Cerebral palsy (CP) is an abnormality

of motor function (as opposed to mental

function) and postural tone that is
acquired at an early age, even before
birth. Signs and symptoms of cerebral
palsy usually show in the first year of life.
This abnormality in the motor system
is the result of brain lesions that are non-
progressive. The motor system of the
body provides the ability to move and
control movements. A brain lesion is any
abnormality of brain structure or function.
"Non-progressive" means that the lesion
does not produce ongoing degeneration of
the brain. It is also implies that the brain
lesion is the result of a one-time brain
injury, that will not occur again. Whatever
 Cerebral palsy affects
approximately one to three out of every
thousand children born. However, it is
much higher in infants born with very low
weight and in premature infants.
Interestingly, new treatment
methods that resulted in an increased
survival rate of low-birth weight and
premature infants actually resulted in an
overall increase number of children with
cerebral palsy. The new technologies,
however, did not change the rate of
cerebral palsy in children born full term
and with normal weight.
 Many cases of CP have unknown
causes. The disorder occurs when there is
abnormal development or damage to areas
in the brain that control motor function. It
occurs in approximately two to three out of
every 1,000 live births. Risk factors for CP
include the following:
prematurity
very low birthweight (especially in
babies weighing less than 1,000
grams, or 2.2 lbs.)
viruses
chemical/substance abuse during
pregnancy
infection
bleeding in the brain
trauma
 The following are the most common
symptoms of CP. However, each child may
experience symptoms differently. The child
may have muscle weakness, poor motor
control, or have shaking, also called
spasticity, of the arms or legs. Muscle
stiffness in the form of stiff legs or clenched
fists may also be seen. Cerebral palsy is
classified according to the kind of motor
function the child may have, including the
following:
spastic diplegia ("di" - means two) - spastic
movements of the arms or legs. Diplegia is also
called paraplegia.

spastic quadriplegia ("quad" means four) -

spastic movements in all four limbs (arms and
legs).

spastic hemiplegia ("hemi" means half) -

spasticity affecting one half, or side, of the
body (such as right arm and right leg).

spastic double hemiplegia - spasticity in both

sides of the body, but the amount of shaking is
different when comparing the right side to the
left side.
 Children with CP may have additional
problems, including the following:

seizures
vision, hearing, or speech problems
learning disabilities and behavior
problems
mental retardation
respiratory problems
bowel and bladder problems
bone abnormalities, including
scoliosis (a lateral, or sideways,
curvature and rotation of the back
bones, giving the appearance that the
person is leaning to one side)
 Babies with CP are often slow to
reach developmental milestones, such
as learning to roll over, sit, crawl, or
walk. They may also have certain
reflexes present that normally
disappear in early infancy. The
symptoms of CP may resemble other
conditions. Always consult your child's
physician for a diagnosis.
 The diagnosis of CP is made with a
physical examination. During the examination,
the physician obtains a complete prenatal and
birth history of the child. The diagnosis of CP
is not usually made until the child is at least 6
to12 months old. This is the time when the
child should be achieving developmental
milestones, such as walking, and hand and
head control. Diagnostic tests may include the
neurological examination (to evaluate
following:
reflexes and brain/motor function)

x-rays - a diagnostic test which uses

invisible electromagnetic energy beams to
produce images of internal tissues, bones,
and organs onto film.
electroencephalogram (EEG) - a procedure
that records the brain's continuous,
electrical activity by means of electrodes
attached to the scalp.

blood tests

gait lab analysis (to evaluate the walking

pattern of the child)

magnetic resonance imaging (MRI) - a

diagnostic procedure that uses a
combination of large magnets,
radiofrequencies, and a computer to
produce detailed images of organs and
computed tomography scan (Also called
CAT or CT scan.) - a diagnostic imaging
procedure that uses a combination of x-
rays and computer technology to produce
cross-sectional images (often called
slices), both horizontally and vertically, of
the body. A CT scan shows detailed images
of any part of the body, including the
bones, muscles, fat, and organs. CT scans
are more detailed than general x-rays.

genetic studies - diagnostic tests that

evaluate for conditions that have a
tendency to run in families.

metabolic tests - diagnostic tests that

evaluate the absence or lack of a specific
 Specific treatment for cerebral palsy
will be determined by your child's
physician based on:
your child's age, overall health, and
medical history

the extent of the disease

the type of CP

your child's tolerance for specific

medications, procedures, or
therapies

expectations for the course of the

disease
 Since CP is a life-long condition that is
not correctable, management includes
focusing on preventing or minimizing
deformities and maximizing the child's
capability at home and in the community. A
child is best treated with an interdisciplinary
team that may include
pediatrician/family the following
practitioner
healthcare providers:
orthopaedic surgeon - a surgeon who
specializes in conditions of the muscles,
ligaments, tendons, and bones.

neurologist - a physician who specializes

in conditions of the brain, spinal cord, and
nerves.

neurosurgeon - a surgeon who specializes

ophthalmologist - a physician who
specializes in eye problems.

Dentist

Nurse

orthotist - an individual who specializes in

making braces and splints.

rehabilitation team (i.e., physical,

occupational, speech therapy, audiology)
 Management of CP includes non-surgical
and surgical options.

Non-surgical interventions may include:

Rehabilitation

positioning aids (used to help the

child sit, lie, or stand)

braces and splints (used to prevent

deformity and to provide support or
protection)

medications (used to help control

seizures or to decrease spasticity in
the muscles; the medications may be
 Surgical interventions may be used to
manage the following conditions:

orthopaedic problems that may

include managing curvatures in the
back, hip dislocations, ankle and foot
deformities, and contracted muscles

spasticity
 A child with cerebral palsy may be
hospitalized for orthopedic surgery to
correct contractures and for treatment of
other complications.
Assign the child a room with children in
the same age-group.

Speak slowly and distinctly. Encourage

the child to ask for things he wants. Listen
patiently and don’t rush him.

During meals, maintain a quiet,

unhurried atmosphere with as few
distractions as possible. The child may
need special utensils and a chair with a
solidfootrest. Teach him to place food far
back in his mouth to facilitate swallowing.
Encourage the child to chew food
thoroughly, drink through a straw, and suck
on a lollipop between meals to develop the
muscle control needed to minimize drooling.

Allow the child to wash and dress

independently, assisting only as needed.

Give all care in an unhurried manner;

otherwise, muscle spasticity may increase.

Encourage the child and his family to

participate in the care plan so they can
continue it at home.

Minimize muscle spasms that increases

postoperative pain by moving and turning
After orthopedic surgery, give good cast
care. Wash and dry the skin at the edge of the
cast frequently, and rub it with alcohol.
Reposition the child often, check for foul odor,
and ventilate under the cast with a blow
dryer. Use a flashlight to check for skin
breakdown beneath the cast. Help the child
relax, perhaps by giving a warm bath, before
reapplying a bivalved cast. Help parents deal
with their child’s handicap.

A good understanding of normal growth and

development will enable you to work with
parents to set realistic goals.

Assist in planning crafts and other activities.

Stress the child’s need to develop peer
relationships; warn against being
overprotective.

Identify and deal with family stress.

Parents may feel unreasonable guilt about
their child’s handicap and may need
psychologic counseling.

Make a referral to supportive community

organizations.