Cerebral Palsy

Cerebral palsy is the general term for a number of neurological conditions that affect movement and co-ordination.

Neurological conditions are caused by problems in the brain and nervous system.

Specifically, cerebral palsy is caused by a problem in the parts of the brain responsible for controlling muscles. The condition can occur if the brain develops abnormally or is damaged before, during or shortly after birth.

Causes of cerebral palsy include:

• an infection caught by the mother during pregnancy
• a difficult or premature birth
• bleeding in the baby’s brain
• changes (mutations) in the genes that affect the brain's development

It is estimated that 1 in 400 people in the UK is affected by cerebral palsy.

Symptoms 

The symptoms of cerebral palsy normally become apparent during the first three years of a child's life.

The main symptoms are:

• muscle stiffness or floppiness
• muscle weakness
• random and uncontrolled body movements
• balance and co-ordination problems

These symptoms can affect different areas of the body and vary in severity from person to person. Some people will only have minor problems, whereas others will be severely disabled.

Many people with cerebral palsy also have a number of associated problems, including repeated seizures or fits, drooling problems and swallowing difficulties. Some people with the condition may have communication and learning difficulties, although intelligence is often unaffected.

A child with cerebral palsy may be slower in achieving important developmental goals, such as learning to crawl, walk or speak.

You should see your GP if you are concerned about your child's development. If necessary, they can refer you to a paediatrician (a doctor who specialises in the treatment of children), who can help identify any problems.

How cerebral palsy is treated

There is no cure for cerebral palsy. However, there are numerous treatments available, which can treat many of its symptoms and help people with the condition to be as independent as possible.

These treatments include physiotherapy, occupational therapy and medication to relieve muscle stiffness and spasms. In some cases, surgery may also be needed.

Cerebral palsy is not a progressive condition. This means the original problem in the brain doesn't get worse with age, and life expectancy is usually unaffected.

However, the physical and emotional strain of living with a long-term condition such as cerebral palsy can put a great deal of stress on the body, which can cause further problems in later life.

Treatment for all forms of cerebral palsy is focussed on enabling the child to live as normal a life as possible. Once a diagnosis has been made (often by the local community disability team) the child is referred to a team of health care professionals who have experience in planning and delivering care to children and young people with cerebral palsy.

This team will usually include a number of healthcare professionals including developmental paediatricians, physiotherapists, occupational therapists, speech and language therapists and nurses.  Regular assessments and reviews are used to monitor progress and identify problems early. These should always involve the patient and the family.  

Click to read more about different types of therapeutic support for dystonic cerebral palsy.

• Physiotherapy
• Occupational therapy
• Speech and language therapy

Therapies can help with a range of daily activites including (click for information):

• Managing communication
• Managing eating, drinking and diet
• Managing excessive saliva 

Medication is often used to manage the muscle spasms and pain. If your child's muscles are particularly stiff and overactive, they may need medication to help relax their muscles. Many people with cerebral palsy also experience a lot of pain associated with gastrointestinal problems including gastric reflux and reduced gut motility causing constipation; these symptoms, which can also aggravate the symptoms of dystonia, can be eased using medication. 

Other treatments

Other treatments for dystonic cerebral palsy are (click to read more):

• Intrathecal baclofen 
• Orthopaedic surgery

Deep Brain Stimulation is not usually effective for those with athetoid or dystonic cerebral palsy but is sometimes appropriate.

There is likely to be an extensive team involved in a newly diagnosed patient with cerebral palsy this may change over time but initially it may include:

• paediatrician
• neuro-developmental paediatrician
• physiotherapist
• occupational therapist
• speech and language therapist
• psychologist/psychotherapist, who helps to support the child and family with any aspect of cognitive and emotional development
• health visitor
• social worker
• incontinence advisor

Some or all of the above will be involved with the child and the family in the development of the care plan to address any needs and problems the child or young person has. 
This care plan will be regularly reviewed and the child reassessed as necessary and changes made as required to cope with altered needs.

Your child should be allocated a key worker who as the name implies is the person responsible for coordinating the care plan and is also the person who the other professionals report issues or concerns to.

Transition from childhood to adulthood is a key time and it is important that children and adult service providers are working together with the young person and the family as well as the school or college/university.

Whilst dystonic cerebral palsy is not a condition that gets worse over time although some deterioration in tone may occur with growth spurts, excessive wear and tear on the joints and bones can sometimes occur because of the condition.

Contracture (shortening of the muscle) is a risk in children who have problems stretching their muscles because of muscle stiffness. If the muscles cannot stretch, they do not grow as fast as the bones. This can lead to deformities, causing pain and discomfort. Physiotherapy is important in reducing the risk of contractures - however it cannot prevent them completely.

Problems can occur at joints due to the muscle spasms which can lead to spine and hip deformities.

Nutrition problems - Swallowing or feeding problems can make it difficult for someone who has cerebral palsy, particularly an infant, to get enough nutrition for growth and development as they use far more calories for any movement than those without cerebral palsy. Finidng a suitable diet is therefore critical.

Mental Health Issues such as depression, social isolation and body image and the challenges of coping with disabilities can contribute to the difficulties faced by young people with cerebral palsy. This is very much a personal experience as many children cope very well.

Osteoarthritis - Pressure on joints or abnormal alignment of joints from muscle spasticity may result in the early development of osteoarthritis.

Epilepsy – can be more common in young people with CP than the normal population.