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Cerebral Palsy – Diagnosis, Causes, and Treatment

The term cerebral palsy constitutes two words. The word cerebral means brain, and palsy means loss or impairment of motor functions. It is a medical condition that affects motor functions like movement of arms, legs etc. Although the disorder primarily affects the arms and legs, it can also frequently hinder vision, hearing and sensation. It occurs due to damage or abnormalities inside the developing brain, disrupting the brain’s ability to control movement and maintain posture and balance.

Cerebral palsy is one of the most widespread causes of disability in children. A study by the Centre for Disease Control and Prevention (CDC) suggests that cerebral palsy affects 1 to 4 out of every 1000 children globally. 

Cerebral Palsy: An Overview

This is a group of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination. Cerebral palsy affects the brain’s outer layer (called the cerebral cortex), the part of the brain that directs muscle movement. In some cases, the cerebral motor cortex does not develop normally during foetal growth. However, in others, it results from an injury to the brain either before, during, or after birth. In either case, the damage is not repairable, and the disabilities that result are permanent.

You can classify cerebral palsy through various Gross Motor Function Classification System (GMFCS) levels, ranging from 1 to 5. A higher level indicates the severity of cerebral palsy in individuals. GMFCS looks at movements such as sitting, walking, and mobility devices. It is helpful because it provides families and clinicians with:

A clear description of a child’s current motor functionAn idea of what equipment or mobility aids a child may need in the future, e.g. crutches, walking frames or wheelchairs.

As per research, generally, a child or young person over the age of 5 may not improve their GMFCS-E&R level. For example, a child classified as Level IV at the age of 6 will need a mobility device throughout their life.

Here are the five different levels of cerebral palsy.

Level 1 Cerebral Palsy (GMFCS Level 1)

It is a mild syndrome where a child can walk without any hindrance. For example, a level-1 child can walk without much trouble, climb stairs without using a railing etc. In addition, they can perform gross motor skills such as running and jumping. However, speed, balance and coordination are limited.

Level 2 Cerebral Palsy (GMFCS Level 2)

Like level-1, a child can walk without any hindrance. However, it will be slightly more challenging than level-1. For example, a child can walk in most settings and climb stairs holding onto a railing. However, they will find difficulty walking long distances and balancing on uneven terrain, inclines, crowded areas, or confined spaces. In addition, a child can walk with physical assistance, a handheld mobility device or wheeled mobility for a long distance. The biggest challenge that children can face in level-2 is in performing gross motor skills like running and jumping. That is because they will only have a minimal ability to do so.

Level 3 Cerebral Palsy (GMFCS Level 3)

Level-3 allows a child to stand without any support. But, they might need some help to sit correctly. For example, a child can walk using a hand-held mobility device in most indoor settings. In addition, they can climb stairs by holding onto a railing with supervision or assistance. However, a child will have to use wheeled mobility when travelling long distances and may self-propel for shorter distances.

Level 4 Cerebral Palsy (GMFCS Level 4)

Level-4 would require assistive devices like a stick to move around. In addition, it would need the help of a wheelchair and some support to sit. For example, children use methods of mobility that require physical assistance or powered mobility. Furthermore, they may walk for short distances at home with physical help or use powered mobility or a body support walker. However, in social settings like a school or outdoors, a level-4 child would need a manual wheelchair or will have to use powered mobility.

Level 5 Cerebral Palsy (GMFCS Level 5)

It is the highest GMFCS level that is the most challenging. The condition forces a child to use supporting devices even to maintain the position of their head and neck. In addition, they need support while standing and sitting and can move around only in a wheelchair. Furthermore, children and their parents have to use a manual wheelchair to transport them in all settings. As a result, the movement abilities and children’s ability to maintain antigravity head and trunk postures and control leg and arm movements are limited.

Cerebral Palsy: Common Symptoms

The symptoms of cerebral palsy vary in different individuals as per their levels and types. These symptoms generally appear at a young age, either in infancy or in the child’s preschool years. However, most of these symptoms are not apparent until 2 or 3 years after the child’s birth. 

