What Is Cerebral Palsy?
Cerebral palsy (CP) is a group of disorders that affect balance, movement, and muscle tone. “Cerebral” means the disorder is related to your brain, and “palsy” refers to weakness or a muscle problem.
CP starts in the area of your brain that controls muscle movement. It can happen when that part of the brain doesn’t develop as it should, or when it is damaged at birth or very early in life.
Most people with cerebral palsy are born with it. That’s called “congenital” CP. But it can also start after birth, in which case it’s called “acquired” CP.
CP can range from mild to severe. Some people with CP have difficulty walking or speaking. For many people, it doesn’t affect intelligence, but some have intellectual disabilities.
What Are the Types of Cerebral Palsy?
CP is divided into four main types, based on the movement involved:
- Spastic cerebral palsy
- Dyskinetic cerebral palsy
- Ataxic cerebral palsy
- Mixed cerebral palsy
Spastic cerebral palsy.
The most common kind is spastic CP. If you have it, your muscles are stiff or tight, or they spasm.
Doctors break down spastic CP into three groups:
Spastic diplegia mostly involves muscle stiffness in the legs. Tight muscles in your legs and hips might cause trouble walking because your legs turn in at the knees. This is also called scissoring.
Spastic hemiplegia means one side of your body is affected. Your arm and leg on that side may be shorter and thinner, which might cause you to walk on your tiptoes. Some people with this type have a curved spine, called scoliosis. Seizures and speech problems can also be part of spastic hemiplegia.
Spastic quadriplegia means all of your limbs are affected, as well as your torso and your face. You may also have seizures and trouble speaking if you have this type of CP. It’s the most serious kind of spastic CP.
Dyskinetic cerebral palsy
If you have dyskinetic CP, your muscle tone might be too tight or too loose. Your movements are uncontrolled: slow and twisting, or quick and jerky. If the muscles in your face or mouth are affected, you might frown, drool, and have trouble speaking.
There are three types of dyskinetic CP:
- Athetoid: Movements are writhing, slow, and curvy.
- Choreoathetoid: Movements are aimless and not controlled.
- Dystonic: Muscle tone is affected.
Ataxic cerebral palsy
This is a rare type and causes problems with coordination and balance. You might be unsteady when you walk. You might also shake, which could make it hard to do tasks that need steadiness, such as writing.
Mixed cerebral palsy
People with this type of CP have symptoms of more than one type. Most people with mixed CP have a combination of spastic and dyskinetic.
What Causes Cerebral Palsy?
CP happens when your brain doesn’t develop normally or is damaged at an early age. There are many things that can cause this, both before and after birth. Usually, it happens before birth. The exact cause is often hard to determine.
There are three main ways that CP develops.
Cerebral palsy and genetics
Genes may play a role in the development of CP. Certain gene changes can affect the way your brain develops or your body handles certain risk factors. Scientists have identified some gene changes linked to CP, but more research needs to be done.
Cerebral palsy and traumatic brain injury
Any bleeding or cut off of blood flow into your brain can cause CP. This can happen before or after birth as a result of a stroke, fall, car accident, or other physical trauma.
Cerebral palsy causes in infants
A difficult delivery can cut off oxygen to the brain, although this is not as common as doctors used to think.
Some infections, such as bacterial meningitis or viral encephalitis, can cause infants to develop swelling in or around their brain, leading to CP. Other times, certain medical conditions can cause jaundice, when your body doesn’t fully filter waste out of the bloodstream. If left untreated, jaundice can cause a yellowing of your eyes and skin, and eventually, CP.
Other possible causes include:
- Infections during pregnancy
- Premature birth
- Birth defects
- Newborn hypoglycemia
- Asphyxiation
What Are the Symptoms of Cerebral Palsy?
Because there are mild and severe forms of cerebral palsy, it has a wide range of symptoms. It often causes delays in baby milestones related to movement, such as rolling over, sitting up, standing, and walking. But not all delays mean your baby has CP.
Cerebral palsy symptoms in infants
Some symptoms may show up at birth, while others may take longer to appear. In babies younger than 6 months, those signs include:
- When you pick your baby up from sleeping (on their back), their head falls backward.
- They feel stiff or floppy.
- When you cradle your baby in your arms, they extend their back and neck, almost as if pushing away from you.
- When you pick them up, their legs get stiff and cross over each other (“scissoring”).
Cerebral palsy symptoms in babies
If your baby is older than 6 months, warning signs can include:
- They can’t roll over.
- They can’t bring their hands together.
- They have trouble bringing their hands to their mouth.
- When they reach, it’s with only one hand. The other stays in a fist.
Cerebral palsy symptoms in toddlers
If your baby is older than 10 months, watch for these signs:
- They crawl by pushing off with one hand and one leg while dragging the other side of their body.
