Cerebral Palsy

Symptoms

The symptoms of cerebral palsy can vary widely between sufferers. They usually appear before a child is 2 years old, sometimes beginning as early as 3 months. Parents may notice that their child is delayed in sitting up, rolling, crawling, or walking.

Symptoms of spastic cerebral palsy, the most common type, include:

  • Muscles that are very tight and do not stretch. They may tighten up even more over time.
  • An abnormal walk: arms tucked in towards the sides, knees crossed or touching, legs making “scissors” movements, walk on the toes
  • Joints are tight and do not open up all the way (‘joint contracture’)
  • Muscle weakness or loss of movement in a group of muscles (paralysis)

The symptoms may affect one arm or leg, one side of the body, both legs, or both arms and legs. The following symptoms may occur in other types of cerebral palsy:

  • Abnormal movements (twisting, jerking, or writhing) of the hands, feet, arms, or legs, which gets worse during periods of stress
  • Tremors
  • An unsteady gait
  • Loss of coordination
  • Floppy muscles, especially at rest, and joints that move around too much

Other brain and nervous system symptoms:

  • Decreased intelligence or learning disabilities are common, but intelligence can be normal
  • Speech problems (dysarthria)
  • Hearing or vision problems
  • Seizures
  • Pain, especially in adults, which can be difficult to manage

Outlook

Cerebral palsy is not a progressive condition: it does not therefore worsen as a child gets older. However, it can put a great deal of strain on the body, something which can lead to problems in later life. There is no cure for cerebral palsy, but a range of treatments can help relieve symptoms and increase a child’s sense of independence and self‐esteem. These include physiotherapy, occupational therapy and medication to relieve muscle stiffness and spasms. Stress and burnout among parents and other caregivers of cerebral palsy patients is common, and needs monitoring.

Expectations (The Prognosis)

Cerebral palsy is a lifelong disorder. Long‐term care may be required. The disorder does not affect life expectancy. The amount of disability varies. Many adults are able to live in the community, either independently or with different levels of help. In severe cases, however, the person may need institutional care.

Prevention

Receiving the proper prenatal care may cut the risk of some rare causes of cerebral palsy. However, dramatic improvements in care over the last 15 years have not lowered the rate of cerebral palsy. In most cases, the injury causing the disorder may not be preventable. Pregnant mothers with certain medical conditions may need to be followed in a high‐risk prenatal clinic.

The Numbers — UK

About Disability Generally (“SCOPE Impact Report 2011‐12”)

  • 4 in every 10 disabled children live in poverty.
  • The average cost of bringing up a disabled child is three times greater than for an able‐bodied child.
  • Parents of disabled children are likelier to divorce.
  • Only 32% of families with disabled children feel accepted by their local communities.
  • 52% of disabled people have experienced discrimination at work.
  • Close to 25% of disabled people who need adapted accommodation don’t have it.
  • 58% of disabled people have been victims of crime, 15% of whom believe it was directly motivated by their impairment.
  • One in three disabled people have been refused service or turned away from pubs, leisure centres, restaurants or other public places.

About Cerebral Palsy

“Life expectancy of children with cerebral palsy”; J L Hutton, K Hemming and UKCP collaboration

  • The current UK incidence rate is around 1 in 400 births.
  • Approximately 1,800 children are diagnosed with cerebral palsy every year.
  • There are an estimated 30,000 children with cerebral palsy in the UK.
  • There are more boys born with cerebral palsy than girls. For every 100 girls with cerebral palsy, there are 135 boys with cerebral palsy.
  • Just under a half of children with cerebral palsy were born prematurely (before 37 weeks).

References

  • Johnston MV. Encephalopathies. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 591.
  • Ashwal S, et al. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2004;62:851‐863. [PubMed]
  • Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society, Delgado MR, Hirtz D, Aisen M, et al. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence‐based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2010;74:336‐343. [PMC free article] [PubMed]
  • Sakzewski L, Ziviani J, Boyd R. Systematic review and meta‐analysis of therapeutic management of upper‐limb dysfunction in children with congenital hemiplegia. Pediatrics. 2009;123:e1111‐e1122. [PubMed]