Following is a list of symptoms that different individuals may show if they are affected by cerebral palsy.

Movement and Coordination

Some of the most common symptoms associated with movement and coordination in cerebral palsy are:

Spasticity

Itis the most common movement disorder in people with cerebral palsy. It leads to exaggerated reflexes and stiff muscles. 

Rigidity

It leads to normal reflexes and stiff muscles. 

Ataxia

It results in a lack of muscle coordination and hence the difficulty in balancing.

Difficulty Walking

There can be many ways individuals may walk if they have cerebral palsy. These may include a scissors-like gait, a crouched gait, or a wide or asymmetrical gait.

Other Symptoms

Muscles are too soft and floppy, so much that they can appear wholly disconnected from the body.Jerky, uncoordinated movements that are often involuntary.Slow and involuntary movements are also common.Strength only in one side of the body, meaning that the affected individual will predominantly use the strong side of the body. For example, the affected individual will step out with one foot and drag the other to move the body forward.Individuals may experience difficulty doing simple day to day tasks like picking up an object, tying shoelaces or buttoning a shirt.

Speech and Eating Issues

Cerebral palsy may also lead to delays in speech development in a child. Even when they start speaking, these children may have difficulty speaking and fail to pronounce some words. In addition, they may pause abruptly or speak too fast at times. 

Children going through the disorder can have problems eating because of improper muscle coordination. Furthermore, improper muscle coordination can lead to difficulty in chewing and swallowing. With swallowing, there can be a problem of excessive drooling as well.

Delayed Development

Cerebral palsy can also lead to developmental delays, both physical and intellectual. 

The physical development issues will make individuals affected with cerebral palsy have difficulty crawling and standing up. As a result, crawling and standing up for them are delayed compared to children who do not have cerebral palsy. With regards to intellectual development, they may have problems learning.

Other Issues

The problems mentioned above are the most common ones as far as cerebral palsy is concerned. However, there may be other problems that a person with cerebral palsy may face. These include seizures, difficulty hearing, abnormal eye movements and issues in vision, pain sensations, bladder and bowel problems and even mental illness conditions like behavioural problems and emotional disorders.

Types of Cerebral Palsy

There are four significant kinds of cerebral palsy depending upon the part of the brain they affect. 

Spastic Cerebral Palsy

It is the most common form of cerebral palsy. As per a study, it affects nearly 80% of people who have cerebral palsy. Spastic cerebral palsy can affect one side or both sides of the body. It causes muscles to become rigid and stiff and reflexes to become more exaggerated. As a result, it causes walking disabilities and makes walking difficult. Furthermore, it also makes it challenging to perform other activities like reading, writing, eating, brushing teeth, bathing etc.

Dyskinetic Cerebral Palsy

Individuals affected by this condition find trouble controlling their body movements. Dyskinetic cerebral palsy generally leads to uncontrollable, involuntary movements slow, rapid and jerky in the arms and legs. However, sometimes these movements can also affect the tongue and face. As a result, dyskinetic cerebral palsy makes it difficult to sit, walk, swallow and talk.

Ataxic Cerebral Palsy

It is the least common form of cerebral palsy. Unlike the other conditions, ataxic cerebral palsy leads to voluntary movement of the muscles that appear to be jerky. It leads to a lack of coordination and trouble balancing.

Hypotonic Cerebral Palsy

Hypotoniccerebral palsy affects an individual’s muscles by making them overly relaxed. The muscles become so relaxed that it diminishes muscle tone in this condition. In addition, the arms and legs don’t move in tandem with the rest of your body. As a result, individuals with these disorders face problems like difficulty speaking, poor reflexes, and walking abnormalities as they grow up.

It is common to have symptoms from all the above types of cerebral palsy. This condition is known as mixed cerebral palsy.

Cerebral Palsy: Causes

Cerebral palsy is a result of neurological disorders. It can happen in a mother’s womb or immediately after birth. Hence, several causes can result in cerebral palsy in a child. However, in most cases, the condition is not known. 

