Cerebral palsy is a permanent physical condition that affects muscle control. It is caused by damage to, or lack of development in, a part of the brain that controls movement. Cerebral palsy is the most common physical disability in childhood occuring in one in every 500 babies. Cerebral palsy is often called ‘CP’ for short.

Cerebral palsy causes problems with motor control and co-ordination.  For example, weakness and stiffness in muscles, awkwardness, slowness, shakiness and difficulties with balance.

A child with cerebral palsy may have slight clumsiness in one arm or leg (monoplegia), or one side of the body may be affected (hemiplegia).  There may be muscle control issues in mostly the lower limbs (diplegia), or in both arms and legs and the torso (quadriplegia).

Other difficulties can include problems with speech, hearing or vision; epilepsy; intellectual or learning difficulties; perceptual difficulties such as judging the size and shape of objects; gastro-oesophageal reflux (heartburn); orthopaedic problems (ie problems with bones); constipation; feeding difficulties; saliva control problems; or repeated chest infections.

There is a wide range of intellectual ability in children with cerebral palsy. Children with even a very severe physical disability can have completely normal intelligence.

There are three types of cerebral palsy:

1. Spastic cerebral palsy is the most common type. Spasticity means stiff or tight muscles. The muscles are stiff because the messages to the muscles are being sent incorrectly from the damaged parts of the brain.

2. Dyskinetic cerebral palsy is when there are abnormal involuntary movements. There are three different types of movement problems:
   i. Dystonia is when there is frequent twisting or repetitive movements, or abnormal postures.
   ii. Athetosis is when there is uncontrolled extra movement particularly in the arms, hands and feet, and around the mouth. This lack of control is most obvious when the child starts to move, for example when the child tries to grasp a toy or a spoon. Also, children with athetoid cerebral palsy often have very weak muscles or feel floppy when carried.
   iii. Chorea is when there are rapid and jerky involuntary movements.
3. Ataxic cerebral palsy (or ataxia) is the least common type. Children with ataxia have unsteady shaky movements or tremors, and problems with balance. Some ataxic children also have dystonia. This means that they have involuntary muscle contractions (muscle contractions that they cannot control) causing abnormal movements and/or postures.

Many children have a mixture of several of these movement patterns.

Causes of cerebral palsy

There are many different causes of cerebral palsy. A problem with the brain can occur:

• If the baby’s brain does not form or grow properly during pregnancy.
• During labour, for example if the baby does not receive enough oxygen.
• In the first few days or weeks of life.  For example, when an infant develops a severe infection such as meningitis, or when there has been bleeding into part of the brain.
• In children who have had an accident that has caused a permanent brain injury in the first two years of life.
• Children born extremely prematurely are particularly at risk of developing cerebral palsy.

In some children, despite a careful review and various tests, the cause of cerebral palsy remains unknown. With new technologies such as MRI brain scans and sophisticated blood tests, more causes are slowly being identified.

Management of cerebral palsy

Management of cerebral palsy is focused on the problems of muscle control and movement, and the treatment of additional health issues. Empowering, supporting and educating families is the most important aspect of care.

Treatment includes:

• Physiotherapy and occupational therapy to encourage motor development.
• Orthotics for the lower limbs and splints for the upper limbs.
• Botulinum toxin A (Botox) to relax tight muscles. This is given by injection and requires light anaesthesia.
• Oral medications including diazepam and baclofen.
• Intrathecal baclofen, ie the medication is delivered into the space around the spinal cord.
• Orthopaedic surgery such as soft tissue surgery for the hip, or hamstring surgery for the knee.
• Plastic surgery including tendon transfers and releases to improve arm use.
• Speech pathology to help with any communication problems and to provide help with eating, drinking or saliva problems.

You’ll find much more detailed information in the booklet ‘Cerebral Palsy – an information guide for parents‘ published by the RCH.  Download the booklet by clicking on this link: CPBooklet.pdf (40 pages).