- They don’t crawl on all fours but scoot instead, or they hop on their knees.
If your baby is older than 1 year and can’t stand without support or crawl, those are also possible signs of CP.
Some babies are diagnosed with CP soon after they’re born. Others aren’t diagnosed until years later.
A doctor may first notice problems with your baby’s movements or muscle tone. If you notice any such problems at home, discuss them with the doctor.
Cerebral palsy doesn’t get worse as time passes, but often, symptoms aren’t noticed right away. For example, you won’t know that your baby has trouble walking until they’re older.
How Is Cerebral Palsy Diagnosed?
At every planned visit, the doctor will check to see if your baby is keeping up with their milestones or if they're delayed. They’ll watch how your baby moves to see if it’s in the normal range. And they’ll ask if you have any concerns.
Your doctor can measure subtle changes over time. It may be harder for a doctor to know for sure if a 9-month-old has a delay compared to a 2½-year-old. That’s because earlier delays are often less obvious than later ones. This is why some children aren’t diagnosed until they’re older. Most children with CP are diagnosed by the time they’re 2 years old. But if your baby’s symptoms are mild, they might not be diagnosed until they’re 4 or 5.
What Are the Tests for Cerebral Palsy?
If your doctor thinks that your child has CP, they may suggest that you see a specialist like a neurologist (an expert on the brain and nerves) or a doctor who has special training in child development.
The doctor will do a physical exam and watch your child’s movements. They’ll ask about your child’s health history, and they’ll want to hear any concerns that you have about the way your child moves. They may need to also order tests to check for problems. These include:
Blood tests. Other health problems may cause symptoms that can look like CP. Your doctor may offer blood tests to rule out other conditions.
CT scan. A CT scan uses X-ray technology to make images of the brain.
MRI. It uses a strong magnet, not X-rays. It uses no radiation and can make higher-quality images than a CT scan. This can be helpful if the damage is hard to detect, but it may not always be needed.
Ultrasound. This involves the use of sound waves to make an image of your baby’s brain. It may not be as helpful as an MRI at finding slight problems in the brain, but it’s an easier test for your baby to take. It can be done only in very young babies before the soft spot gets too small.
EEG(electroencephalogram). For this test, small electrodes will be stuck to your baby’s head to measure their brain waves. Sometimes, this exam can help diagnose epilepsy (seizure disorder), which is somewhat common in children with cerebral palsy.
Am I at Risk of Having a Child With CP?
You may have a condition while you’re pregnant that can increase the chances your baby will have CP. Among them are:
- Being pregnant with multiples, such as twins or triplets
- Having a health issue, such as seizures or a problem with your thyroid gland
- Having blood that’s not compatible with your baby’s, which is also called Rh disease
- Coming in contact with a toxic substance, such as mercury, which is found in some kinds of fish
Certain infections and viruses, when they strike during pregnancy, can increase the risk your baby will be born with cerebral palsy. They include:
- Rubella ( German measles ), a viral illness that can be prevented with a vaccine
- Chickenpox, also called varicella, a contagious illness that can be prevented by a vaccine
- Cytomegalovirus, which causes flu-like symptoms in the mother
- Herpes, which can be passed from mother to unborn child and can damage the baby’s developing nervous system
- Toxoplasmosis, which is carried by parasites found in soil, cat feces, and tainted food
- Sexually transmitted diseases such as chlamydia and HIV
Just as some illnesses in mothers raise the chances of CP, so do some infections in babies. Here are some of them:
- Bacterial meningitis causes swelling in the brain and tissues around the spinal cord.
- Viral encephalitis can cause swelling around the brain and spinal cord.
- Severe jaundice (yellowing of the skin) happens when excessive bilirubin, a yellow pigment that helps blood cells break down, builds up in the blood.
Cerebral Palsy Treatment
Although there’s no cure for CP, there are many treatments that can help you live your best life. These treatments may vary from person to person depending on their specific needs, and many will be lifelong. The earlier you start treatment, the more likely it is to help.
A good medical team can help you choose which treatments are right for you or your child. Your team might include a pediatrician, physical medicine and rehabilitation specialist, neurologist, and mental health specialist. They might recommend medicines, therapies, or other treatments that can help.
Medicines
Some medications can help loosen up stiff muscles, treat pain, or manage complications. They include:
Botox. Although more famous for cosmetic use, Botox (or onabotulinumtoxin A) can treat muscle stiffness and drooling. You’ll get a shot into the affected muscle every 3 months.
Muscle relaxants. These drugs, including baclofen (Fleqsuvy, Ozobax, Lyvispah), tizanidine (Zanaflex), diazepam (Valium, Diazepam Intensol), and dantrolene (Dantrium), can help loosen up your muscles. Usually, you take them by mouth. But for baclofen, sometimes you can get a pump surgically implanted in your stomach to deliver the drug directly to your spinal cord. This is called intrathecal baclofen.
