Cerebral palsy

Cerebral palsy is a group of conditions that affect movement and posture. It's caused by damage that occurs to the developing brain, most often before birth.

Symptoms appear during infancy or preschool years and vary from very mild to serious. Children with cerebral palsy may have exaggerated reflexes. The arms, legs and trunk may appear floppy. Or they may have stiff muscles, known as spasticity. Symptoms also can include irregular posture, movements that can't be controlled, a walk that's not steady or some combination of these.

Cerebral palsy may make it hard to swallow. It also can cause eye muscle imbalance, in which the eyes don't focus on the same object. People with the condition might have reduced range of motion in their joints due to muscle stiffness.

The cause of cerebral palsy and its effect on function vary from person to person. Some people with cerebral palsy can walk while others need assistance. Some people have intellectual disabilities, but others do not. Epilepsy, blindness or deafness also might affect some people with cerebral palsy. There is no cure, but treatments can help improve function. The symptoms of cerebral palsy may vary during the child's development, but the condition doesn't get worse. The condition generally stays the same over time.

Symptoms of cerebral palsy can vary greatly. In some people, cerebral palsy affects the whole body. In other people, symptoms might only affect one or two limbs or one side of the body. General symptoms include trouble with movement and coordination, speech and eating, development, and other issues.

Movement and coordination

Movement and coordination symptoms may include:

• Stiff muscles and exaggerated reflexes, known as spasticity. This is the most common movement condition related to cerebral palsy.
• Variations in muscle tone, such as being either too stiff or too floppy.
• Stiff muscles with regular reflexes, known as rigidity.
• Lack of balance and muscle coordination, known as ataxia.
• Jerky movements that can't be controlled, known as tremors.
• Slow, writhing movements.
• Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling.
• Trouble walking. People with cerebral palsy may walk on their toes or crouch down when they walk. They also may have a scissors-like walk with their knees crossing. Or they may have a wide gait or a walk that's not steady.
• Trouble with fine motor skills, such as buttoning clothes or picking up utensils.

Speech and eating

These symptoms related to speech and eating may occur:

• Delays in speech development.
• Trouble speaking.
• Trouble with sucking, chewing or eating.
• Drooling or trouble with swallowing.

Development

Some children with cerebral palsy have these symptoms related to development:

• Delays in reaching motor skills milestones, such as sitting up or crawling.
• Learning disabilities.
• Intellectual disabilities.
• Delayed growth, resulting in smaller size than would be expected.

Other symptoms

Damage to the brain can contribute to other neurological symptoms, such as:

• Seizures, which are symptoms of epilepsy. Children with cerebral palsy may be diagnosed with epilepsy.
• Trouble hearing.
• Trouble with vision and changes in eye movements.
• Pain or trouble feeling sensations such as touch.
• Bladder and bowel issues, including constipation and urinary incontinence.
• Mental health conditions, such as emotional conditions and behavior issues.

The brain condition causing cerebral palsy doesn't change with time. Symptoms usually don't worsen with age. However, as the child gets older, some symptoms might become more or less clear. And muscle shortening and muscle rigidity can worsen if not treated aggressively.

When to see a doctor

Contact your child's health care professional and get a prompt diagnosis if your child has symptoms of a movement condition. Also see a health professional if your child has delays in development.

See your child's health care professional if you have concerns about episodes of loss of awareness or of irregular bodily movements or posture. It's also important to contact your child's health care professional if your child has trouble swallowing, poor coordination, eye muscle imbalance or other developmental issues.

Cerebral palsy is caused by irregular brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. Often the cause isn't known. Many factors can lead to changes in brain development. Some include:

• Gene changes that result in genetic conditions or differences in brain development.
• Maternal infections that affect an unborn baby.
• Stroke, which interrupts blood supply to the developing brain.
• Bleeding into the brain in the womb or as a newborn.
• Infant infections that cause swelling in or around the brain.
• Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical trauma.
• Lack of oxygen to the brain related to a hard labor or delivery, although this cause is less common than previously thought.

A number of factors are associated with an increased risk of cerebral palsy.

Maternal health

Certain infections or toxic exposures during pregnancy can significantly increase cerebral palsy risk to the baby. Inflammation triggered by infection or fever can damage the unborn baby's developing brain.

