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Life with
CEREBRAL PALSY

Cerebral Palsy

Here you will find information to help you become familiar with CP.

Cerebral palsy (CP) is a common physical disability that is diagnosed during early childhood. It is a group of permanent neurological disorders that are non-progressive, affecting motor function and posture.1

There are many different types of CP, which vary in the parts of the body that are affected, the type of impairment and the severity of mobility limitations.

→Click to learn about the different types of CP

Motor impairment in CP can result in poor nutrition, so proper nutritional assessment and support is key. The prevalence of undernutrition in children with CP is unknown, but according to studies, undernutrition may affect as many as 46% of children with CP.2 Developing a nutritional plan, together with the child’s caregivers, is essential to maximizing a child’s growth, development and quality of life. This often involves other healthcare professionals who can assist in achieving these goals.

 

A multifaceted condition requires a multidisciplinary approach

The health care of neurologically impaired children requires a multidisciplinary approach to provide the best care possible. This approach will also ensure that the child’s caregivers feel supported on their journey.

cerebral palsy care

CP impacts the quality of life of both the child and their caregivers.



References:

  1. Colver A et al. Cerebral palsy. Lancet. 2014;383:1240-49.
  2. Marchand V et al. Nutrition support for neurologically impaired children: a clinical report of the north American society for pediatric gastroenterology, hepatology, and nutrition. Journal of Pediatric Gastroenterology and Nutrition. 2006; 43(1):123-135

Cerebral palsy (CP) can be diagnosed several months after birth or even years later. Usually, CP is diagnosed before the age of three.

The diagnosis is essentially clinical. A systematic approach, focusing on maternal, obstetric and perinatal histories, a review of developmental milestones, and a thorough neurological examination and observation of the child in various positions (supine, prone, sitting, standing, walking and running) is required.

The symptoms are complex and vary depending on the types and degree of motor impairment. You can read all about the degree of motor impairment in the following section.

→Click to learn about the different types of CP


Some early signs of CP may include:1,2



References:

  1. Colver A et al. Cerebral palsy. Lancet. 2014;383:1240-49.
  2. National Institute for Health and Care Excellence. Cerebral palsy in under 25s: assessment and management. Full Guideline. NG62. 2017. Accessed November 7, 2018 at: https://www.nice.org.uk/guidance/ng62/evidence/full-guideline-pdf-4357166226

Each child with cerebral palsy (CP) is unique, with varying abilities and disabilities. Severity can be generally classified according to the type of motor function impairment and the part of the body that is mostly affected.1

  • Quadriplegia, or bilateral CP, affects all four limbs and occurs in about 23% of cases.
  • Diplegia affects both legs and occurs in about 38% of cases.
  • Hemiplegia, or unilateral CP, affects one side of the body and occurs in about 39% of cases.

The types of CP include:2,3,4,5,6

Motor symptoms of CP can be divided depending on the location of the lesion and the etiology.

The following illustration shows the different syndromes associated with spastic and athetoid CP.7

Motor syndromes of CP1,2



motor syndromes

 


The severity of CP mobility limitations can also be categorized into five different levels according to the Gross Motor Function Classification System – Expanded and Revised (GMFCS – E & R).8 Each level clearly describes the child’s current physical abilities and whether equipment or mobility aids are or will be needed in the future.

GMFCS E & R between 6th and 12th birthday: Descriptors and illustrations

GMFCS E & R between 12th and 18th birthday: Descriptors and illustrations



It is important to recognize the diversity in CP cases and that every child with CP is unique, requiring personalized, tailored care.

 

References:

  1. Reddihough DS and Collins KJ. The epidemiology and causes of cerebral palsy. Aust J Physiother. 2003;49(1):7-12.
  2. Odding E, Disabil Rehabil 2006 28;28(4):183-91.
  3. Dahlseng MO, Dev Med Child Neurol 2012;54(10):938-44.
  4. Carnahan KD, BMC Musculoskeletal Disorders 2007;8:50.
  5. Andersen GL, Eur J Paediatr Neurol 2008;12(1):4-13.
  6. Sigurdardóttir S, Dev Med Child Neurol 2009;51:356–363.
  7. Wong E. Motor syndromes of cerebral palsy. Nelson Textbook of Pediatrics. Saunders.2011;19E:2680
  8. Palisano R et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23.