Here are some of the common causes.

Pre-Birth Causes

Fetal Stroke or Hypo-Oxygenemia: Reduced blood or oxygen supply to the brain.Infection caught by the mother: Rubella, chickenpox etc.An injury to the unborn baby’s head in the womb can also lead to cerebral palsy.

Post-Birth Causes

A severe head injury in the early yearsA strokeBrain not getting enough oxygen (maybe due to nearly choking or drowning)

Cerebral Palsy: Diagnosis

Most children with cerebral palsy are diagnosed during the first two years. However, if the symptoms are mild, it can be challenging for a doctor to make a reliable diagnosis before 4 or 5.

The primary level of diagnosis involves a thorough physical examination of the child. The doctor will assess the child’s development, growth, muscle tone, age-appropriate motor control, hearing and vision, posture, and coordination. That will help them rule out the possibilities of other disorders that could cause similar symptoms. Although symptoms can change over time, cerebral palsy is not progressive. Therefore, if a child continuously loses motor skills, the problem is a condition other than CP. For example, it can be a genetic or muscle disease, metabolism disorder, or tumours in the nervous system.

Besides a physical examination, a doctor can recommend some lab tests to diagnose the brain injury that causes the problem. Some of the standard tests are:

Cranial UltrasoundComputed TomographyMagnetic Resonance Imaging (MRI)

Cerebral Palsy: Treatment

Although there is no permanent cure for cerebral palsy, some treatments and practices can improve a child’s symptoms. As per a study, these practices and treatments include medications, therapies and surgical procedures. The exact choice of these procedures depends upon the specific symptoms that the child undergoes.

Therapies

Like treatments, there is no standard therapy for cerebral palsy. Instead, a healthcare professional will diagnose the child’s impairment to understand the symptoms and affected motor movements. Then, they will work with a child and their parents to develop an appropriate plan to tackle the core disabilities that affect the child’s quality of life. 

Many children go on to enjoy near-normal adult lives if they successfully manage their disabilities. The earlier treatment begins, the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them. Hence, it is essential to rely on therapies under an expert’s guidance to ensure that the child can lead an everyday life with CP disorders. 

Physical Therapy

It usually begins in the first few years of life or soon after diagnosis. this is one of the best therapies for children with cerebral palsy. It involves specific exercises like resistive or strength training programs to help the child develop more strength. In addition, it involves activities to help maintain or improve muscle strength, balance, and motor skills and prevent contractures. In addition, healthcare experts also recommend using special braces (called orthotic devices) to improve mobility and stretch spastic muscles.

Occupational Therapy

Occupational therapy focuses on optimising upper body function, improving posture, and making the most of a child’s mobility. The therapists help individuals address new ways to perform their everyday activities such as dressing, going to school, and participating in day-to-day activities.

Recreation Therapy

Recreation therapy encourages children to participate in art and cultural programs, sports, and other events. It helps them expand physical and cognitive skills and abilities. Children’s parents usually notice an improvement in their condition after participating in recreational therapies. These improvements are primarily in their child’s speech, self-esteem, and emotional well-being.

Speech and Language Therapy

Speech and language therapy helps improve a child’s ability to speak more clearly and helps combat swallowing disorders. Children learn new ways to communicate using sign language or special communication devices such as a computer with a voice synthesiser or a special board covered with everyday objects and symbols. That way, the child can point to indicate their wishes, making communication easier.

Eating and Drooling Disorder Treatments

Treatments for problems with eating and drooling are often necessary when children with CP have difficulty eating and drinking. That is because the child has little control over the muscles that move their mouth, jaw, and tongue. As a result, they are also at risk of letting the food or liquid enter the windpipe next to the food pipe. It happens during a breath because that is when your windpipe is open. Furthermore, they are also at risk of malnutrition, recurrent lung infections, and progressive lung disease.

Medications

Muscle or nerve injections and oral muscle relaxants are the standard medical procedures to treat the patient. In addition, doctors can also give medications to reduce drooling. Drugs/medicines generally work well to reduce muscle stiffness, treat pain, manage complications and improve functionality. 

