerebral palsy can be difficult to cope with, which can lead to problems such as depression in some people

Speak to your care team about the likely effects of cerebral palsy on you or your child.

Help and support

If you or your child have been diagnosed with cerebral palsy, you may find it useful to contact a support group for information and advice.

Scope is the main UK charity for people with cerebral palsy and their families. They offer:

You may also want to ask your care team if they can provide information about support groups in your local area.

Symptoms

Symptoms

The symptoms of cerebral palsy aren't usually obvious just after a baby is born. They normally become noticeable during the first two or three years of a child's life.

Speak to your health visitor or GP if you have any concerns about your child's health or development.

Movement and development problems

The main symptoms of cerebral palsy are problems with movement, co-ordination and development.

Possible signs in a child include:

  • delays in reaching development milestones - for example, not sitting by eight months or not walking by 18 months
  • seeming too stiff or too floppy (hypotonia)
  • weak arms or legs
  • fidgety, jerky or clumsy movements
  • random, uncontrolled movements
  • muscle spasms
  • shaking hands (tremors)
  • walking on tip-toes

The severity of symptoms varies significantly from child to child.

The parts of the body that are affected can also vary. Some cases only affect one side of the body, some mainly affect the legs, and some affect the whole body.

Other symptoms

People with cerebral palsy can also have a range of other problems, including:

Types of cerebral palsy

Your doctors may refer to your or your child's condition as a particular type of cerebral palsy, based on the symptoms you or your child has.

There are four main types of cerebral palsy:

  • spastic 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
  • dyskinetic cerebral palsy - the muscles switch between stiffness and floppiness, causing random, uncontrolled body movements or spasms
  • ataxic cerebral palsy - when a person has balance and co-ordination problems, resulting in shaky or clumsy movements and sometimes tremors
  • mixed cerebral palsy - when a person has symptoms of more than one of the types mentioned above

You may also hear terms such as hemiplegia or diplegia. These refer to the parts of the body affected by cerebral palsy.

Hemiplegia means one side of the body is affected, diplegia is where two limbs are affected, monoplegia where one limb is affected and quadriplegia means all four limbs (and usually the whole body) are affected.

Causes

Causes

Cerebral palsy is caused by a problem with the brain that occurs before, during or soon after birth.

It can be the result of the brain either being damaged or not developing normally, although the exact cause isn't always clear.

Problems before birth

Cerebral palsy is most often due to a problem that affects the development of a baby's brain while it's growing in the womb.

These include:

  • periventricular leukomalacia (PVL) - damage to part of the brain called white matter, possibly as a result of a reduction in the baby's blood or oxygen supply
  • an infection caught by the mother - such as cytomegalovirus, rubellachickenpox or toxoplasmosis
  • stroke in the baby - this is where there's bleeding in the baby's brain or the blood supply to their brain is cut off
  • an injury to the unborn baby's head

Problems during or after birth

Cerebral palsy is also sometimes caused by damage to a baby's brain during or shortly after birth.

For example, it can be due to:

  • the brain temporarily not getting enough oxygen (asphyxiation) during a difficult birth
  • an infection of the brain, such as meningitis
  • serious head injury
  • choking or nearly drowning, resulting in the brain not getting enough oxygen
  • a very low blood sugar level
  • a stroke

Increased risk

There are some things that can increase a baby's risk of being born with cerebral palsy.

These include:

  • being born prematurely (before the 37th week of pregnancy) - babies born at 32 weeks or earlier are at a particularly high risk
  • a low birth weight
  • a twin or multiple pregnancy
  • the mother being 35 years of age or older
  • the mother having unusually low blood pressure or high blood pressure

Your doctor may recommend that your baby has regular check-ups to look for symptoms of cerebral palsy for the first two years of their life if there's an increased risk they could have cerebral palsy.

Diagnosis

Diagnosis

If you're concerned about your child's development, speak to your health visitor or GP. If needed, they can refer you to a specialist team who can check for any problems.

Several tests may be done to look for cerebral palsy or other possible causes of your child's symptoms.

But it may not be possible to make a definitive diagnosis for several months or years, as some symptoms aren't obvious until a child is a few years old.

Examination and checks

First a specialist may:

  • ask about your child's medical history and development
  • check your child for typical symptoms of cerebral palsy
  • ask if there were 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

A brain scan may be recommended to look for damage associated with cerebral palsy.

One or more of the following scans may be recommended:

  • a cranial ultrasound scan - where a small handheld device that sends out sound waves is moved over the top of your child's head to create an image of their brain
  • MRI scan - a scanner that uses magnetic fields and radio waves to produce a more detailed image of the brain
  • CT scan - a scanner that takes several X-ray pictures to create a detailed image of the brain

Other tests

Several other tests may also be done to help confirm cerebral palsy and rule out other conditions.