• Cytomegalovirus. This common virus causes flu-like symptoms. If a mother has her first active infection during pregnancy, it can lead to birth defects.
• German measles, known as rubella. This viral infection can be prevented with a vaccine.
• Herpes. This infection can be passed from mother to child during pregnancy, affecting the womb and placenta.
• Syphilis. This is a bacterial infection that's usually spread by sexual contact.
• Toxoplasmosis. This infection is caused by a parasite found in contaminated food, soil and the feces of infected cats.
• Zika virus infection. This infection is spread through mosquito bites and can affect the brain development of an unborn baby.
• Intrauterine infections. This includes infections of the placenta or fetal membranes.
• Exposure to toxins. One example is exposure to methyl mercury.
• Other conditions. Other conditions affecting the mother that can slightly increase the risk of cerebral palsy include thyroid conditions, preeclampsia or seizures.

Infant illness

Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:

• Bacterial meningitis. This bacterial infection causes swelling in the membranes surrounding the brain and spinal cord.
• Viral encephalitis. This viral infection also causes swelling in the membranes surrounding the brain and spinal cord.
• Severe or untreated jaundice. Jaundice appears as a yellowing of the skin and eyes. The condition occurs when certain byproducts of "used" blood cells aren't filtered from the bloodstream.
• Bleeding into the brain. This condition is commonly caused by the baby having a stroke in the womb or in early infancy.

Factors of pregnancy and birth

The potential contribution from each is limited, but these pregnancy and birth factors may increase the risk of cerebral palsy risk:

• Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
• Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. The risk also can be related to the likelihood of premature birth and low birth weight. If one or more of the babies die, the survivors' risk of cerebral palsy increases.
• Premature birth. Babies born prematurely are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
• Delivery complications. Events during labor and delivery may increase the risk of cerebral palsy.

Muscle weakness, muscle spasticity and trouble with coordination can contribute to complications in childhood or in adulthood, including:

• Contracture. Contracture is muscle tissue shortening due to severe muscle tightening. This can be the result of spasticity. Contracture can slow bone growth, cause bones to bend, and result in joint changes, dislocation or partial dislocation. These can include a dislocated hip, a curved spine or other bone changes.
• Malnutrition. Trouble with swallowing and feeding can make it hard to get enough nutrition, particularly for an infant. This can impair growth and weaken bones. Some children or adults need a feeding tube to get enough nutrition.
• Mental health conditions. People with cerebral palsy might have mental health conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression. Behavior issues also can occur.
• Heart and lung disease. People with cerebral palsy may develop heart disease, lung disease and breathing conditions. Trouble swallowing can result in respiratory issues, such as aspiration pneumonia. Aspiration pneumonia happens when a child inhales food, drink, saliva or vomit into the lungs.
• Osteoarthritis. Pressure on joints or misalignment of joints from muscle spasticity may lead to this painful bone disease.
• Osteoporosis. Fractures due to low bone density can result from lack of mobility, poor nutrition and anti-seizure medicines.
• Other complications. These can include sleep conditions, chronic pain, skin breakdown, intestinal issues and issues with oral health.

Often cerebral palsy can't be prevented, but you can reduce risks. If you're pregnant or planning to become pregnant, take these steps to minimize pregnancy complications:

• Make sure you're vaccinated. Getting vaccinated against diseases such as rubella might prevent an infection. It's best to make sure you're fully vaccinated before getting pregnant.
• Take care of yourself. The healthier you are heading into a pregnancy, the less likely you'll be to develop an infection that results in cerebral palsy.
• Seek early and continuous prenatal care. See your health care professional regularly during pregnancy. Proper prenatal care can reduce health risks to you and your unborn baby. Seeing your health care professional regularly can help prevent premature birth, low birth weight and infections.
• Avoid alcohol, tobacco and illegal drugs. These have been linked to cerebral palsy risk.

Rarely, cerebral palsy can be caused by brain damage that occurs in childhood. Practice good general safety. Prevent head injuries by providing your child with a car seat, bicycle helmet, safety rails on the bed and appropriate supervision.

Symptoms of cerebral palsy can become more apparent over time. A diagnosis might not be made until a few months to a year after birth. If symptoms are mild, diagnosis may be delayed longer.

If cerebral palsy is suspected, a health care professional evaluates your child's symptoms. The health care professional also reviews your child's medical history, conducts a physical exam and monitors your child's growth and development during appointments.

Your child may be referred to specialists trained in treating children with brain and nervous system conditions. Specialists include pediatric neurologists, pediatric physical medicine and rehabilitation specialists, and child development specialists.

Your child also might need a series of tests to make a diagnosis and rule out other possible causes.