Surgical Procedures

Orthopaedic surgery: Children with severe cerebral palsy may need orthopaedic surgery to place their arms or legs in the correct positions.Severing Specific Nerve Fibres includes cutting the nerves connected to a specific spastic muscle. It may help ease muscle stiffness. 

Conclusion

Cerebral palsy is a condition of a group of disorders that hinder movement and muscle tone or posture. It is a medical condition caused before birth or soon after birth. Children suffering from this condition usually require medical care throughout their lives. Medical care helps in making daily tasks easier. However, the exact choice of these procedures depends upon the specific symptoms that the child is experiencing. Standard methods include medications, therapies and surgical procedures. Regardless of the type and severity of the condition, proper management can help improve the quality of life in people who have cerebral palsy. 

Q. Are cerebral palsy patients immunocompromised?   

A. There are two significant causes of weaker immunity in patients with cerebral palsy. The first one is poor nutrition. That is because some patients having cerebral palsy may have problems eating and swallowing, causing them to have limited nutrition intake. The other reason is that they can do very minimal activity due to their condition. During the recent Covid pandemic, an advisory said that patients with cerebral palsy had a higher risk of contracting the disease. Similarly, as per a study, patients with cerebral palsy have a higher risk of developing respiratory disorders from Covid 19. 

Q. Are cerebral palsy babies fussy?

A. Although there is no conclusive evidence to prove that, in some cases, they might be fussy. Some forms of cerebral palsy are also painful. So it can sometimes be the pain that causes the baby to act up. 

Q. Are cerebral palsy and autism linked?

A. There is no direct link between the occurrence of cerebral palsy and autism. However, since the causes of origin are common, they often occur together. Research also proves that cerebral palsy and autism can often occur together.

Q. Is cerebral palsy genetic?

A. Cerebral palsy is not an inherited disorder. It results from a severe head injury or a limited oxygen supply to the baby’s brain. Hence, it would not be accurate to say it is a genetic disorder. 

Q. Is cerebral palsy progressive?

A. No, cerebral palsy is a non-progressive disorder. The injury in the brain remains the same throughout one’s life. However, the associated symptoms may change over time, for better or worse. Hence, consult a doctor if your child shows progressive signs because it can be due to a similar disorder. 

Q. Is cerebral palsy curable?

A. There is no cure for cerebral palsy. Children suffering from this condition usually require medical care throughout their lives. There are several ways in which proper treatment can improve the affected child’s day to day functioning. These include medications, therapies and surgical procedures. The exact choice of these procedures depends upon the specific symptoms that the child is experiencing. 

Q. Can cerebral palsy be detected before birth?

A. No, it is not possible to detect cerebral palsy before birth. Cerebral palsy is caused before birth or just after birth. But the symptoms are usually visible once the child turns 2 or 3 years. So it is not possible to detect cerebral palsy before birth. 

Q. Does cerebral palsy affect the brain?

A. Yes, cerebral palsy affects the brain.Cerebral palsy, when broken down etymologically, means weakness of the brain. So all the symptoms of cerebral palsy are caused by impairment or damage to the brain. For example, muscle coordination, the ability to speak, and maintaining balance are all brain functions.   

Q. Does cerebral palsy go away?

A. Cerebral palsy never goes away. The damage in the brain remains as it is. However, the conditions associated with it may improve or worsen over time. There are several ways in which proper treatment can improve the affected child’s day to day functioning. These include medications, therapies and surgical procedures. The exact choice of these procedures depends upon the specific symptoms that the child is experiencing. 

Q. Does my baby have cerebral palsy?

A. Cerebral palsy results from neurological damage before or after birth, but the symptoms are usually visible once the child turns 2 or 3 years old. If you see signs like exaggerated reflexes, improper muscle coordination, hearing impairment, floppiness of muscles or a combination of all of these symptoms, you must see a doctor. A formal diagnosis will help ascertain if your child has cerebral palsy.

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