McKesson Clinical Reference Systems: Women's Health Advisor 2002.2

What is cerebral palsy?

Cerebral palsy refers to a group of disorders that result when a baby's or young child's brain is damaged. Movement and posture are affected and often there is some level of mental retardation, but not always. Cerebral palsy cannot be cured, but it doesn't worsen once it has developed. It is the most common handicapping disorder in the U.S., affecting between 2 to 6 babies per 1000.

How does it occur?

Cerebral palsy can result from a number of events that cause brain damage before or during birth, and within the first 5 years of life. Some of the causes are still unknown.

Some of the ways a child's brain may become damaged include:

• The mother has an infection, such as rubella (German measles), is anemic, or abuses drugs or alcohol during the pregnancy.
• The baby's brain does not get enough oxygen at some stage of development or during delivery.
• The baby is born prematurely with internal bleeding in the head.
• The mother and baby have different blood types.
• The mother has a difficult labor or a traumatic delivery.
• The placenta separates early or there is damage to the umbilical cord.
• The baby's brain has too much bile pigment (bilirubin).
• The membranes surrounding the brain become inflamed (meningitis).
• There is a virus infection in the brain (encephalitis).
• The child has severe convulsions.
• The child has a bad head injury.

Sometimes children develop cerebral palsy when there is no obvious cause.

What are the symptoms?

The symptoms of cerebral palsy may include:

• spasticity (stiffening of the limbs, jerky movements, and poor muscle control)
• arms or legs appear to be locked in an abnormal position (for example, arms tucked to the sides or legs crossed in a scissorlike position, toes pointing down)
• standing and walking on tiptoe at all times
• weak muscles with little or no strength
• lack of normal balance
• sucking and swallowing problems
• abnormal walking pattern (gait): for example, with one foot dragging or one leg trailing behind
• convulsions
• hearing loss
• vision defect, such as cross-eye
• speech difficulty
• mental retardation (in 75% of cases).

Cerebral palsy does not affect the chest muscles directly, although breathing can be affected by a change in posture.

How is it diagnosed?

The doctor will look for symptoms and use a variety of tests to diagnose cerebral palsy and determine the extent of impairment. Cerebral palsy may not be easily detected during the first year.

An electroencephalogram (EEG) and x-rays of the brain, such as a CT scan, are often used to detect and measure brain damage. Other tests are sometimes used to rule out other diseases or genetic disorders that resemble cerebral palsy.

How is it treated?

The treatment for cerebral palsy is most often a combination of speech and occupational therapy, prescription drugs, surgery, and sometimes counseling.

Physical therapy is used for muscle training and exercising. The child or adult learns how to place affected arms and legs in a comfortable position and how to maintain balance. Sometimes orthopedic surgery is necessary to change the position of arms and legs so the adult or child can use frames, braces, and crutches to walk.

Speech therapy helps the child improve speaking and other skills that involve the mouth, such as eating. Special techniques and devices, such as computers, can help children and adults who can't speak to communicate with others.

Eye surgery or prescription glasses may be suggested to repair cross-eye and help with seeing difficulties. A hearing aid often reduces hearing problems.

Medications and anticonvulsant drugs are often prescribed to treat abnormal muscle movement and help control convulsions. If a child has convulsions with cerebral palsy and does not receive medication, additional brain damage may result.

Occupational therapy and exposure to a normal school environment promote self-sufficiency and an independent lifestyle.

You will want to schedule regular follow-up appointments with the doctor to monitor your child's development.

How long will the effects last?

Physical, educational, or other types of therapy may help reduce the long-term severity of the disability. In rare instances, symptoms may decrease with time.

How should I take care of someone with cerebral palsy?

If you are caring for a child or adult with cerebral palsy, be sure the person takes any drugs the doctor prescribes.

Most children with cerebral palsy develop slowly or have disabilities such as hearing, vision, or mobility problems that hamper their learning processes. They should be assisted in every way to overcome any barriers to learning and experiencing their environment.

Seek out physical, occupational, speech, and other professional therapists. Establish a support team including your doctor, therapists, social worker, pastor, and others. Have the person's mental ability and physical development frequently evaluated. Hearing and vision tests should also be scheduled frequently.

Find out about community and national organizations that can provide you additional resource material and referrals to other sources for assistance. One such organization is:

The United Cerebral Palsy Associations
1660 L Street, NW
Suite 700
Washington, DC 20036

(202) 776-0406 (Voice)
(202) 973-7197 (Voice - TDD)
(800) 872-5827 (Voice - Toll-free)

http://www.ucpa.org

Check with your doctor, hospital, and local social service agencies for the handicapped for more information.

What can be done to help prevent cerebral palsy?

It may be possible to reduce the risk of prenatal brain damage that causes cerebral palsy by taking measures during pregnancy such as:

• Guard your body as much as possible against infection.
• Avoid use of drugs and alcohol.
• Be sure to have had appropriate immunizations for diseases such as rubella (German measles) before pregnancy.

Check with your health care provider about other precautions to take in prenatal care including diet, exercise, and any medical conditions you may already have.

Research on cerebral palsy continues actively, so prevention may soon be available.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.