Cerebral palsy, or CP, is a group of disorders that affect balance, movement, and muscle tone.

“Cerebral” means the disorder is related to the brain, and “palsy” refers to weakness or a muscle
problem.

CP starts in the area of the brain that controls the ability to move muscles. Cerebral palsy can
happen when that part of the brain doesn’t develop as it should, or when it is damaged right
around the time of birth or very early in life.

Most people with cerebral palsy are born with it. That’s called “congenital” CP. But it can also
start after birth, in which case it’s called “acquired” CP.

People with cerebral palsy can have mild issues with muscle control, or it could be so severe that
they can’t walk. Some people with CP have difficulty speaking. Others have intellectual
disabilities, while many have normal intelligence.

What Causes It?

 Bleeding in the brain while the baby is in the womb, during birth or afterward
 A lack of blood flow to important organs
 Seizures at birth or in the first month of life
 Some genetic conditions
 Traumatic brain injuries

Am I at Risk for Having a Child With CP?

You may have a condition while you’re pregnant that can increase the chances your baby will
have CP. Among them are:

 Being pregnant with multiples, such as twins or triplets

 Having a health issue such as seizures or a problem with your thyroid gland
 Having blood that’s not compatible with your baby’s, which is also called Rh disease
 Coming in contact with a toxic substance such as mercury, which is found in some kinds
of fish

Certain infections and viruses, when they strike during pregnancy, can increase the risk your
baby will be born with cerebral palsy. They include:

 Rubella, or German measles, a viral illness that can be prevented with a vaccine
 Chickenpox, also called varicella (a vaccine can prevent this contagious illness.)
 Cytomegalovirus, which causes flulike symptoms in the mother
 Herpes, which can be passed from mother to unborn child and can  damage the baby’s
developing nervous system
 Toxoplasmosis, which is carried by parasites found in soil, cat feces and tainted food
 Syphilis, a sexually transmitted bacterial infection
  Zika, a virus carried by mosquitoes
Medications

Medications that can lessen the tightness of muscles may be used to improve functional abilities,
treat pain and manage complications related to spasticity or other cerebral palsy symptoms.

It's important to talk about drug treatment risks with your doctor and discuss whether medical
treatment is appropriate for your child's needs. Medication selection depends on whether the
problem affects only certain muscles (isolated) or the whole body (generalized). Drug treatments
may include the following:

 Isolated spasticity. When spasticity is isolated to one muscle group, your doctor may
recommend onabotulinumtoxinA (Botox) injections directly into the muscle, nerve or
both. Botox injections may help to improve drooling. Your child will need injections
about every three months.

Side effects may include pain, mild flu-like symptoms, bruising or severe weakness.
Other more-serious side effects include difficulty breathing and swallowing.

 Generalized spasticity. If the whole body is affected, oral muscle relaxants may relax
stiff, contracted muscles. These drugs include diazepam (Valium), dantrolene (Dantrium)
and baclofen (Gablofen).

Diazepam carries some dependency risk, so it's not recommended for long-term use. Its
side effects include drowsiness, weakness and drooling.

Dantrolene side effects include sleepiness, weakness, nausea and diarrhea.

Baclofen side effects include sleepiness, confusion and nausea. Note that baclofen may
also be pumped directly into the spinal cord with a tube. The pump is surgically
implanted under the skin of the abdomen.

Your child also may be prescribed medications to reduce drooling. Medications such as
trihexyphenidyl, scopolamine or glycopyrrolate (Robinul, Robinul Forte) may be helpful, as can
Botox injection into the salivary glands.

Therapies

A variety of nondrug therapies can help a person with cerebral palsy enhance functional abilities:

 Physical therapy. Muscle training and exercises may help your child's strength,
flexibility, balance, motor development and mobility. You'll also learn how to safely care
for your child's everyday needs at home, such as bathing and feeding your child.
 For the first 1 to 2 years after birth, both physical and occupational therapists provide
support with issues such as head and trunk control, rolling, and grasping. Later, both
types of therapists are involved in wheelchair assessments.

Braces or splints may be recommended for your child. Some of these supports help with
function, such as improved walking. Others may stretch stiff muscles to help prevent
rigid muscles (contractures).

 Occupational therapy. Using alternative strategies and adaptive equipment,

occupational therapists work to promote your child's independent participation in daily
activities and routines in the home, the school and the community.

Adaptive equipment may include walkers, quadrupedal canes, seating systems or electric
wheelchairs.

 Speech and language therapy. Speech-language pathologists can help improve your
child's ability to speak clearly or to communicate using sign language.

Speech-language pathologists can also teach your child to use communication devices,
such as a computer and voice synthesizer, if communication is difficult.

Another communication device may be a board covered with pictures of items and
activities your child may see in daily life. Sentences can be constructed by pointing to the
pictures.

Speech therapists may also address difficulties with muscles used in eating and
swallowing.

