Cerebral Palsy in Children

WHAT IS CEREBRAL PALSY?

Cerebral Palsy is a term used to cover several neurological conditions.

These conditions are caused beforeduring or shortly after birth as a result of injury to the brain due to any of the following reasons:Limited or interrupted oxygen supply to the brainA bleed within the baby’s brain
A premature or difficult birth processThe mother catching an infection whilst pregnantChanges in genes which affect the development of the brain 
Cerebral Palsy can affect muscle control, coordination, and tone, reflexes, posture and balance. Often a person with Cerebral Palsy will display signs of the condition, but the effects can vary greatly from person to person
‘Cerebral Palsy’ comes from the Latin words ‘Cerebrum’ and ‘Paralysis’

WHAT ARE THE DIFFERENT TYPES OF CEREBRAL PALSY?

The NHS describes three different categories of Cerebral Palsy, it is also possible to have a combination of categories which is referred to as ‘Mixed Cerebral Palsy’.

Spastic Cerebral Palsy
This affects muscle stiffness or weakness. Click here to learn more.
Athetoid Cerebral Palsy
This affects muscle tone, causing involuntary spasms. Click here to learn more.
Ataxic Cerebral Palsy
This affects balance and coordination. Click here to learn more.

The affect Cerebral Palsy has on individuals ranges from the very mild, to more severe cases that can make it difficult for people to control their limbs.

Spastic Cerebral Palsy

Spastic cerebral palsy is the most common form of the disorder, affecting around 70% to 80% of all people diagnosed. This form of cerebral palsy mainly affects the muscle groups, but may cause associated disorders as well. [1]

Spastic cerebral palsy occurs as a result of brain damage, usually before or during birth, or sometimes within the first years of a child’s life. It’s a disorder that affects coordination and control of motor function. This causes the child to be delayed in reaching normal developmental milestones, and that is when it becomes more evident. [2]

Muscles need enough tone in them to maintain correct posture, to enable standing and walking, and to maintain speed and flexibility. Motor nerve fibers, via the spinal cord, interact with the muscles to help control how they move.

For someone with spastic cerebral palsy, brain damage affects muscle control, coordination, and movement, mainly in the arms and legs. In turn, this influences the way the spinal cord and nerves react, which then causes the muscles to become tense, and spastic. [3]

Children born with spastic cerebral palsy do not usually have limb deformities at birth, but over time these may develop, due to muscle tenseness and stretching limitations.

Spastic cerebral palsy may be classified as quadriplegic, diplegic, or hemiplegic, according to how and where it affects the body.

Spastic Cerebral Palsy Symptoms

Spastic cerebral palsy, also known as hypertonic cerebral palsy, is characterized by hypertonia, meaning increased muscle tone, and leads to stiff, and sometimes painful limbs. [4]

Symptoms may include:

  • Involuntary limb movements
  • Continuous muscle spasms and contractions
  • Abnormal walking, marked by knees crossing in a scissor-like movement
  • Joint contractures
  • Limited stretching abilities
  • Flexion at the elbows, wrists, and fingers
  • Poor coordination and control of muscle movements

These symptoms can make it difficult for those with spastic cerebral palsy to walk, get dressed, brush their teeth, use the bathroom, and take a shower without assistance. The limitations on activities of daily living (ADLs) will depend on how severe the disorder is. Children with mild cases of spastic CP may not need any help but may still have mild difficulties with ADLs.

If both legs are affected, children may also have problems transferring from one position to the next, standing and sitting upright, walking, and running.

Children with spastic cerebral palsy may also develop other nervous system-related symptoms, which may include:

  • Speech difficulties
  • Hearing problems
  • Vision abnormalities
  • Cognitive, learning and behavioral disabilities [5]
  • Seizures

Related problems may include:

  • Drooling
  • Difficulties with chewing and swallowing
  • Hoarse voice or speech problems
  • Breathing irregularities
  • Failure to thrive or poor weight gain
  • Gastric reflux
  • Constipation and bladder incontinence
  • Spinal and joint deformities

Treatment Options for Spastic Cerebral Palsy

Although there’s no cure for any form of cerebral palsy, there are a number of treatment options available to help control the symptoms, including:

  • Physical therapy, as well as language, occupational, and behavioral therapies
  • Medications to control symptoms, such as muscle spasms or seizures
  • Baclofen pump (to help control muscle spasticity)
  • Spine or spinal cord surgery (to repair scoliosis or reduce spasticity)
  • Muscle-release and tendon-lengthening surgery
  • Devices to aid in communication
  • Orthotics, braces or other devices to help with positioning, standing or muscle control
  • Constraint-induced therapy (CIT)

Keep in mind that treatment options will depend on the age of the child, how severe the symptoms are, and any associated disorders. Most parents will work with a team of medical experts to implement the best treatments for the child, including therapists, surgeons, dietitians, and neurologists. [6]

Spastic Cerebral Palsy Prognosis

Again, there is no cure for spastic cerebral palsy, but with the proper treatment, children can grow up and thrive as adults. It’s essential, however, to start a treatment plan as early as possible for the child to have the best outcomes, not only as an adult but as he or she grows along the path through childhood and into adolescence.