Introduction to cerebral palsy:
When parents hear the words “cerebral palsy,” it often conjures up an image of a twisted, wheel chair-bound child. Cerebral palsy can have a broad range of severity. Sometimes it is so mild that it doesn’t limit activity at all. Sometimes it is quite severe. By definition, though, the brain damage that causes CP does not continue to get worse over time.
What is it?
Cerebral palsy, or static encephalopathy, is a condition where non-progressive damage to the brain results in a disorder of posture or movement. CP may be accompanied by seizures or by problems with vision, speech, or intellect.
Who gets it?
CP affects about one or two in 500 kids. When it was first described more than a century ago, CP was felt to be the result of birth trauma or inadequate oxygen during delivery. Physicians expected that as obstetric care improved, CP would disappear. However, great improvements in obstetric care have not reduced the rate of CP.
Current theories suggest that usually the CP causes difficult births, rather than the other way around. Often congenital anomalies or infections are clearly present before birth. The child with CP may have had a stroke before birth.
What are the symptoms?
Cerebral palsy may affect:
- one limb (monoplegia)
- one side of the body (hemiplegia)
- both arms or legs (diplegia)
- three limbs (triplegia)
- all four limbs (quadriplegia)
The affected limbs might be floppy, rigid, or spastic. They might have a tremor, move on their own, or be uncoordinated. The affected limbs might function so well that most people would not notice, they might be virtually unusable, or anywhere in between. Toe walking might be the only symptom of CP.
The CP might be isolated, or might be associated with other problems (seizures, vision, hearing, speech, behavior, attention, intellect) that cause more problems than the CP itself. CP can also predispose to urinary tract infections.
Children with CP might have normal or superior intellect. Up to a quarter of children with CP have developmental delays or mental retardation.
Is it contagious?
CP is not spread from person to person. However, intrauterine infections can lead to CP.
How long does it last?
By definition, the brain damage that results in CP does not get better or worse with time. Complications arising from decreased use of the limbs can progress.
How is it diagnosed?
CP is suggested by findings on the physical examination. It is important to verify that these findings are not caused by any progressive or degenerative disorder, tumor, or muscle problem. A variety of tests, including CT, MRI, EEG, vision, and hearing tests may be used to define the scope of the problem.
How is it treated?
CP is best treated with a multi-disciplinary team. The team might include physicians, an occupational therapist, physical therapist, speech therapist, psychologist, ophthalmologist, or audiologist. Therapy is tailored to the individual child’s needs.
A variety of medicines might be used to reduce spasticity, unwanted movements, or seizures. Surgery is sometimes needed to remove contractures.
How can it be prevented?
Preventing birth trauma may prevent a few cases of CP, but this is by no means reliable. Preventing and rapidly treating maternal infections is probably more effective.