Cerebral palsy (CP) is a term used to describe a disorder affecting body movement and muscle coordination. It is caused by damage to one of the parts of the developing brain which controls and organizes a person’s movement and posture. Because of this messages between the body and brain are ‘scrambled’
No two people with CP will be affected in the same way. For some people the effects will be very mild. For others they can be severe or profound with many variations in between.
The damage to the developing brain can happen before, during or after birth and is usually diagnosed before the age of three. Almost 50% of children with CP are born early. Small preterm (early) babies have vulnerable brains which may haemorrhage (bleed heavily). This is because of the immaturity of the developing brain and the vulnerability of the tissue in the brain.Other causes include:
It is often not possible for doctors to give an exact reason why part of the baby’s brain has been injured or failed to develop, as there may be no obvious single reason why a child has cerebral palsy.
CP can happen in any family. It affects both sexes, although slightly more males than females have CP. Some risk factors are well-known, such as extreme prematurity, low birth weight and multiple births. The risk of CP is 5 times greater with twins and 18 times greater with triplets. However, it is not usually possible to say which children are most likely to have CP.
CP affects approximately 1 in every 400 children. Over the last few years the number of people with CP who have profound and multiple difficulties has increased.
There are three different systems within the brain involved in controlling movement. Impairment can happen in one or more of these areas. The type of CP which results depends on which area of the brain is most affected.
There are three types of CP:
Spastic cerebral palsy (spasticity)
Present in 75% to 88% of people with CP, which makes it the most common form of the condition. “Spastic” means “stiff” and people with this type of CP have tightness or stiffness and weakness in some muscles. This causes degrees of difficulty in moving the body, which may be mild or severe. People with spastic CP have a tendency to remain in certain positions and also to develop shortening of some muscles. This can sometimes limit the movement of joints.
Dyskinetic cerebral palsy (dyskinesia)
Sometimes referred to as dystonic, athetoid or choreoathetoid CP. Present in about 15% of people with CP. People with dyskinetic cerebral palsy experience uncontrolled, involuntary sustained or intermittent muscle contractions as the tone of the muscle can change from floppy and loose (hypotonia) to tight with slow, rhythmic twisting movements. The whole body can be affected resulting in difficulties maintaining an upright position. Speech can be hard to understand as there may be difficulty controlling the tongue, breathing and vocal cords.
Ataxic cerebral palsy (ataxia)
Present in about 4% of people with CP. They can experience problems with balance and coordination. This is due to difficulty in controlling movements of the trunk, head, legs and arms. Ataxia affects the whole body and when walking, they will probably be very unsteady on their feet. People with ataxic CP are likely to have shaky hand movements and jerky speech.
Sometimes it may be difficult to know what kind of cerebral palsy a person has, as it can be a mixture of the above three, if more than one of the movement systems is impaired.
There are three commonly used descriptions of ways cerebral palsy affects different parts of the body:
As stated earlier, no two people will be affected in exactly the same way. This is because the effects of CP vary according to how much damage has been done to the developing brain. People with CP have difficulty controlling some or all of their movements. In some people this is hardly noticeable, while others might have difficulty talking, walking or using their hands. Some people will be unable to sit up without support and will need help to do most everyday tasks.
A person with cerebral palsy may have some or most of the following features, to a greater or less extent:
The results of these difficulties may mean a delay in achieving the “milestones of development”. In other words a child may be slower than average in acquiring physical skills such as hand control or learning to walk. Some people who are severely affected may never develop the most complex of these skills. However, it can be difficult for a doctor to predict accurately how a young child with cerebral palsy will be affected as they grow older. Good therapy, support and education of parents to know how to assist their child, can help progress in early years.
Depending on the severity of the condition, the person with CP might get treatment from different therapists. The three most common for people with CP are:
Some people with CP may need no or little treatment
The damage to the brain does not worsen as an individual gets older. However, over time certain of the physical effects, such as muscles tightening and shortening, can produce other problems such as joint stiffness. This can cause discomfort and hinder a person’s activity, if ignored.
Certain difficulties are more common in people with CP:
The most common visual impairment is a squint, which may need correction with glasses or an operation. More serious visual impairments are much less common. Visual field defects are sometimes present and should be tested for. This means that the part of the brain that is responsible for understanding the images the person sees is not working properly. The eyes may look healthy when examined, but the person will not be able to see normally.
A small number of people with CP have hearing impairments which cause difficulties with speech and language. Some children with CP develop “glue ear” or other ear infections. This can cause a hearing impairment, which, in turn, can make learning to speak more difficult until it is treated.
Some people with CP have difficulty in perceiving space and relating it to their own bodies (for example, they cannot judge distances) or thinking spatially (eg visualising a three-dimensional building, being able to tell right from left, understanding the concepts of “in”, “on”, ” under “, etc). It may affect people’s ability to do things like dressing or making it more difficult to learn maths, reading and writing. This is caused by an abnormality in the part of the brain and is not related to intelligence.
Speech and Language
Some people with CP have no speech. Others have difficulty speaking. Some have difficulty controlling movement, which means that the muscles in the mouth, tongue, palate and voice box are affected. This can make speech sound unclear. However, many children with CP learn some kind of verbal communication.
Chewing and Swallowing
Sometimes chewing and swallowing is difficult because of problems controlling the mouth muscles, lips and tongue. An early sign may be difficulty with sucking. Eating is sometimes difficult for people with CP. This can be called dysphagia. They may also have reflux (food or drink flowing back up to the throat).
Around one in three people with CP have epilepsy. It is impossible to predict whether or when a child may develop seizures (fits). Some children start to have them when they are very young, others in adult life. Epilepsy can often be well controlled with medication.
Some children have difficulty planning motor movements or doing apparently simple tasks like dressing. This is due to difficulties in parts of the brain which organize movement and spatial awareness. These children may be labelled “clumsy” or have learning difficulties at school, particularly relating to maths. Activities like skipping, running or climbing (known as gross motor activities) are very difficult. These children can walk quite well but will often trip or fall. Special therapy programs can help children with dyspraxia with their motor organization and teach them to dress themselves. These programs can supplement learning programs at school.
Other physical difficulties
Some people with CP may have some other difficulties. These could include:
In most cases these difficulties can be reduced or overcome.
It is often assumed that people with CP who are unable to talk, or have difficulty controlling their movements, have a learning disability. This is not always the case and should never be assumed. CP does not necessarily affect intelligence, though some people might have a learning disability. The degree of speech and movement a person has does not indicate their level of intelligence.
Specific Learning Difficulties
Some people have difficulty learning to read, draw, or do arithmetic. This is because a particular part of the brain is affected. If the problem is out of proportion to a person’s general intelligence, it is called a specific learning difficulty.
We don’t know enough yet about how and why CP happens to cure or prevent it. However, because of improvements in medical care before and during birth, fewer babies have been born with certain types of CP. In term babies with Hypoxic ischemic encephalopathy (HIE) ‘cooling therapy’ has shown very encouraging results. Ongoing research, particularly around prematurity where the incidence of CP is high, is helping to reduce the level of brain and lung damage and visual impairment.
Research into improving mobility is also being carried out. Although brain damage is not reversible there are many treatments and therapies which can help people with CP. Equipment such as splints to help with walking, special buggies and wheelchairs, seating and standing frames, computers and much more can be provided to build on and support people’s abilities.
Many adults with cerebral palsy lead independent lives, with or without support. Many children with cerebral palsy attend mainstream schools and go on to further and higher education. Attitudes towards disability are changing all the time for the better.