Movement and posture disorders result from defect or lesion of the immature brain. The exact causes of cerebral palsy (CP) may remain unknown in a large number of cases.1

It is helpful to classify the known causes according to the timing, whether prenatal, perinatal or postnatal.1

Prenatal/Perinatal


Prenatal causes are responsible for approximately 75% of all cases of CP.1

In the absence of clear evidence, prenatal causes are assumed to be the cause of CP.2-4

Perinatal causes:
Perinatal causes happen during pregnancy.1

Known causes are:1

  • Vascular events, demonstrated by brain imaging (for example, middle cerebral artery occlusion)
  • Asphyxia (accounts for between 6% and 8% of CP cases)
  • Maternal infections during the first and second trimesters of pregnancy (rubella, cytomegalovirus, toxoplasmosis)

Less common causes are:1

  • Metabolic disorders
  • Maternal ingestion of toxins
  • Rare genetic syndromes

Postnatal


Postnatal causes are responsible for 10 to 18% of CP cases.1,3,6

Infections, such as meningitis and injuries, are responsible for most cases of post-neonatally acquired CP in developed countries.1

Meningitis, septicemia and other conditions, such as malaria, remain extremely important causes of CP.1

The introduction of new vaccines against meningitis will hopefully decrease the number of children with infections and subsequent neurological sequelae.1

Accidental injuries, such as motor vehicle accidents and near-drowning episodes, as well as non-accidental injuries, may result in CP.1

Other causes include apparent life-threatening events, cerebrovascular accidents and surgery for congenital malformations.1

There are also certain risk factors that are associated with CP, such as:

  • Maternal factors before pregnancy (delayed onset of menstruation, irregular menstruation, long intermenstrual intervals)1
  • Medical conditions (intellectual disability, seizures, thyroid disease)1

Other factors:

  • Premature birth, which is associated with half of all cases of CP7
  • Severe jaundice, which is an established cause of dyskinetic CP5
  • Iodine deficiency5

References:

  1. Reddihough DS and Collins KJ. The epidemiology and causes of cerebral palsy. Aust J Physiother. 2003;49(1):7-12.
  2. Gaffney G et al. Cerebral palsy and neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed. 1994;70(3):F195-200.
  3. Holm VA. The causes of cerebral palsy. A contemporary perspective. JAMA. 1982;247(10):1473-7.
  4. Palmer L. Antenatal antecedents of moderate and severe cerebral palsy. Paediatr Perinat Epidemiol. 1995;9(2):171-84.
  5. Colver A et al. Cerebral palsy. Lancet. 2014;383:1240-49.
  6. Pharoah PO et al. Acquired cerebral palsy. Arch Dis Child. 1989;64(7):1013-6.
  7. Rouse DJ and Gibbins KJ. Magnesium sulfate for cerebral palsy prevention. Semin Perinatol. 2013;37(6):414-6.

Thanks to a growing body of research, the epidemiology and aetiology of cerebral palsy is now better understood. MRI scanning has helped in understanding the interference that happens in brain development in utero. Nevertheless, on-going and future research, especially in brain plasticity, are key to better understanding the causes and to improving treatment of the disorder.1,2

Possible prevention techniques that can effectively decrease the burden of the disease are:

  • Antenatal Magnesium Sulfate (MgSO4), which has been demonstrated to help in preventing cerebral palsy in prematurely delivered neonates.1
  • Improved nutrition, infection control, and accident prevention should especially help in reducing the prevalence of post-neonatal cerebral palsy.2

Helping individuals with cerebral palsy to feel more included in the society is another key development area. New technologies directed both to the individual, such as voice synthesisers, and to the environment, such as intelligent household appliances, help in improving their quality of life.2

Understanding the detailed causes and complications of cerebral palsy is essential for a better diagnosis and treatment. However, understanding the emotional journey of caregivers before, during and after diagnosis is also essential for the overall wellbeing of the family.

→Visit our next section, “The Journey”

Furthermore, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment contain updated nutritional guidelines that are relevant for children with CP. The authors state that nutritional assessment and nutritional interventions in neurologically impaired children are a challenge for physicians but should be part of the child’s comprehensive care and rehabilitation.3

→We invite you to visit our section dedicated to nutrition

References:

  1. Rouse DJ and Gibbins KJ. Magnesium sulfate for cerebral palsy prevention. Semin Perinatol. 2013;37(6):414-6.
  2. Colver A et al. Cerebral palsy. Lancet. 2014;383:1240-49.
  3. Romano C et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment. J Pediatr Gastroenterol Nutr. 2017;65(2):242-264.