 Recreational therapy. Some children may benefit from recreational therapies, such as
therapeutic horseback riding. This type of therapy can help improve your child's motor skills,
speech and emotional well-being.

Surgical or other procedures

Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by
spasticity. These treatments include:

 Orthopedic surgery. Children with severe contractures or deformities may need surgery
on bones or joints to place their arms, hips or legs in their correct positions.

Surgical procedures can also lengthen muscles and tendons that are proportionally too
short because of severe contractures. These corrections can lessen pain and improve
mobility. The procedures may also make it easier to use a walker, braces or crutches.
  Severing nerves. In some severe cases, when other treatments haven't helped, surgeons may
cut the nerves serving the spastic muscles in a procedure called selective dorsal rhizotomy. This
relaxes the muscle and reduces pain, but can also cause numbness.

Cerebral palsy can affect a person’s posture, balance and ability to move, communicate, eat,
sleep and learn.

The parts of the body affected by cerebral palsy, the level of severity and combination of
symptoms can differ for each person. For example, one person may have a weakness in one hand
and find tasks like writing or tying shoelaces challenging. Another person may have little or no
control over their movements or speech and require 24 hour assistance.

People with cerebral palsy may experience uncontrolled or unpredictable movements, muscles
can be stiff, weak or tight and in some cases people have shaky movements or tremors. People
with severe cerebral palsy may also have difficulties with swallowing, breathing, head and neck
control, bladder and bowel control, eating and have dental and digestive problems.

1 in 3
is unable to walk

1 in 4
is unable to talk

1 in 10
has a severe vision impairment
3 in 4
experience pain

1 in 4
has epilepsy

1 in 2
has an intellectual impairment

Mobility issues
1 in 3 children with cerebral palsy will be unable to walk. At greatest risk are those who have spastic
quadriplegia, intellectual disability, epilepsy, vision impairment and an inability to sit independently at 2
years of age.See:

 Ankle Foot Orthoses

 Conductive education
 Constraint-induced movement therapy for the leg (CIMT-Leg)
 Early motor intervention
 Hydrotherapy for adolescents and adults
 Massage for pain and movement
 Powered mobility
 Treadmill training for people with cerebral palsy

Communication issues

Cerebral palsy can affect a person’s ability to finely coordinate the muscles around the mouth
and tongue that are needed for speech. The coordinated breathing that is needed to support
speech can also be affected, e.g. some people may sound ‘breathy’ when they speak. Some
people with cerebral palsy may not be able to produce any sounds, others may be able to produce
sounds but have difficulty controlling their movement enough to produce speech that is clear and
understood by others. 1 in 4 people with cerebral palsy cannot talk.

See:

 Communication Partner Training

 Conductive education
 Eye-gaze technology
 Speech generating devices
 Speech therapy for children with dysarthria

Pain

3 in 4 people with cerebral palsy experience pain. Pain is often a result of the impairments that
are associated with cerebral palsy, e.g. contractures, abnormal postures, dystonia, skin
breakdown, hip subluxation, Gastro-oesophageal reflux and scoliosis. This pain can affect a
person’s behavior, their ability to do things for themselves, to sleep and their social relationships.
People might avoid day-to-day tasks that are important for independence, such as attending
school and social events. Pain can be relieved, so it is best to be guided by your medical
practitioner.

See:

 Botulinum Toxin-A injections for supporting pain and comfort

 Cognitive-behaviour therapy for pain
 Gastrostomy feeding
 Hydrotherapy for adolescents and adults
 Massage for pain and movement
 Sleep positioning systems

Eating and drinking issues

Cerebral palsy can affect the muscles that open and close the mouth and move the lips and the
tongue. Some people with cerebral palsy may have difficulties in chewing and swallowing food
and drink – a condition known as dysphagia. Because cerebral palsy often impacts fine motor
skills, many people are unable to easily use cutlery, hold a cup, or transfer food from a plate to
their mouth using their hands. Others may suffer from gastroesophageal reflux – where acid from
the stomach rises into the esophagus – which makes eating uncomfortable or painful. This can
sometimes be controlled by medication.1 in 15 people with cerebral palsy are unable to take food
through their mouth and need to be fed through a feeding tube.

See:

 Gastrostomy feeding
 Modified foods and thickened fluids
Saliva control

Because cerebral palsy can affect the muscles around the mouth, 1 in 5 children with cerebral
palsy have saliva loss (also known as dribbling, drooling or sialorrhoea). The saliva loss may be
more noticeable when they are concentrating on doing other tasks.

Intellectual disability

1 in 2 people with cerebral palsy have an intellectual disability. 1 in 5 people have a moderate to
severe intellectual disability. Generally, the greater the level of a person’s physical impairment,
the more likely it is that they will have an intellectual disability. However, there are people who
have a profound level of physical impairment, who do not have an intellectual disability.
Conversely, there can be others with a mild physical impairment who have an intellectual
disability.