Brain scans

Brain-imaging tests can reveal areas of damage or irregular brain development. These tests might include the following:

• MRI. An MRI uses radio waves and a magnetic field to produce detailed 3D or cross-sectional images of the brain. An MRI can often identify changes in your child's brain. This test is painless, but it is noisy and can take up to an hour to complete. Your child will likely receive a sedative or light general anesthesia beforehand.
• Cranial ultrasound. This can be performed during infancy. A cranial ultrasound uses high-frequency sound waves to produce images of the brain. An ultrasound doesn't produce a detailed image, but it may be used because it's quick and it can provide a valuable preliminary assessment of the brain.

Electroencephalogram (EEG)

If your child is suspected of having seizures, an EEG can evaluate the condition further. Seizures can develop in a child with epilepsy. In an EEG test, a series of electrodes are attached to your child's scalp. The EEG records the electrical activity of your child's brain. Changes in brain wave patterns are common in epilepsy.

Laboratory tests

Tests of the blood, urine or skin might be used to screen for genetic or metabolic conditions.

Additional tests

If your child is diagnosed with cerebral palsy, your child likely will be referred to specialists to have tests for other conditions. These tests can look at:

• Vision.
• Hearing.
• Speech.
• Intellect.
• Development.
• Movement.
• Other medical conditions.

The type of cerebral palsy is determined by the main movement condition that's present. However, several movement conditions can occur together.

• Spastic cerebral palsy. This is the most common type. It causes stiff muscles and exaggerated reflexes.
• Dyskinetic cerebral palsy. This type makes it hard to control voluntary muscles.
• Ataxic cerebral palsy.People with this type have trouble with balance and coordination.

After a diagnosis of cerebral palsy, your health care professional may use a rating scale tool such as the Gross Motor Function Classification System. This tool measures function, mobility, posture and balance. This information can help in selecting treatments.

Children and adults with cerebral palsy may require lifelong care with a health care team. Your child's health care professional and a physical medicine and rehabilitation specialist may oversee your child's care. Your child also may see a pediatric neurologist, therapists and mental health specialists. These experts give special attention to needs and issues that are more common in people with cerebral palsy. They work together with your child's health care professional. Together you can develop a treatment plan.

There is no cure for cerebral palsy. However, there are many treatment options that may help improve your child's daily functioning. Selecting care depends on your child's specific symptoms and needs, which may change over time. Early intervention can improve outcomes.

Treatment options can include medicines, therapies, surgical procedures and other treatments as needed.

Medications

Medicines that can lessen muscle tightness might be used to improve functional abilities. They also can treat pain and manage complications related to spasticity or other symptoms.

• Muscle or nerve injections. To treat tightening of a specific muscle, your health care professional might recommend injections of onabotulinumtoxinA (Botox), or another agent. The injections are repeated about every three months.

  Side effects can include pain at the injection site and mild flu-like symptoms. Other side effects include trouble breathing and swallowing.

• Oral muscle relaxants. Medicines such as baclofen (Fleqsuvy, Ozobax, Lyvispah), tizanidine (Zanaflex), diazepam (Valium,Diazepam Intensol) or dantrolene (Dantrium) are often used to relax muscles.

  Sometimes baclofen is pumped into the spinal cord with a tube, known as intrathecal baclofen. The pump is surgically implanted under the skin of the stomach.

• Medicines to reduce drooling. One option is Botox injections into the salivary glands.

Talk to your health care professional about benefits and risks of medicines.

Therapies

A variety of therapies play an important role in treating cerebral palsy:

• Physical therapy. Muscle training and exercises can help your child's strength, flexibility, balance, motor development and mobility. A physical therapist also teaches you how to safely care for your child's everyday needs at home. This can include bathing and feeding your child. The therapist can provide guidance on how you can continue muscle training and exercise with your child at home between therapy visits.

  For the first 1 to 2 years after birth, both physical and occupational therapists work on issues such as head and trunk control, rolling, and grasping. Later, both types of therapists are involved in wheelchair assessments.

  Braces, splints or other supportive devices might be recommended. They may help with function, such as improved walking, and stretching stiff muscles.