Therapies
Some therapies can help improve your movement abilities. They include:
Physical therapy. This is when a physical therapist helps you train your muscles. These exercises are meant to improve your flexibility, strength, and balance. The physical therapist can show you how to practice these exercises at home. If you have a young child with CP, your physical therapist will focus on helping them with head and trunk control, grasping, and rolling. They can also teach you how to feed and care for your child.
Occupational therapy. This type of therapy focuses on helping you participate in daily activities of living.
Speech therapy. This therapy helps you speak more clearly or communicate in other ways, such as sign language or a voice synthesizer. Speech-language pathologists also can help you eat and swallow.
Recreational therapies. These therapies can help you participate in athletic activities, stay healthy, build confidence, and have fun. Options include therapeutic horseback riding, skiing, and more.
Surgeries
Some people may need surgery to treat muscle tightness or bone problems. Surgical options include:
Orthopedic surgery. An orthopedic surgeon can move bones and joints to the right places. They can also lengthen muscles or tendons, which is particularly helpful if you have contractures (muscle tissue shortening). Surgery can help relieve pain and make it easier to move.
Cutting nerve fibers (selective dorsal rhizotomy). This treatment is only done when moving becomes hard or painful and other options haven’t helped. It’s when a surgeon cuts the nerves connecting to a certain muscle. This relaxes the muscle and eases pain, but in rare cases can cause numbness.
Mobility aids
A wheelchair can help you get from place to place, or braces and splints can help you walk and stretch your muscles. Other options include walkers, canes, and standing and seating systems.
As you get older, you may need to get treatment for common problems linked to CP, including heart disease and mental health conditions.
How to Prevent Cerebral Palsy
You can’t prevent CP, but you can take certain steps to lower your risk.
If you are pregnant or planning to become pregnant, consider:
Get vaccinated. Certain infections during pregnancy can cause your baby to have CP. Make sure you’re up to date on vaccinations before getting pregnant, as getting some vaccines during pregnancy can harm the baby.
Avoid illness. Wash your hands, eat healthy, exercise, avoid people who are ill, and take other measures to prevent getting sick.
Treat medical problems. Being healthy can help your baby to be healthy too.
If you’re getting fertility treatments, aim for a single pregnancy. Having twins or triplets can increase their risk for CP. So, if you’re getting in vitro fertilization (IVF), only have one embryo implanted at a time.
Get early, regular prenatal care. As soon as you realize you are pregnant, make an appointment with an OB/GYN. Seeing your doctor regularly can help keep your baby healthy, reducing the risk for low birthweight, premature birth, and other conditions linked to CP. They can also check for and treat Rh (blood type) incompatibility between mother and baby, which can cause kernicterus and jaundice.
Avoid drinking, smoking, and using drugs. These can raise your baby’s risk for CP.
If you get sick, call your doctor right away. Certain infections can cause your baby to develop CP.
If you are at risk for premature labor, talk to your doctor about taking magnesium sulfate. This supplement helps promote blood flow to your baby’s brain.
After your baby is born, you can help protect them from brain damage:
Give premature babies prescription caffeine. When given as a medication, caffeine can promote good breathing. Talk with your child’s pediatrician before starting any new supplement.
Use cooling therapy for babies who had asphyxia. If your baby didn’t get enough oxygen during delivery, keeping their body or head cool can help prevent brain damage. Talk with your child’s pediatrician about how this works and whether it’s right for your baby.
Make sure your baby is up to date on their vaccinations. Talk with their pediatrician about when they should be vaccinated for infections such as Haemophilus influenzae type B (HiB vaccine) and Streptococcus pneumoniae (pneumococcal vaccine), which can lead to CP due to brain swelling.
Practice safety. Put rails on their bed to prevent falls, make sure they wear a helmet while riding bikes, and buckle them into an age-appropriate car seat.
Takeaways
CP is a lifelong neurological condition that affects muscle movement and stiffness. Although there’s no cure, several treatments can help you live your best life. Talk with your doctors about which therapies are right for you or your child.
Cerebral Palsy FAQs
What is cerebral palsy?
CP is a type of neurological condition that causes muscle weakness and difficulty moving. You can be born with it or develop it in early childhood.
What are the main symptoms of cerebral palsy?
CP symptoms can range from mild to severe. Some people may have trouble walking or speaking.
What treatments are available for cerebral palsy?
CP can be treated with medications to relax the muscles, various therapies, surgeries, and mobility aids. Treatment is lifelong.
How can parents support a child with cerebral palsy?
As your child grows, you may need to advocate for them in school, health care, and other contexts. Encourage and respect their independence as much as possible. This can help them engage with others in the community and have a high quality of life.