Learning difficulties

Children with cerebral palsy may experience specific learning difficulties. These may include a
short attention span, motor planning difficulties (organisation and sequencing of movement),
perceptual difficulties and language difficulties. These can impact on literacy, numeracy and
other classroom skills and activities. Learning may also be affected by difficulties in fine motor
and gross motor coordination and communication. Students with cerebral palsy need to put more
effort into concentrating on their movements and sequence of actions than others, so they may
tire more easily.

Hearing impairment

1 in 20 people with cerebral palsy also have some level of hearing impairment. 1 in 25 children
with cerebral palsy are deaf.

Vision impairment

Vision impairment is not uncommon in people with cerebral palsy. Children with the more
severe forms of cerebral palsy are more likely than others to experience myopia, absence of
binocular fusion, dyskinetic strabismus (also known as ‘turned eye’ or ‘squint’), severe gaze
dysfunction, and optic neuropathy or cerebral visual impairment. 1 in 10 children with cerebral
palsy are blind.

Behavior and emotional wellbeing

One in 4 children with cerebral palsy have behaviour problems. At greatest risk are those with an
intellectual disability, epilepsy, severe pain or a milder level of physical disability. Problem
behaviors include dependency, being headstrong, hyperactive, anxious, or prone to conflict with
their peer group, or exhibiting antisocial behaviours. Children with cerebral palsy may also have
emotional problems such as difficulties with their peer group and strong emotional responses to
new challenges. Teenagers and adults with cerebral palsy may be more prone to depression and
anxiety disorders.

See:

 Cognitive behaviour therapy for anxiety

 Counselling at the Time of Diagnosis
 Solution focused brief therapy
 Stepping Stones Triple P parenting program

Epilepsy

1 in 4 children with cerebral palsy have epilepsy. When children have cerebral palsy and an
intellectual disability, the incidence of epilepsy is higher – 48%. Seizures can affect speech,
intellectual and physical functioning. Medication is the most effective intervention for epilepsy
and the child’s doctor or therapist may also recommend modifications to the student’s school
supports and equipment. Some medications have side effects which cause drowsiness or
irritability. Both epilepsy and the related medication can affect a person’s behavior and attention
span.

Sleep issues

1 in 5 children with cerebral palsy have a sleep disorder. There are a range of contributing
factors, including the muscle spasms associated with cerebral palsy, other forms of musculo-
skeletal pain, and decreased ability to change body position during the night. Epilepsy is also
known to disturb sleep and is likely to predispose to sleep disorders. Blindness or severe visual
impairment can affect the timing and maintenance of sleep through their effect on melatonin
secretion and the lack of light perception.

See:

 Behavioural interventions for children’s sleep problems

 Sleep positioning systems

Spinal and hip abnormalities

Abnormalities of the spine and hips are associated with cerebral palsy and can make sitting,
standing and walking difficult, and cause chronic pain. 1 in 3 children with cerebral palsy have
hip displacement. Children and adults who have a severe physical disability or those whose body
is affected on both sides are at greater risk of hip problems. This means that people who use
wheelchairs most of the time are more at risk of hip problems than those who walk with assistive
devices or independently.
Bladder and bowel control

Continence and constipation are issues for many people with cerebral palsy. 1 in 4 children with
cerebral palsy have bladder control problems. Children with intellectual disability and/or a
severe form of cerebral palsy are most at risk. Lack of mobility and difficulty eating can
predispose people with cerebral palsy to constipation.

astic cerebral palsy This is the most common type of cerebral palsy. Spasticity means stiffness or
tightness of muscles. The muscles are stiff because the messages to the muscles are relayed incorrectly
from the damaged parts of the brain. When people without cerebral palsy perform a movement, groups
of muscles contract whilst the opposite groups of muscles relax or shorten in order to perform the
movement. In children with spastic cerebral palsy, both groups of muscles may contract together,
making the movement difficult. Dyskinetic cerebral palsy This refers to the type of cerebral palsy with
abnormal involuntary movements. It is divided into two types of movement problems, called dystonia
and athetosis. • Dystonia – this is the term used for sustained muscle contractions that frequently cause
twisting or repetitive movements, or abnormal postures. • Athetosis – this is the word used for the
uncontrolled extra movements that occur particularly in the arms, hands and feet, and around the
mouth. The lack of control is often most noticeable when the child starts to move – for example, when
the child attempts to grasp a toy or a spoon. In addition, children with athetoid cerebral palsy often feel
floppy when carried. Ataxic cerebral palsy This is the least common type of cerebral palsy. Ataxic (or
ataxia) is the word used for unsteady shaky movements or tremor. Children with ataxia also have
problems with balance. Mixed types Many children do not have just one type, but a mixture of several
of these movement patterns. Some of these concepts are difficult to understand. Please discuss them
further with your therapist or doctor.