• Occupational therapy. Occupational therapists work to help your child gain independence in daily activities at home, at school and in the community. Adaptive equipment recommended for your child can include walkers, wide-based canes, standing and seating systems, or electric wheelchairs.
• Speech and language therapy. Speech-language pathologists can help improve your child's ability to speak clearly or to communicate using sign language. They also can teach the use of communication devices, such as a computer and voice synthesizer, if communication is hard. Speech therapists also can address issues with eating and swallowing.
• Recreational therapy. Some children benefit from regular or adaptive recreational or competitive sports, such as therapeutic horseback riding or skiing. This type of therapy can help improve your child's motor skills, speech and emotional well-being. Both adults and children benefit from regular physical activity and exercise for general health and fitness.

Surgical procedures

Surgery may be needed to lessen muscle tightness or correct bone changes caused by spasticity. These treatments include:

• Orthopedic surgery. Children with muscle tissue shortening, known as contractures, might need surgery. Surgery on bones or joints can place arms, spine, hips or legs in the correct positions. Surgical procedures also can lengthen muscles and lengthen or reposition tendons that are shortened. These corrections can lessen pain and improve mobility. The procedures also can make it easier to use a walker, braces or crutches.
• Cutting nerve fibers, known as selective dorsal rhizotomy. This procedure may be done when walking or moving is hard and painful and other treatments haven't helped. Surgeons cut the nerves serving specific spastic muscles. This relaxes the muscle in the legs and reduces pain. But it can cause numbness.

Other treatments

Medicines and other treatments may be recommended for seizures, pain, osteoporosis or mental health conditions. Treatments also may be needed to help with sleep, oral health, feeding and nutrition, bladder incontinence, vision, or hearing.

Adults with cerebral palsy

As a child with cerebral palsy becomes an adult, health care needs can change. Children with cerebral palsy need general health screenings recommended for all adults. But they also need ongoing health care for conditions that are more common in adults with cerebral palsy. These can include:

• Trouble with vision and hearing.
• Maintenance of muscle tone.
• Seizure management.
• Pain and fatigue.
• Dental issues.
• Orthopedic issues, such as contractures, arthritis and osteoporosis.
• Heart and lung disease.
• Mental health issues, such as depression.

Some children and teenagers with cerebral palsy use complementary and alternative medicine. Alternative therapies are not proved and have not been adopted into routine clinical practice. If you're considering a complementary and alternative medicine or therapy, talk with your child's health care professional about potential risks and benefits.

When a child is diagnosed with a disabling condition, the whole family faces new challenges. Here are a few tips for caring for your child and yourself:

• Foster your child's independence. Encourage any effort at independence, no matter how small. At any age, your child's participation in social, educational, employment, recreational and other community activities can help them participate in society. It also can have a positive effect on your child's quality of life.
• Be an advocate for your child. You're an important part of your child's health care team. Don't be afraid to speak out on your child's behalf or to ask tough questions of health care professionals, therapists and teachers.
• Find support. A circle of support can make a big difference in helping you and your family cope with cerebral palsy and its effects. As a parent, you might feel grief and guilt over your child's condition. Your doctor can help you locate support groups, organizations and counseling services in your community. Your child also might benefit from family support programs, school programs and counseling.
• Access services. Early intervention and special education services are available for children under 21 years of age through the Individuals with Disabilities Education Act. Services for adults with disabilities also are available. Talk with your health care team about how to access programs and services in your area.

Community resources and support for adults

Caring for your adult loved one with cerebral palsy may include planning for current and future lifestyle needs, such as:

• Guardianship.
• Living arrangements.
• Social and recreational participation.
• Employment.
• Financial support.

If your child has cerebral palsy, your child's health care professional may ask about your child's symptoms and when they started. The health professional also may ask if you had risk factors during pregnancy or delivery.

What you can do

Before your appointment make a list of:

• Symptoms that concern you and when they began.
• All medicines, vitamins and other supplements your child takes, including doses.
• Your child's medical history, including other conditions.
• Information about your pregnancy and delivery.
• Questions to ask the health care professional.

Take a relative or friend with you, if possible, to help you remember the information you receive.

Questions to ask a health care professional can include:

• What tests will my child need?
• When will we know the results of the tests?
• What specialists will we need to see?
• How will you monitor my child's health and development?
• Can you suggest educational materials and local support services regarding cerebral palsy?
• Can my child be seen by specialists in a cerebral palsy clinic?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your health care professional is likely to ask you questions, including:

• What concerns do you have about your child's growth and development?
• How well does your child eat?
• How does your child respond to touch?
• Do you observe favoring of one side of the body?
• Is your child reaching certain milestones in development, such as rolling over, pushing up, sitting up, crawling, walking or speaking?
• Did you have any medical conditions during your pregnancy or delivery?