These may include:

  • an electroencephalogram (EEG) - where small pads are placed on the scalp to monitor brain activity and check for signs of epilepsy
  • an electromyogram (EMG) - where tiny needles are gently inserted into the muscles and nerves to check how well they're working
  • blood tests to check for problems that can cause similar symptoms to cerebral palsy

Treatment

Treatment

There's currently no cure for cerebral palsy, but treatments are available to help people with the condition have a normal and independent a life as possible.

Children and adults with the condition are cared for by a team of healthcare professionals, who will work with you to come up with a care plan.

This plan will be continually reassessed as the person's needs change.

There are a wide range of treatments available. This page has information about:

Physiotherapy

Speech therapy

Occupational therapy

Medication

Treatments for feeding problems

Treatments for drooling

Surgery

Physiotherapy

Physiotherapy is a treatment that involves techniques such as exercise and stretching to help maintain and hopefully improve movement. It's one of the most important treatments for cerebral palsy.

The main goals of physiotherapy are to:

  • encourage movement
  • increase strength and stop muscles becoming weak
  • stop muscles shortening and losing their range of movement (called a contracture), which can be painful and affect how the bones and muscles grow

A physiotherapist will teach you some exercises to strengthen and stretch your child's muscles. You can do these with your child every day.

They may also provide walking aids (such as a walking frame or walking sticks) if needed, and/or special arm or leg braces (called orthoses) to support the limbs.

Speech therapy

Speech therapy can help children who have trouble communicating by allowing them to practise their speech with exercises, or teaching them an alternative method of communication, such as sign language or pictures.

A speech therapist may also be able to provide special equipment to help your child communicate, such as a computer connected to a machine that generates speech.

Younger children may be given a device similar to a laptop that's covered with symbols of everyday objects and activities. The child then presses a combination of symbols to communicate.

Watch a video about speech and language therapy for more information.

Occupational therapy

Occupational therapy involves a therapist identifying problems that you or your child have carrying out everyday tasks.

They can advise you on the best way to carry out activities that require complex movements, such as going to the toilet or getting dressed.

Occupational therapy can be extremely useful in boosting your child's self-esteem and independence, especially as they get older.

Medication

There are medications that can help relieve several of the symptoms of cerebral palsy.

These include:

  • medications for muscle stiffness - such as diazepam or baclofen - that can be taken as tablets or liquids (baclofen can also sometimes be given using a small pump inserted under the skin, which allows the medicine to trickle into the area inside the spine)
  • botulinum toxin injections - injections that relax certain muscles or groups of muscles for a few months at a time
  • a medicine called melatonin for sleeping difficulties
  • anti-seizure medication for epilepsy
  • laxatives for constipation
  • painkillers for any pain or discomfort
  • medication to reduce drooling - see treatments for drooling below

It's unlikely you or your child will need to take all of these medicines.

Speak to your care team if you have any questions about a medicine that's been offered, including why they recommend it and what side effects it might cause.

Treatments for feeding problems

Some people with cerebral palsy have difficulty swallowing food.

This can be serious because it can mean they're at risk of choking or developing a chest infection as a result of accidentally inhaling food. Long-lasting feeding difficulties could also lead to malnutrition.

Treatments for swallowing problems include:

  • swallowing techniques and exercises taught by a speech therapist
  • making dietary changes, such as eating soft or liquid foods
  • a feeding tube, in more severe cases

A feeding tube can either be passed into the stomach through the nose or directly into the stomach through the skin of the tummy.

Read more about treatments for swallowing difficulties.

Treatments for drooling

Drooling problems are common in people with cerebral palsy.

While not usually serious, the excess saliva can irritate the skin around the mouth, which may increase the risk of the skin becoming infected.

Treatments that can help with excessive drooling include:

  • techniques and exercises taught by a speech therapist
  • anticholinergic medication - tablets or skin patches that reduce how much saliva is produced
  • botulinum toxin injections into the saliva glands - injections that can help relieve drooling problems for a few months at a time
  • surgery to redirect the saliva glands so that saliva runs towards the back of the mouth, rather than the front

Surgery

Some people with cerebral palsy may need surgery to help with movement difficulties or other problems.

Surgery can be carried out to:

  • restore movement to parts of the body if they are restricted by a tight muscle or piece of connective tissue
  • repair a hip joint that has popped out (dislocated)
  • correct curvature of the spine (scoliosis) - read more about surgery for scoliosis
  • treat problems with bladder control (urinary incontinence) - read more about surgery for urinary incontinence
  • make walking easier by reducing stiffness in the legs - this operation is known as a selective dorsal rhizotomy (SDR)

If your care team suggests surgery for you or your child, speak to them about what results you can expect, what the risks are and what the recovery period might be like.

For some types of surgery it can take months or even years for the full benefits to be achieved and extensive physiotherapy may be needed to help aid recovery.

The National Institute for Health and Care Excellence (NICE) has more information on selective dorsal rhizotomy for spasticity in cerebral palsy (PDF, 59kb).